651-645-0099

 

Pre-existing conditions are back in the headlines, especially as the Supreme Court hears a case that could impact the Affordable Care Act (ACA). The ACA offers important protections for Americans living with pre-existing conditions. In light of this, it’s important to remember what pre-existing conditions are, including how the Affordable Care Act (a.k.a. the ACA, or “Obamacare”) changed how insurance companies treat them.

What exactly is a pre-existing condition?

A pre-existing condition is any health condition you have before your health insurance coverage starts. Some people are born with these conditions. Other people develop them over time.

What is the position of Minnesota’s nonprofit health plans on pre-existing conditions?

Minnesota’s nonprofit health plans favor upholding the Affordable Care Act because we believe that all Minnesotans should be covered, including the 2.3 million in Minnesota with pre-existing conditions. It is also important to remember that some protections for those with underlying health conditions are written into Minnesota state law, particularly for those who have maintained continuous coverage. Minnesota’s nonprofit health plans will always work to get Minnesotans the affordable, equitable and quality-based care they deserve.

What are some health conditions commonly seen as pre-existing?

The 10 most common pre-existing conditions are acne, anxiety, diabetes, asthma, sleep apnea, depression, COPD, extreme obesity, atherosclerosis and cancer. But many others exist, including pregnancy, heart conditions of various types, strokes, care related to transplanted organs and Alzheimer’s.

How many people have pre-existing health conditions?

According to the U.S. Department of Health and Human Services, half of all Americans live with something that would have been classified as a pre-existing condition before the ACA. Kaiser Family Foundation found that more than 54 million non-elderly Americans have at least one health condition that could have caused them to be denied individual insurance coverage before the ACA.

How were pre-existing conditions treated before the ACA?

Before the ACA took effect in 2010, health insurance plans used an underwriting process for individual market plans. In other words, if you bought health insurance on your own instead of getting it from the government or an employer, you had to submit detailed medical records. Insurers would use these records to determine your premiums and other out-of-pocket costs. Depending on the severity of your pre-existing conditions, you could face higher premiums or be given a rider saying that care related to those specific conditions would not be covered or be denied coverage.

If you were denied coverage, Minnesota (and most other states) placed you in a high-risk insurance pool for people with pre-existing conditions that provided limited and often expensive coverage. In fact, it’s estimated that roughly 1 out of 5 Minnesotans currently enrolled in today’s individual insurance market used to be enrolled in the state’s high-risk pool.

What protections did the ACA give people with pre-existing conditions?

Today, pre-existing conditions can’t keep you from getting insurance, and they must be covered under your insurance plan. Under the ACA, health plans are required to provide coverage to everyone who enrolls during the open enrollment period, and they can no longer take your health into consideration when pricing your plan. Instead, they must use “adjusted community ratings” to pay for out-of-pocket expenses so you don’t have to face an endless bill for treating a chronic condition.

How will health plans continue to support those with pre-existing conditions?

Only time will tell what the outcome of the ACA case will actually be, but regardless of what happens, the Council is supportive of the many provisions that support coverage for Minnesotans and bringing forth solutions that improve health care for everyone throughout the state.

 

 

 

 

 

Indeed, mental health needs are growing in Minnesota, especially as we endure the impacts of COVID-19. We are seeing greater isolation, substance abuse and unemployment. Parents and students are adjusting to the new realities of school. Communities of color are facing added traumas of injustice. Health workers are stressed by the demands of COVID-19. And many people have had to say goodbye to a loved one due to the virus.

A recent survey by Blue Cross and Blue Shield of Minnesota (BCBSM) also found that one in five Minnesota seniors report feeling lonely, anxious or depressed, and a majority of seniors fear a resurgence of COVID-19 cases.

As we honor this important day, I want to share elements of the mental health work being done by Minnesota’s nonprofit health plans and some of the free online resources that are available for those who need it. Our local health plan members care deeply about the health, safety and wellness of Minnesotans and have launched vital mental health initiatives over the years to support this mission. In recent months, they’ve ramped up efforts even more to meet Minnesotans’ mental health needs.

We’re proud of these efforts. But we also know that when it comes to mental health and illness, the work is never done, and no blog can truly capture the full scope of what our local health plan members do to support the health, safety and wellness of Minnesotans. That said, I strongly encourage readers to contact their health plan to discuss additional resources that available to them. Our member plans will continue to focus their efforts and expertise on mental health, and we look forward to sharing even more resources for Minnesotans in the months and years to come.

 

One of the very unfortunate realities of the COVID-19 pandemic has been job loss.  And with the loss of employment, often comes the loss of health insurance. As we continue to grapple with this ongoing health and economic crisis, it is important to know what other options for health care coverage are available — and that you don’t end up paying more than you need to.

Depending on your health, age and financial situation, you may qualify for low or no-cost health insurance coverage or for subsidies that will help lower what you pay for coverage if you are buying insurance on your own.

For instance, if you are 65 or have a disability (as defined by the federal government), you may want to shop for Medicare. If you are under 65, you can get insurance in a few ways, including through MNsure or directly from an insurer. Those under 65 may also qualify for Medicaid or MinnesotaCare, both of which are low or no-cost options.

You’ll also want to think about the types of care you already utilize and how often. For instance: How many times a year do you usually go to the doctor? And do you regularly take any prescription medications?

In this fragile and ever-changing economy, here are some answers to some frequently asked questions about what to do if you lose your employer-sponsored health insurance.

What should I do first?

If you’ve lost your employer-based health insurance coverage, first decide whether you want to extend your current health plan or buy a new one. If you want to continue your current plan, you can do that through COBRA continuation coverage. COBRA is a federal law that may let you stay on your employee health insurance for up to 18 months, as long as you pay the full premium and a small administrative fee. To learn about your COBRA options, contact your employer.

You may also consider enrolling in a spouse’s health coverage if that’s available, as your job loss would likely qualify as a life-changing event under that coverage. This is usually the most cost-effective option.

If that’s not possible and you need to buy a plan on your own, visit the Minnesota Health Insurance Marketplace, or MNsure, at www.mnsure.org. This site will show you your options for buying health insurance for yourself and/or your family, as well as how to potentially save money on premiums and other expenses. Since the start of the COVID-19 pandemic, more than 100,000 Minnesotans have come through MNsure to find health insurance coverage.

When can I buy coverage on the Marketplace?

Most people can only buy health insurance through the Marketplace during the traditional enrollment period. This year, that’s Nov. 1-Dec. 22. But if you’ve had a sudden loss of coverage or reduction in income, you may qualify for a special enrollment period and be able to purchase coverage immediately. In general, your coverage can start the first day of the month after you lost your insurance.

What’s the advantage of buying a health insurance plan on the Marketplace?

The main advantage is that you can find out if you qualify for subsidies on your monthly premiums and out-of-pocket health care costs, especially if you make less than $25,520 or are a member of a federally recognized American Indian tribe. The average amount of aid provided monthly is $431, so these savings can be substantial. If your annual income has fallen due to the pandemic or other issues, you may also qualify for other programs and benefits that could save you money. For example:

Which nonprofit Minnesota health insurance plans can I choose from?

Four of the Council’s seven member health plans have insurance plans on the Marketplace: Blue Cross Blue Shield Minnesota, HealthPartners, Medica and UCare. You can see all of the health and dental plans offering health insurance on MNsure at https://www.mnsure.org/shop-compare/about-plans/networks/index.jsp.

What if I need help buying an insurance plan?

MNsure has a statewide network of expert assisters to help you apply and enroll over the phone, as well as online help tools. The Contact Center is open 8 a.m. to 4 p.m. Monday-Friday at 651-539-2099 or 855-366-7873. You can also visit the Get Insurance page on the Minnesota Council of Health Plans website, which offers information on how to shop, kinds of insurance and where to get insurance.

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

With so much attention being paid to COVID-19 — and rightly so — it’s easy to forget about another serious virus that we deal with every year: influenza, or the flu. While it’s important to get your flu shot every year, 2020 is arguably the most critical year in decades to make sure that you and your family are protected against this virus.

Let’s start with a quick primer on influenza.

What is the flu?

Influenza, or “the flu,” isn’t just one virus. It’s a contagious respiratory illness caused by different types of influenza viruses that change every year. These viruses can cause mild to severe illness, and even death. Some people simply feel cold-like symptoms. Others have more serious reactions and have to be hospitalized.

What serious conditions can influenza lead to?

In more severe cases, the flu can cause pneumonia, bronchitis and infections in the ears and sinuses. It can also make chronic health problems worse. If you have asthma, it can cause an asthma attack. If you have chronic congestive heart failure, it can increase your risk of a heart attack. Even if you don’t have pre-existing conditions, the flu can lead to serious issues, especially if you’re not vaccinated against it.

Who’s most at risk of flu complications?

If you fit into any of the following categories, you could have a higher risk of getting more seriously ill from the flu:

What does the flu shot do?

The flu shot stimulates your immune system to be better prepared to recognize and attack the influenza virus. Because the flu virus changes every year, the influenza vaccine is updated annually to provide the best match between the vaccine and the actual virus.

How effective is the flu vaccine?

Effectiveness varies year to year, but recent CDC studies show that flu vaccination reduces the risk of flu illness 40-60% among the overall population during seasons when it’s well-matched to circulating flu viruses.

Why should I get a flu shot?

There are almost too many reasons to list here, but here are the top ones:

Why is it especially important to get a flu shot this year?

Put simply: COVID-19. Flu season is already challenging for hospitals and emergency rooms. As an example, the 2018–2019 flu season resulted in about half a million hospitalizations and more than 34,000 deaths nationwide. Communities of color, which have already been disproportionately impacted by COVID-19, historically have also been more likely to have chronic health conditions that put them at higher risk of influenza-related complications.

Because COVID-19 symptoms so closely mirror the flu, a crush of influenza cases could further strain the medical system in testing, diagnosis, isolation and treatment of COVID patients. If this happens, getting the best medical care for either COVID or influenza becomes more challenging.

Bottom line: As flu season rapidly approaches, it’s important to talk to your doctor about how and when to receive this year’s influenza vaccine. This year more than any other, the flu shot is essential to keep you, your children, your neighbors and our entire health care system healthy. For more information on how health plans, hospitals, health systems and clinics are making flu vaccinations more accessible during the pandemic, click here.

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

Influenza, or the “seasonal flu,” is a disease that can cause serious illness, even death. The flu shot has always been key in protecting ourselves against this infection – especially older adults, young children, pregnant women and those with chronic conditions – but the COVID-19 pandemic makes getting this vaccination even more critical for everyone this year.

Why? Aside from the immediate health risks associated with the flu itself, an influx of flu patients on top of COVID-19 cases – a “twindemic” — could potentially overwhelm hospitals and their ICUs. At the peak of the COVID-19 outbreak in spring 2020, more than 600 Minnesotans were hospitalized at the same time for COVID-19 treatment. Meanwhile, the Minnesota Department of Health reports that the 2017-2018 flu season – a severe year for infections — resulted in more 6,000 hospitalizations throughout the state for the flu. Having a high level of hospitalizations for both COVID-19 and seasonal flu at the same time would stretch hospital and ICU resources.

The seasonal flu can present itself in many of the same ways COVID-19 does, with symptoms such as fever, headache, cough, sore throat, muscle aches and fatigue. In more severe cases, the flu can cause pneumonia, bronchitis and infections in the ears and sinuses. It can also make chronic health problems worse. If you have asthma, it can cause an asthma attack. If you have chronic congestive heart failure, it can increase your risk of a heart attack.

Additionally, having the flu can take a toll on the body’s immune system, leaving people more vulnerable to a serious bout of COVID-19. Contracting both infections could be even more harmful.

Flu vaccination rates in Minnesota — especially for children — were already in need of improvement before the pandemic. During the 2017-2018 season, nearly 62% of Minnesota children between the ages of 6 months and 17 years received vaccinations, according to CDC estimates, and the rates fell with age. For children 0.5-4 years old, it was 75%; for 5-12, 65%; and for 13-17, only 50%. Meanwhile, flu vaccination rates for adults in any given year are typically less than 50%.

That’s why this year presents an important opportunity for Minnesotans to do what they can to avert a bigger public health crisis. In addition to doing what we can to mitigate the spread of COVID-19, we can also reduce the number of influenza infections, hospitalizations and deaths by getting ourselves vaccinated against this disease.

Minnesota’s hospitals, health systems, clinics and health plans are already taking a number of steps to make getting critical vaccinations – including the flu shot – safer and easier during the pandemic.

A few important points to know:

By getting ourselves and our children immunized against the flu and other infections — and by continuing the important practices of hand-washing, mask-wearing and physical distancing — together we can create a new standard for disease prevention that will benefit us long after the pandemic passes.

Talk to your doctor about how and when to receive this year’s flu vaccine or click here to learn more facts about the flu. Stay healthy, Minnesota!

 

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

With the arrival of fall, it’s time we went “back to school” on measles, and why the MMR (measles, mumps and rubella) vaccination is vital.  So, here’s a little “Measles 101,” including information on why it’s important — and safe — to be vaccinated against it.

Measles can be serious, even fatal, in small children. Measles symptoms can lead to pneumonia, brain damage, deafness and even death. Worldwide, measles kills more than 100,000 people a year, most under the age of 5.

Measles is highly contagious. Overall, 90% of people who come in contact with measles will catch it if they’re not vaccinated. It’s spread through the air when infected people breathe and cough, and it can stay there for long periods of time. People have contracted measles from walking into a room where infected people stood two hours earlier.

Measles is preventable. Like COVID-19, measles is caused by a virus. But unlike COVID-19, we’ve long had a safe and effective vaccine to prevent it. This vaccine has been so effective that the U.S. declared measles “eliminated” in 2000.

Measles outbreaks in the U.S. are on the rise. After a long period of decline, 2019 saw the most U.S. measles cases in the last 25 years. This is largely due to myths and misinformation about vaccines in general. To be clear: Vaccines do not cause autism spectrum disorder, infant immune systems are strong enough to handle current vaccination schedules (and infants are at risk for exposure and infection if you space immunizations out), and there’s no risk of getting the measles from the vaccine.

Additionally, the following are some commonly asked questions about measles:

How do I know if my child might have measles?

Measles symptoms usually appear 10-14 days after exposure to the virus. They can include fever, dry cough, runny nose, sore throat, inflamed eyes (conjunctivitis), diarrhea, ear infections, a blotchy skin rash, and the appearance on the inner lining of the cheek of tiny white spots with bluish-white centers on a red background.

When should I get my child vaccinated against measles?

The measles vaccine is combined with mumps and rubella in what’s called the MMR vaccine. Your child should get this shot when they’re 12-15 months old, and again when they’re between 4 and 6. If you have a child between 6 and 12 months that will be traveling internationally or to a place that’s experiencing a measles outbreak, they should get an early MMR vaccine.

What if I’ve have never received a measles vaccine?

If you were born in or after 1957 and have never had measles or been inoculated against it, then you should get at least one dose of the MMR vaccine as soon as possible.

What should I do when I’m done reading this article?

If you have any concerns that you or your children are not up to date on measles shots, please talk to your doctor about next steps. For more information on why the measles vaccine is so important this year, click here.

 

By the Minnesota Council of Health Plans and the Minnesota Hospital Association

As we continue to grapple with the COVID-19 pandemic, childhood vaccinations are of utmost importance. A spike in vaccine-preventable infections among youth, layered on top of the current pandemic, could have serious implications for all Minnesotans.

Recent vaccination trends are especially troubling when it comes to measles. In May, Minnesota health officials reported a 70% drop in MMR (measles, mumps and rubella) vaccinations compared with a year ago, as more Minnesotans reduced participation in preventative care during the early stages of the state’s COVID-19 pandemic due to stay at home orders, health concerns, adjusting to social distancing guidelines and other factors.

But measles is a disease that we all need to take seriously, particularly as we commence back-to-school season, begin fall sports and start to do more activities indoors. Worldwide, measles kills more than 100,000 people a year, and 90% of people who come in contact with someone who has measles will contract it if they’re not vaccinated. The infection is spread through the air when those who have it breathe and cough; people have been known to contract the disease from walking into a room where infected people stood just two hours earlier.

It’s also important to note that there was a resurgence in measles cases long before the COVID-19 pandemic emerged. In 2017, Minnesota experienced its worst measles outbreak since 1990, with almost a third of the patients who contracted the infection needing hospitalization. And just last year, the United States saw its highest number of measles cases in the past 25 years.

That’s why Minnesota’s hospitals, health systems, clinics and health plans are taking extensive and innovative measures to ensure that vaccinations are easier and more accessible for everyone as we endure this pandemic. They are spreading the word to families on the importance of the MMR vaccine and others (including vaccines for Whooping Cough, chickenpox, and HPV) in preventing further outbreaks and exacerbating the public health crisis brought on by COVID-19. Their efforts include:

Remember, measles is preventable and health plans cover recommended immunizations, like the MMR vaccine, without charging members a copayment or coinsurance when provided by an in-network provider.

With COVID-19 continuing to spread throughout Minnesota and impacting everything we do, we want to reduce the risk of other vaccine-preventable disease outbreaks. Accessing preventive care – including vaccinations – can help keep you, your family and your community healthy. Talk to your doctor about the MMR vaccine and whether your kids are up to date on their immunizations. You can also get more information on measles and the MMR vaccine here or on the Centers for Disease Control and Prevention website.  Your vigilance on this matter will ultimately help our state avert another serious public health crisis.

 

By Dr. Jeremy Cauwels, Chief Medical Officer at Sanford Health Plan; Dr. Patrick Courneya, Chief Health Plan Medical Officer at HealthPartners; Dr. Julia Joseph-Di Caprio, Chief Medical Officer at UCare; Dr. John Mach, Chief Medical Officer at Medica; Dr. Marc Manley, Chief Medical Director at Hennepin Health; Dr. Abigail Miller, Chief Medical Officer at PreferredOne; and Dr. Mark Steffen, Chief Medical Officer at Blue Cross and Blue Shield of Minnesota

Let there be no doubt, extensive preparations have been made to protect patients visiting Minnesota’s hospitals and clinics amid the COVID-19 pandemic. But if we want to mitigate additional harm from this crisis, it’s imperative that Minnesotans seek medical care when they need it.

While we continue to do everything we can to minimize the spread of COVID-19 – including washing our hands, wearing masks in public and practicing social distancing – we must also get the preventive, routine and follow-up care that protects and improves our health. Statistics reveal that this is not happening at an alarming rate, and that could ultimately lead us to a more serious public health crisis.

As Star Tribune reporter Joe Carlson wrote in his June 16 article titled “COVID-19 fears keep millions of Americans from seeking hospital care,” people across the nation are jeopardizing their health and well-being by avoiding hospital care, even in medical emergencies, for fear of contracting COVID-19. Local hospital systems have reported significant drops – from 35-50% – in emergency room (ER) visits during the March-April timeframe of this year. Nationally, there’s been a 42% decline in ER use, according to a recent study from the Centers for Disease Control and Prevention.

Clinic visits are also down significantly across the state. That means Minnesotans are not getting the non-emergency and preventive care they need to help stop or curtail chronic illnesses like cancer, diabetes and hypertension – which are worsening already significant health disparities among underserved communities throughout Minnesota. According to an analysis by Epic Health Research Network, screening appointments for breast, colon and cervical cancer dropped 94%, 86% and 94% respectively in March 2020 across 23 states, compared to the average number of appointments before January 20, 2020.

The decline in clinic visits also means babies, children, teens, as well as adults, are not receiving the necessary vaccinations to prevent the spread of other infectious diseases like measles – and in just a few months, the seasonal flu. According to a report from Healthcare Purchasing News, MMR (measles, mumps, rubella) doses in Minnesota were down 71 percent toward the end of March. If layered on top of COVID-19, a surge in either of these infections could deal a devastating blow to our state.

It’s important to learn the facts about non-COVID-19 hospital and clinic visits, as well as the implications of avoiding necessary medical care. Following are some key things to know:

Some recent data suggest that non-COVID patients are starting to seek medical care more often. An analysis from TransUnion Healthcare found outpatient hospital visits down 31% nationally in mid-May vs. 64% in early April. But the decline is still far too steep. We are urging Minnesotans to seek medical attention for serious illnesses and get all necessary vaccinations for themselves and their children. Seeking medical care is not only smart – it will be vital if we are going to prevent the spread of other serious illnesses.

From the Blue Cross Blue Shield Minnesota Blog:

The COVID-19 pandemic may have shifted past a phase of stay at home orders, but the effects of the fear, isolation and stress caused by the many unknowns of this virus remain at the forefront of our everyday lives.

As we navigate a world of wearing masks out in public, limiting social gatherings and figuring out what our school and work environments will look like into the fall and beyond, the world continues to be filled with a great deal of unknowns.

And with the continued uncertainty—alongside the trauma and anxiety stirred by the recent unrest following the unjust death of George Floyd—more and more people are experiencing adverse impacts on their mental health.

To gain a better understanding of how the pandemic has affected mental health, we had a conversation with Dr. Steven Sehr, senior medical director for behavioral health at Blue Cross and Blue Shield of Minnesota, and Dr. Ryan Van Wyk, specialty lead for the North Memorial Health Mental Health Services Center.

“As time has gone on, we are seeing more of the effects of social isolation. There’s depression, a significant rise in severe substance abuse, despair, isolation and hopelessness,” Dr. Sehr said.

“In some cases, this pandemic has exacerbated symptoms for people previously coping with trauma, validating their sense of fear that the world is not safe—and heightening their sense of threat. So, that has stirred up a lot of symptoms that people may have been managing in a more effective way prior to the pandemic,” Dr. Van Wyk said.

Click here to read the full Q&A from these experts on ways we can support one another to work through these challenging times.

As the impact of George Floyd’s tragic death continues to reverberate around our state, nation and world, millions of people have banded together to call for greater awareness of racial injustice and push for substantial change. Minnesota’s nonprofit health plans are committed to being part of that effort, and I want to share the actions they’re taking to promote racial equity, diversity, inclusion and awareness.

Our member health plans have long valued the diverse backgrounds of the communities they serve, and over the years they’ve launched various initiatives to address health equity issues and close gaps in care. They’ve worked to not only create diverse workforces within their organizations, they have also worked to address the cultural needs of their members and improve their access to care.

Already through our collaboration as a Council, health plans are collectively working on an ambitious goal of reducing health disparities by 50% by 2025. To get there, we know we need to do more. We have an obligation to ensure that we are meeting the needs of everyone we serve — and that all who engage with us feel valued and supported.

That’s why our mission is now shifting into high gear as health plans have made robust pledges to further advance racial justice within their organizations and in our communities. This includes commitments to conduct listening sessions in their workforces, forge new and stronger community partnerships, provide training on unconscious bias, and expand the work of their equity and inclusion teams.

For example:

We’re so proud of these efforts, but they’re also only the beginning. Our member health plans recognize that true success in addressing systemic racial inequity goes far beyond an initial push in the wake of a high-profile tragedy. The hard work involves listening and then doing. Blue Cross president and CEO Craig Samitt said it best in his recent blog post: “While collectively raising voices to condemn racism, discrimination and social injustice is important and essential, it’s not enough because actions speak louder than words.”

Those actions will ultimately lead to greater patient satisfaction, lower health disparities and a healthier Minnesota. In that spirit, we must keep the momentum going. We must never forget. And I’m looking forward to sharing more with you as our health plans fully commit to real and meaningful change.