MEDICA HEALTH PLANSPub 78
Pub 78
Programs
Program 1 [2020]
SEE SCHEDULE O.MEDICA HEALTH PLANS (MHP) IN 2020 PROVIDED HMO COVERAGE TO ENROLLEES IN THE STATE OF MINNESOTA'S SENIOR CARE PLUS (MSC+) AND SPECIAL NEEDS BASIC CARE PROGRAMS (SNBC).MSC+ PROVIDES MANAGED CARE FOR LOW-INCOME PEOPLE IN MINNESOTA WHO ARE AGES 65 OR OLDER ON MEDICAL ASSISTANCE. SNBC PROVIDES MANAGED CARE FOR INDIVIDUALS AGES 18-64 ON MEDICAL ASSISTANCE AND ARE CERTIFIED WITH PHYSICAL, DEVELOPMENTAL OR MENTAL DISABILITIES.A TOTAL OF 16,209 MEDICA MEMBERS - 22.7% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2020. THERE WERE 4,195 MINNESOTA SENIOR CARE PLUS MEMBERS AND 12,014 SPECIAL NEEDS BASIC CARE MEMBERS.STATE OF MINNESOTA HEALTH CARE PROGRAMSMINNESOTA REQUIRES A HEALTH PLAN THAT CONTRACTS WITH THE MINNESOTA DEPARTMENT OF HUMAN SERVICES (DHS) TO PROVIDE MANAGED CARE BE LICENSED BY THE MINNESOTA DEPARTMENT OF HEALTH (MDH) AS AN HMO. MINNESOTA HEALTH CARE PROGRAMS COVER PEOPLE WHO CANNOT GET OR AFFORD HEALTH INSURANCE ELSEWHERE AND HELPS THEM PAY SOME OR ALL MEDICAL BILLS. DHS MANAGES THE ENROLLMENT OF ENROLLEES AND ENFORCES ELIGIBILITY RULES THAT PERTAIN TO INCOME, ASSETS AND OTHER FACTORS.MEDICA'S MANAGED CARE PRODUCTS SERVE ADULTS WITH DISABILITIES, SOME CHILDREN WITH DISABILITIES, AND LOW-INCOME PEOPLE 65 OR OLDER. MANAGED CARE IS AVAILABLE FOR LOW-INCOME PEOPLE 65 OR OLDER WHO ARE ASSESSED TO REQUIRE AN INSTITUTIONAL LEVEL OF CARE.MINNESOTA DHS DETERMINES CAPITATED RATES AS A COMPONENT OF THE ANNUAL CONTRACT NEGOTIATION PROCESS WITH MHP AND PAYS MHP A FIXED RATE PER ENROLLEE PER MONTH. MHP BEARS THE RISK FOR THE TOTAL COST OF CARE FOR THESE ENROLLEES.-IN 2020 MEDICA HEALTH PLANS MEDICAL LOSS RATIO FOR STATE OF MINNESOTA HEALTH PROGRAMS WAS 88.4%.-THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 5.6% INCLUDING PREMIUM TAXES.GeographiesNot indicatedDatesJan 1, 2020 – Dec 31, 2020Source990No causes providedNo populations provided–$675.4MProgram 2 [2020]
SEE SCHEDULE O.IN 2020 MHP PROVIDED FULLY INSURED COMMERCIAL HMO HEALTH INSURANCE COVERAGE TO GROUPS AND INDIVIDUALS IN MINNESOTA. AS OF 12/31/2020 THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP WAS 648 WHICH WAS APPROXIMATELY .9% OF MHP'S TOTAL 2020 ENROLLMENT.GeographiesNot indicatedDatesJan 1, 2020 – Dec 31, 2020Source990No causes providedNo populations provided–$1.7MProgram 3 [2020]
SEE SCHEDULE O.IN 2020, MHP PARTICIPATED IN MINNESOTA SENIOR HEALTH OPTIONS (MSHO), A MEDICARE-RELATED PRODUCT, IN MINNESOTA. ENROLLMENT IN THAT PRODUCT WAS 10,661 OR 15.0% OF MHP'S TOTAL ENROLLMENT. MSHO IS A PRODUCT FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE IN 2020, MEDICA OFFERED MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENT PLANS. MEDICARE ADVANTAGE HAD ENROLLMENT OF 28,348 MEMBERS OR 39.8% OF MHP'S TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND PART B BENEFITS. MEDICARE SUPPLEMENT HAD ENROLLMENT OF 15,415 MEMBERS OR 21.6% OF MHP'S TOTAL ENROLLMENT. MEDICARE SUPPLEMENT IS A PLAN THAT HELPS PAY SOME HEALTH CARE COSTS THAT MEDICARE DOES NOT COVER, SUCH AS COPAYMENTS, COINSURANCE, AND DEDUCTIBLES.IN 2020, MEDICA BEGAN OFFERING I-SNP PLANS. I-SNP'S RESTRICT ENROLLMENT TO MA ELIGIBLE INDIVIDUALS WHO, FOR 90 DAYS OR MORE, HAVE HAD OR ARE EXPECTED TO NEED THE LEVEL OF SERVICES PROVIDED IN A LONG-TERM CARE(LTC) SNF, A LTC NURSING FACILITY, A SNF/NF, AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES, OR AN INPATIENT PSYCHIATRIC FACILITY. I-SNP HAD ENROLLMENT OF 15 MEMBERS.GeographiesNot indicatedDatesJan 1, 2020 – Dec 31, 2020Source990No causes providedNo populations provided–$327.9M
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