What changes are coming to Medicare Advantage plans at Blessing?
Effective January 1, 2025, Blessing Health clinics and doctors will be in network with the following Medicare plans:
- Traditional Medicare
- Blue Cross Blue Shield of Illinois Medicare Advantage
- Molina Medicare Advantage
- Total Retiree Advantage Illinois (trail)
- United HealthCare Medicare Advantage
- Humana - Employer PPO plan
Who Do I Call if I have Questions?
- Speak with a certified counselor by calling the Blessing Resource Center at 217-277-5000.
- Attend one of the free educational Medicare sessions in October and November. Click here for a full schedule with dates, times and locations.
What are Medicare Advantage plans?
Medicare Advantage Plans are offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits. Alongside Medicare Advantage, you may hear these plans referred to as “Part C” plans. In many cases, these plans will also offer prescription (or “Part D”) plans as well. Note that Medicare Advantage plans are administered by insurance companies and have different kinds of benefit designs. Medicare Advantage plans can be purchased either on an individual basis or through your employer.
For State of Illinois retirees within our service area, Medicare Advantage plans are offered on a group basis through the Total Retiree Advantage Illinois (“trail”) program. We encourage you review the State of Illinois website for more information on benefit plans offered. Blessing Health cannot answer any specific benefit questions and we encourage you to review the state’s website for additional plan details. Finally, we encourage you to review our Insurance page for information on plans accepted through the TRAIL program.
When can I enroll for Medicare or Medicare Advantage plans?
Enrollment timelines for those wishing to choose a traditional Medicare or Medicare Advantage plan are set by CMS. Information on switching plans and enrollment periods is included below from Medicare.gov:
- To switch to a new Medicare Advantage plan: Simply sign up with the plan you choose during one of the enrollment periods. Doing so will disenroll you from your current plan when the new plan coverage begins.
- To switch to traditional Medicare: Contact your current plan or call 1-800-MEDICARE.
There are three windows in which you can gain coverage:
- Initial Enrollment Period: When you first become eligible for Medicare, you can join a plan.
- Open Enrollment Period: From Oct. 15 to Dec. 7 each year, you can join, switch or drop a plan. Coverage selected will begin on Jan. 1.
- Medicare Advantage Open Enrollment Period: From Jan. 1 to March 31 each year, individuals enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan OR switch to traditional Medicare once during this time.
Patients 64 years and older who had an appointment with Blessing Health over the past year will receive information in the mail regarding Medicare Advantage plans accepted at Blessing Health in 2025.
People with additional Medicare questions should call the Blessing Resource Center at 217-277-5000, Monday-Friday, 8 am to 5 pm, to speak with a certified counselor.
Why are these changes happening?
Nationwide, a growing number of health systems and hospitals are either ending their participation in all Medicare Advantage plans, or limiting their partners as Blessing Health is doing. A Becker’s Hospital Review article dated, July 23, 2024, states 15 health systems dropped all or some of their Medicare Advantage plans during the first six months of the 2024.
Providers say the reasons for dropping the plans include patient care being delayed due to some Medicare Advantage plans’ pre-authorization process, denial rates and inability to approve needed care. Specifically, some plans apply more stringent medical necessity criteria than traditional Medicare. These factors can limit patient access to timely care. You can learn more answers in our Frequently Asked Questions below:
Frequently Asked Questions (FAQs)
Because patients’ care is being delayed due to the MA plans pre-authorization process, denial rates and inability to approve needed care, Specifically, some MA plans apply more stringent medical necessity criteria than Traditional Medicare including excessive prior authorization requirements and other utilization management demands that can limit patient access to timely care. This directly results in delays and denials in care that can cause harm to our patients.
Blessing is not alone in this decision. Many healthcare organizations across the country are exiting MA plans in their area because of similar issues. Aligning with MA plans that ensure our communities receive access to the care they need when they need it is our focus. Choosing healthcare coverage is a major life event and patients place a large amount of trust on the payer they select to provide care when the need arises, we want to help ensure that the plans offered are the ones you can trust.
Blessing, Adams County Health Department, and SIU have partnered with Illinois Department on Aging to certify local counselors to educate you on all Medicare plans. At these sessions, certified Senior Health Insurance Program Counselors will be available to meet with you one-on-one to answer questions and help you sign up for your Medicare choice during open enrollment period, October 15th through December 7th, 2024. A complete list of dates times and locations is at the bottom of this page.
Blessing will continue to be in network with the following Medicare Advantage plans: Blue Cross Blue Shield of Illinois, Molina, United Healthcare, and Total Retiree Advantage Illinois (trail) and Traditional Medicare.
If you want to leave Medicare Advantage and move to original Medicare, you have specific times you can do that:
- You can disenroll from Medicare Advantage plans during the Medicare annual enrollment period (AEP) October 15 – December 7 each year. Changes made during AEP will be effective January 1 of the following year.
- You can also disenroll from Medicare Advantage and switch back to Original Medicare during the Open Enrollment period (OEP) January 1 – March 31 each year.
- If you disenroll from a Medicare Advantage Prescription Drug Plan (MAPD) Plan, you will need to enroll in a Medicare Prescription Drug Plan for your Medicare Part D prescription drug coverage.
Yes. Blessing will no longer participate in Aetna (non-TRAIL), Anthem, Cigna, Health Alliance, Humana and Wellcare MA plans effective January 1, 2025. Blessing continues to participate in Blue Cross Blue Shield of Illinois, Molina and United Healthcare plans.
If you remain with a plan in which Blessing does not participate with in 2025, you will be able to receive care with your Blessing provider(s), however they will process as out of network and go toward the In and Out of Network Deductible according to your plan.
We understand that Medicare terms can be confusing. Let us help you break down some the terms used within Medicare:
- “Part A” refers to the inpatient component of your Medicare coverage.
- “Part A deductible” is the amount you would pay before your Medicare coverage would apply to your hospitalization event. The Part A deductible applies from the initial day of hospitalization to day 60.
- “Part A daily coinsurance” is the additional per-day amount you would pay for hospitalization from day 61 to day 90.
- “Part A Lifetime Reserve” is the additional per-day amount you would pay for hospitalizations from day 90 to day 150.
- “Part B deductible” is the amount you would have to pay before your Medicare Part B coinsurance would apply.
- “SNF daily coinsurance days” is the amount you would pay per day for a skilled nursing facility (SNF) stay.
| Medicare Benefit Year | Part A Deductible | Part A Daily Co-Insurance Days 61-90 | Lifetime Reserve Days 91-150 | Part B Deductible | SNF Daily Co-Insurance days Days 21-100 |
|---|---|---|---|---|---|
| 2024 | $1632 | $408 | $816 | $240 | $204 |
| 2023 | $1600 | $400 | $800 | $226 | $200 |
Additional information about Medicare premiums, deductibles and coinsurance rates is available on Medicare.gov
Educational Open House Schedule
In efforts to educate the public on these changes, Blessing Health is hosting a series of informational sessions throughout October. Seniors and caregivers are invited to attend any of the sessions to get answers to questions and to learn more about your options.
- October 15, 3-6PM: Blessing Resource Center
- October 16, 12-2PM: Blessing Mt. Sterling Clinic
- October 18, 12-2PM: Blessing Health Kahoka
- October 22, 12-2 PM: Illini Rural Health Clinic
- October 23, 3-6PM: Blessing Resource Center
- October 29, 12-2PM: Blessing Health Palmyra
- October 30, 12-2PM: Blessing Health Hannibal
- November 6, 12-2PM: Blessing Health Hamilton Warsaw
- November 8, 12-2PM: Blessing East Adams Clinic
Contact Us
People with additional Medicare questions should call the Blessing Resource Center at 217-277-5000, Monday-Friday, 8 am to 5 pm, to speak with a certified counselor.