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Advantage Plans Out-Of-Network for MRHS in 2024

MRHS to Host Free Medicare Information Sessions presented by SHIINE

Madison Regional Health System is committed to providing quality healthcare close to home, and to fulfill that commitment, maintain positive patient experiences, and be fiscally responsible to the organization’s stakeholders, Madison Regional Health System has decided to end Medicare Advantage plan contracts. As contracts expire in 2024, Madison Regional Health System will not renew these contracts and will no longer be in-network for any Medicare Advantage plans. Medicare Advantage plans are offered by commercial insurance companies on behalf of Medicare and are different than the original Medicare program. Madison Regional Health System will still accept and be in-network for original Medicare (Part A and B) and supplement plans (Part F and G).

 “Commercial healthcare plans, including Medicare Advantage plans, have certain processes in place to evaluate and manage the coverage and reimbursement of healthcare services. The purpose of these processes is to ensure appropriate coverage for the consumer and there are instances where certain treatments or services might not meet the plan’s criteria. At times this creates unforeseen financial implications for our patients or our facility. We are encouraging individuals to understand their coverage policies, including in and out-of-network provisions, referral processes, and cost-sharing expectations which include premiums, co-payments, co-insurance, and various deductibles,” stated Teresa Mallett, CFO, Madison Regional Health System.

On September 15, 2023, Madison Regional Health System will host Senior Health Information and Insurance Education (SHIINE). SHIINE will give information on the original Medicare program, supplement plans, Medicare Advantage plans, and be available to answer questions. The free information sessions will be held at 10:00 AM and 2:00 PM with limited space available. It is encouraged that you reserve your spot by calling 605-256-6551. Madison Regional Health System is located at 323 SW 10th St. Madison, SD.

The service area of Madison Regional Health System includes a significant population of Medicare-eligible individuals or their caretakers, all of whom could benefit from education about Medicare options. Mallett expands on the reason for hosting SHIINE by saying, “We know that healthcare provisions and related costs impact the quality of life for our patients and the communities we serve. We want everyone to feel empowered and confident in making informed healthcare decisions for themselves and their loved ones. Open enrollment is fast approaching, and helping provide our service area with the opportunity to learn about Medicare and supplement plan options, some of which are very complex, is something we feel is necessary.”

Madison Regional Health System is not authorized to assist with Medicare enrollment decisions, and is encouraging individuals who are currently enrolled in Medicare or Medicare Advantage plans or decision-makers for those individuals to attend one of the information sessions. Medicare Advantage Plan participants will still be able to receive services from Madison Regional Health System, but will need to refer to their out-of-network benefits.

“We recognize that Medicare Advantage plans may be a well-suited option for some consumers, and we sincerely apologize for the inconvenience this may cause some patients. Our decision to end Medicare Advantage plan contracts aligns with our commitment to provide quality healthcare close to home. By focusing on our mission versus focusing on barriers that are not in our control, we continue to be good stewards of our resources and prioritize the care our patients deserve,” added Mallett.

Madison Regional Health System will continue to provide financial counseling to anyone who needs it and has financial assistance programing for eligible individuals. If you wish to speak with a financial counselor at Madison Regional Health System, please call 605-256-6551. Information about SHIINE, can be found by visiting