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Although the Gundersen Health Plan was founded in 1995 (as Gundersen Lutheran, Inc.) the organization’s history goes back 125 years, to the practice of its namesake doctor, Adolf Gundersen. Practicing as a local physician in La Crosse, Wisconsin, Gundersen became the Medical Director of Lutheran Hospital upon its opening in 1902. In 1917, Gundersen’s battle to have control over hiring standards for doctors (in response to what he saw as poor quality physicians) in the hospital took him to the State Supreme Court, where he won. The case set a national precedent for hospitals to be given the right to decide what requirements can be set for their staff.
In 1995, Gundersen Clinic and Lutheran Hospital formed Gundersen Lutheran, Inc., a medical system that would become Gundersen Health system in 2013. At the time of founding Gundersen Lutheran, a health plan was created to serve the employees of the company. After a short time, the plan was expanded and offered to other local businesses, and eventually to individuals.
Today, Gundersen Health Plans are available in parts of three states: Wisconsin, Minnesota, and Iowa. They offer a range of plans including HMO, POS, and self-funded options. In addition to these plans, they also offer Medicare Advantage and Medicare Supplement Insurance.
Gundersen Medicare Plans
Gundersen has four Medicare Advantage Plans as well as several options for those seeking Medicare Supplement Insurance. These plans are available to those living in the company’s specific service area. Gundersen does not currently write separate Part D Prescription Drug Coverage.
All of Gundersen’s Medicare Advantage plans are HMO plans. Called Senior Preferred, there are four plans, each with varying levels of coverage and premiums.
The Value Plan is the most affordable of the Advantage options. It has a $35 co pay for all office visits, including specialists and Urgent Care. Emergency care has a $75 co pay. There is a $200 per day co pay on hospital stays for the first 17 days. Skilled nursing facilities have no co pay for the first 21 days, and a $125 co pay per day for days 21-100. Vision services are included, but unlike most Medicare Advantage Plans, Part D Prescription Drug coverage is not included with this plan.
The next step up is the Value D Plan. This plan mirrors the coverage of the regular Value plan, but it does include Part D coverage. The drug coverage has a $360 deductible for Tiers 3-5. Tier 1 drugs are covered with an $11 co pay for a one-month supply. Tiers 2 and 3 have a $20 and $7 co pay respectively. Tier 4 has a $100 co pay, and Tier 5 is covered at 25% coinsurance.
The Elite Plan is a more expensive option with lower co pays for most services. There is a $20 co pay for all office visits – specialist and Urgent Care included, and $75 for emergency care. The hospital co pay is a flat rate of $500 per admission, while Skilled Nursing Facilities have the same coverage as the value plan. Vision is included with a lower co pay than Value. Like the Value Plan, the Elite Plan does not include Part D coverage.
The Elite D Plan is the version that does offer Part D for an increased premium. The coverage is otherwise the same. Again, there is a $360 deductible for Tiers 3-5. Co pays for a 30-day supply vary slightly depending on the state. Wisconsin and Iowa have the same co pays: $8.50 for Tier 1, $20 for Tier 2, $47 for Tier 3, $100 for Tier 4, and 25% co insurance for Tier 5. These same rates apply to Minnesota, with the one main difference being that Tier 1 drugs have a $10 co pay.
Because there is no supplemental policy for Part D available from Gundersen, customers who want this coverage will have to either choose a plan that includes it, or seek the coverage elsewhere.
Gundersen’s Senior Choice Medicare Supplement plans offer a variety of coverage to pay for the costs not covered by Medicare.
The Senior Choice Base Plan offers the same coverage as what is known as Plan A in most states: coinsurance costs for Part A and Part B, hospice coinsurance, and the first three pints of blood annually.
From the Base plan, there are a number of riders that can be added to increase the coverage as needed. These riders are:
- Part A 50% deductible
- Part A 100% deductible
- Part B 100% deductible OR
- Part B co pay/Co insurance (only one of these two can be chosen)
- Part B Excess Charge
- Home Health
- Foreign Travel Emergency
While this system differs from how most states handle Supplemental coverage – with plans on the letter system – it allows for most of the same coverage in a more a la carte fashion, allowing the customer to select the coverage they prefer to have.
Medicare Plan Rates
Rates are readily available on the Gundersen Health Plan website, located right alongside the plan descriptions. The rates differ slightly in Minnesota for some of the plan options.
The Senior Preferred Plan Value level is $25 a month in all three states. The Value D Plan is $73.20 a month in Wisconsin and Iowa, and $72.50 a month in Minnesota.
The Elite Plan is $130 a month in all three states. The Elite D Plan is $187.60 in the first two states and $187.10 in Minnesota. The price differences for Minnesota are nominal.
Rates for the Senior Choice plans vary greatly based on the age, location, and smoking status of the insured. The website does offer a chart with rates (PDF) starting at base and then adding on all of the available riders. This should make it easy for customers to locate their rate based on all of the variables that apply.
Since this is a local health plan, we are unable to compare it to the national companies’ rates. Overall, the Medicare Advantage options do appear to have very reasonable premiums, although it’s vital to remember that the two non-D plans do not include any prescription drug coverage, which affects the value for your premium dollar.
Ratings and Reviews
Gundersen Health System has a B+ Rating with the BBB. There have been 8 complaints in the past three years, and four of those were resolved in the past 12 months. This very low complaint level doesn’t explain the B+ rating in our experience, although this is a relatively small company.
As a small company, they don’t appear on any of the major review sites. Few of the reviews we could locate had anything to do with the health plans, but rather with the services at the Gundersen hospitals and clinics. We weren’t able to find anything directly pertaining to Medicare. It is worth noting that the Health System itself appears to be very highly regarded, and they have been repeatedly ranked in the top 50 hospitals in the country.
The Bottom Line
Gundersen serves a limited area, but for those within that area, they appear to be a solid choice. If you are looking for an HMO Medicare Plan with local service and reasonable rates, they certainly have some good options. Their plans may not compete with large, national insurance companies premium-wise, but their reputation is likely to serve as a good balance for the higher rates.
For a list of companies that we recommend, visit our Best Insurance Companies page.