CMS has suspended new Medicare Advantage enrollment into Aspirus Health Plan, part of Wausau, Wis.-based Aspirus Health, after the insurer’s claims processor was taken over by Minnesota regulators.
The intermediate sanction, issued Feb. 24, bars new Medicare beneficiaries from enrolling in Aspirus Medicare Advantage, effective immediately. The insurer has more than 6,000 MA members currently. CMS said the sanction came after a Jan. 20 order from Wisconsin regulators directed Aspirus to stop signing up new members or renewing existing policies tied to its third-party administrator, UCare.
UCare, a Minneapolis-based nonprofit insurer, was ordered into rehabilitation in December amid major financial issues that threatened its ability to pay providers and cover member claims. UCare had been administering Aspirus’s MA operations, including customer service, care management and claims processing.
“To protect policyholders, OCI has required Aspirus to pause writing or renewing Medicare Advantage business and report weekly on their progress toward transitioning policyholders to a new TPA,” a spokesperson for the Wisconsin Office of the Commissioner of Insurance told Becker’s.
UCare posted a $504 million operating loss in 2024 and exited the Medicare Advantage market for 2026, affecting 158,000 people. In November, Medica agreed to acquire the company’s remaining Medicaid and ACA contracts, and Minnesota placed UCare into rehabilitation the following month.
Minnesota-based health systems, including Fairview Health Services, Hennepin Healthcare, Mayo Clinic and Allina Health, have sought to intervene in the rehabilitation proceedings, alleging a combined $500 million in unpaid obligations. The state estimates UCare owes providers $900 million overall.
Aspirus must complete the transition to a new TPA by July 31. The sanction will remain in place until Wisconsin regulators confirm Aspirus is back in good standing and can accept new enrollees.
CMS said Aspirus’s inability to accept new members puts it in violation of its federal contract, which requires MA organizations to accept new enrollments. The agency warned that Aspirus could face additional sanctions, penalties or contract termination if issues threatening member health and safety aren’t fixed. The insurer has until March 9 to submit a rebuttal and until March 12 to request a hearing with CMS.
Becker’s has contacted Aspirus and UCare and will update this article if more information becomes available.
