Much of this is the result of commercial healthcare gaming the system with pricing. Medicare Advantage can not compete head-to-head with Traditional Medicare much less the VA. VA sent me to Barrows (Arizona) for an issue with my back and right leg. I was going numb and it was painful to walk. So to make up for just giving me epidural shots in my spine (surgeon’s suggestions), they decide to work on my blood pressure, cholesterol, and weight. They wanted another comprehensive blood test even though I had one two months earlier. Said no to it all. My cholesterol and blood pressure is far better than average. I dropped 24 pounds and still decreasing. The word for all of this is “Coding” the patient so Medicare and the VA pays more for it. I still
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Much of this is the result of commercial healthcare gaming the system with pricing. Medicare Advantage can not compete head-to-head with Traditional Medicare much less the VA. VA sent me to Barrows (Arizona) for an issue with my back and right leg. I was going numb and it was painful to walk.
So to make up for just giving me epidural shots in my spine (surgeon’s suggestions), they decide to work on my blood pressure, cholesterol, and weight. They wanted another comprehensive blood test even though I had one two months earlier. Said no to it all. My cholesterol and blood pressure is far better than average. I dropped 24 pounds and still decreasing. The word for all of this is “Coding” the patient so Medicare and the VA pays more for it. I still hurt when I walk after a bit of time.
When you read this (below), systems in Medicare Advantage are far more expensive than Traditional Medicare. The healthcare systems are pushing back. Most complaints (that are mentioned) are about Humana, United Healthcare, and others. You can figure out who is the worst,
The Healthcare systems are dropping the worst violators.
Twenty Three health systems dropping Medicare Advantage plans in 2024,
by Jakob Emerson
Medicare Advantage provides health coverage to more than half of the nation’s older adults, but some hospitals and health systems are opting to end their contracts with MA plans over administrative challenges.
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers.
In 2023, Becker’s began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
Data on this issue is limited. But in January, the Healthcare Financial Management Association released a survey of 135 health system CFOs, which found that 16% of systems are planning to stop accepting one or more MA plans in the next two years. Another 45% said they are considering the same but have not made a final decision. The report also found that 62% of CFOs believe collecting from MA is “significantly more difficult” than it was two years ago.
Twenty-three health systems dropping Medicare Advantage plans in 2024:
Editor’s note: This is not an exhaustive list. It will continue to be updated this year
1. Quincy, Ill.-based Blessing Health is implementing a new MA approach in 2025 and will only contract with BCBS, UnitedHealthcare, Molina and Total Retiree Advantage Illinois.
Blessing and other hospitals say the reasons for dropping or limiting Medicare Advantage 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.
2. Lawrence, Kan.-based LMH Health will no longer accept Aetna or Humana Medicare Advantage, effective Jan. 1.
“Reimbursement from insurance companies is one of the biggest challenges hospitals face, and especially so with those administering Medicare Advantage programs. Aetna and Humana have the lowest reimbursement of any of the Medicare Advantage programs we accept, paying the hospital and physicians well below the cost to provide care to patients,” said Rob Chestnut, LMH Health Chief Financial Officer.
“Prior authorization denials disrupt patient care and Medicare Advantage plans have the most excessive prior authorization denial rate. They often ‘delay, deny or don’t pay,’ allowing private companies to make more money.”
3. Brewer, Maine-based Northern Light Health is ending its Medicare Advantage contract with Humana, effective Sept. 30
Brewer, Maine (August 21, 2024) — Northern Light Health is ending its Medicare Advantage network contract with Humana effective September 30, 2024. This was a difficult decision and was made after spending considerable time and effort over the past year to try to resolve numerous ongoing administrative issues. This decision only affects our patients on the Humana Medicare Advantage plan. Humana Military patients are **not** affected.
Northern Light Health will continue to provide care to our Humana patients as an out-of-network provider. Receiving care from an out-of-network provider may mean higher out-of- pocket costs. Patients must contact Humana at 1-800-457-4708 to learn about their out-of-network benefits. Patients may also contact Medicare at 1-800-633-4227 with questions regarding their options.
4. Sioux Falls, S.D.-based Sanford Health is dropping Humana Medicare Advantage in Minnesota in 2025.
Sanford Health said ongoing challenges and concerns, such as coverage denials and delays in accessing care, are part of its decision to end participation with Humana Medicare Advantage on Dec. 31.
“This is a difficult decision, but ending our partnership with Humana Medicare Advantage is the right thing to do for our patients,” said Martha Leclerc, vice president of corporate contracting for Sanford Health.
“We have attempted to work with Humana for several years, but unfortunately, we have continued to experience delays in patient care, barriers to scheduling and denials of coverage causing financial burden and undue stress to our patients.”
5. Kimball (Neb.) Health Services will no longer accept any Medicare Advantage plans starting in 2025.
Effective January 1, 2025, Kimball Health Services, Kimball Health Services Clinic, and Kimball Health Services Pine Bluffs Clinic will no longer be in-network for any Medicare Advantage plan.
6. Carson City, Nev.-based Carson Tahoe Health will no longer be in network with UnitedHealthcare Medicare Advantage by May 30, 2025.
The system and its medical group will no longer be in network with UnitedHealthcare’s commercial and Medicare Advantage plans after May 30, 2025, citing challenges around processing claims and prior authorization requests.
7. Midland-based MyMichigan Health will no longer participate in the Aetna Medicare Advantage Network at all facilities after Dec., 2024.
Palmer said there was not enough “common ground” between MyMichigan Health Network and Aetna in terms of how the organizations view changes in the health care industry.
8. Bloomington, Minn.-based HealthPartners will no longer be in network with UnitedHealthcare Medicare Advantage plans by 2025.
In the letter to patients, Steve Connelly, MD and Mark Sannes, MD, the system’s co-executive medical directors, wrote that UnitedHealthcare denies and delays payments “at a rate unlike any other insurer in our market.”
“At times, this denial rate has been up to 10 times higher than other insurers we work with. UnitedHealthcare’s practices create unnecessary waits and delays for you, and they interfere with our ability to provide you with timely and appropriate care,” Dr. Connelly and Dr. Sannes wrote.
9. Canton, Ohio-based Aultman Health System‘s hospitals will no longer be in network with Humana Medicare Advantage after July 1, and its physicians will no longer be in network after Aug. 1.
Regrettably, Humana is unwilling to work with us to find a reasonable solution to this issue. Additionally, Aultman is routinely facing burdensome administrative processes with Humana resulting in delays in patient care. These include inadequate reimbursement, delays in prior authorizations and denials of claims.
10. Albany (N.Y.) Med Health System stopped accepting Humana Medicare Advantage on July 1.
11. Munster, Ind.-based Powers Health (formerly Community Healthcare System) went out of network with Humana and Aetna’s Medicare Advantage plans on June 1.
12. Lawton, Okla.-based Comanche County Memorial Hospital stopped accepting UnitedHealthcare Medicare Advantage plans on May 1.
13. Houston-based Memorial Hermann Health System stopped contracting with Humana Medicare Advantage on Jan. 1.
14. York, Pa.-based WellSpan Health stopped accepting Humana Medicare Advantage and UnitedHealthcare Medicare Advantage plans on Jan. 1. UnitedHealthcare D-SNP plans in some locations are still accepted.
15. Newark, Del.-based ChristianaCare is out of network with Humana’s Medicare Advantage plans as of Jan. 1, with the exception of home health services.
16. Greenville, N.C.-based ECU Health stopped accepting Humana’s Medicare Advantage plans in January.
17. Zanesville, Ohio-based Genesis Healthcare System dropped Anthem BCBS and Humana Medicare Advantage plans in January.
Despite our best efforts over several months, Anthem and Humana decided not to agree to the partnership that we achieved with the other four plans. Because of their unwillingness to engage with us in a way that allows us to deliver high quality, affordable care, these two Medicare Advantage plans will not be in-network with Genesis, effective Jan. 1, 2024.
18. Corvallis, Ore.-based Samaritan Health Services’ hospitals went out of network with United Healthcare Medicare Advantage plans on Jan. 9. Samaritan’s physicians and provider services will be out of network on Nov. 1.
19. Cameron (Mo.) Regional Medical Center stopped accepting Aetna and Humana Medicare Advantage in 2024.
20. Bend, Ore.-based St. Charles Health System stopped accepting Humana Medicare Advantage on Jan. 1 and Centene MA on Feb. 1.
Citing continued, unresolved concerns about patient care and administrative burdens, St. Charles Health System announced today it will no longer be an in-network provider for Medicare Advantage plans from Humana, HealthNet and WellCare starting in 2024. Seniors and others on Medicare plans will continue to have options for insurance coverage at St. Charles, as the health system continues to accept traditional Medicare and some Medicare Advantage plans.
21. Brookings (S.D.) Health System stopped accepting all Medicare Advantage plans in 2024.
Brookings Health does not endorse these tactics, which we have experienced from some plans. As such, we have chosen not to renew contracts with any MA plans starting in 2024. Brookings Health routinely reviews contracts and plans and may re-partner with MA plans in the future.
22. Louisville, Ky.-based Baptist Health went out of network with UnitedHealthcare Medicare Advantage and Centene’s WellCare on Jan. 1.
23. San Diego-based Scripps Health ended all Medicare Advantage contracts for its integrated medical groups, effective Jan. 1.
Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps’ individual physician associations.