Tag: Kelli Jo Greiner

Help for Medicare Advantage Patients Who Lose Doctors Is Shelved, for Now

RETIRING        Nationwide, hospitals and other providers are leaving private Medicare Advantage plans, putting thousands of seniors at risk of higher costs and of losing trusted doctors.

By Susan Jaffe | The New York Times | April 18, 2026

Amy Trojanowski liked the extra benefits her Humana Medicare Advantage plan provided — a $200 debit card replenished monthly to use toward groceries, over-the-counter pharmacy items and even her electric bill. She also appreciated the dental and vision coverage. But those things couldn’t compare to the doctor she had been seeing for nearly a decade.

“I love her so much,” said Ms. Trojanowski, 60, who lives near Raleigh, N.C. The doctor’s practice is part of UNC Health, a 20-hospital system affiliated with the University of North Carolina at Chapel Hill.

Last October, however, Humana informed her that UNC Health would no longer participate in the plan’s provider network in 2026….

In November, the Centers for Medicare & Medicaid Services proposed a regulation with a solution for Advantage members “who experience provider network changes midyear” and “may want to stay with their current provider,” according to a C.M.S. fact sheet. Officials would streamline a complicated process “to allow these enrollees to change their coverage more easily.” State insurance officials, the American Medical Association and the American Hospital Association, along with other provider and patient advocacy groups, generally supported the idea.

But early this month, C.M.S. abandoned the proposal, which would have taken effect in 2027, even as disruptions in provider networks continue. C.M.S. officials declined to explain the reason for the reversal. But in an email, a C.M.S. spokesman, Christopher Krepich, wrote that the agency “routinely proposes policies to solicit public input and carefully considers all feedback” before finalizing them. [Continued in The New York Times.]…

When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too

By Susan Jaffe | KFF Health News | April 28, 2025

For several years, Fred Neary had been seeing five doctors at the Baylor Scott & White Health system, whose 52 hospitals serve central and northern Texas, including Neary’s home in Dallas. But in October, his Humana Medicare Advantage plan — an alternative to government-run Medicare — warned that Baylor and the insurer were fighting over a new contract. If they couldn’t reach an agreement, he’d have to find new doctors or new health insurance.

“All my medical information is with Baylor Scott & White,” said Neary, 87, who retired from a career in financial services. His doctors are a five-minute drive from his house. “After so many years, starting over with that many new doctor relationships didn’t feel like an option.”

After several anxious weeks, Neary learned Humana and Baylor were parting ways as of this year, and he was forced to choose between the two. Because the breakup happened during the annual fall enrollment period for Medicare Advantage, he was able to pick a new Advantage plan with coverage starting Jan. 1, a day after his Humana plan ended.

Other Advantage members who lose providers are not as lucky. Although disputes between health systems and insurers happen all the time, members are usually locked into their plans for the year and restricted to a network of providers, even if that network shrinks. Unless members qualify for what’s called a special enrollment period, switching plans or returning to traditional Medicare is allowed only at year’s end, with new coverage starting in January.

But in the past 15 months, the Centers for Medicare & Medicaid Services, which oversees the Medicare Advantage program, has quietly offered roughly three-month special enrollment periods allowing thousands of Advantage members in at least 13 states to change plans. They were also allowed to leave Advantage plans entirely and choose traditional Medicare coverage without penalty, regardless of when they lost their providers. But even when CMS lets Advantage members leave a plan that lost a key provider, insurers can still enroll new members without telling them the network has shrunk.

…CMS would not identify plans whose members were allowed to disenroll after losing health providers. The agency also would not say whether the plans violated federal provider network rules intended to ensure that Medicare Advantage members have sufficient providers within certain distances and travel times. [Continued in KFF Health News, Fortune, MSN, Medpage Today, Boston Herald, Los Angeles Daily News, and Yahoo News.]

 

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Your Doctor or Your Insurer? Little-Known Rules May Ease the Choice in Medicare Advantage

By Susan Jaffe, KFF Health News | March 29, 2024

Bart Klion (Hans Pennink for KFF Health News)

Bart Klion, 95, and his wife, Barbara, faced a tough choice in January: The upstate New York couple learned that this year they could keep either their private, Medicare Advantage insurance plan — or their doctors at Saratoga Hospital.

The Albany Medical Center system, which includes their hospital, is leaving the Klions’ Humana plan — or, depending on which side is talking, the other way around. The breakup threatened to cut the couple’s lifeline to cope with serious chronic health conditions.

Klion refused to pick the lesser of two bad options without a fight.

..With rare exceptions, Advantage members are locked into their plans for the rest of the year — while health providers may leave at any time. …But a few years ago, CMS created an escape hatch by expanding special enrollment periods, or SEPs, which allow for “exceptional circumstances.” Beneficiaries who qualify can request SEPs to change plans or return to original Medicare. [Continued on KFF Health News]…