Major news recently broke in the health insurance world that affects hundreds of thousands of Americans. The announcement that Humana to depart 13 markets has left many Medicare Advantage members wondering what comes next. This decision means big changes are on the horizon for those enrolled in specific plans.
If you or a loved one is a Humana member, it is vital to understand how this move could impact your healthcare coverage in 2025. This article will break down what is happening, which areas are affected, and what steps you can take to ensure you continue to have the health coverage you need. We will cover the details of this significant shift in the Medicare landscape.
Table of Contents
Key Takeaways
- Humana is exiting Medicare Advantage PPO and/or HMO plans in 13 specific markets starting in 2025.
- This change is expected to affect approximately 560,000 beneficiaries, which is about 10% of Humana’s total Medicare Advantage membership.
- The decision is part of Humana’s strategy to adjust to rising healthcare costs and changes in government payment rates.
- Affected members will need to choose a new Medicare plan during the Annual Enrollment Period (AEP) from October 15 to December 7.
- Resources like the State Health Insurance Assistance Program (SHIP) can provide free, unbiased help to find a new plan.
Understanding the Humana to Depart 13 Markets Announcement
The news that Humana to depart 13 markets is a significant development for the insurance giant and its members. Humana’s Chief Financial Officer, Susan Diamond, confirmed that the company would be discontinuing certain Medicare Advantage plans in specific counties across several states. This strategic decision is a response to multiple financial pressures, including higher-than-expected medical costs from members utilizing more healthcare services.
Additionally, changes in how the government calculates payments to Medicare Advantage plans have created a challenging financial environment. By pulling out of these less profitable areas, Humana aims to strengthen its financial position and focus on markets where it can operate more sustainably. This move is not happening in isolation; other insurers are also re-evaluating their offerings in light of the current economic climate.
Why is This Happening Now?
Several factors have led to Humana’s decision. The primary driver is financial. After the pandemic, there has been a noticeable increase in seniors seeking medical care they may have postponed, leading to higher costs for insurers. At the same time, the Centers for Medicare & Medicaid Services (CMS) updated its payment rates to private insurers, which were not as favorable as many in the industry had hoped.
This combination of rising costs and adjusted revenue created a difficult situation. Humana is essentially trimming its business to ensure long-term stability. This is a business decision aimed at maintaining profitability and focusing resources on more successful markets, even though it causes disruption for many beneficiaries.
The Full Scope: Humana to Depart 13 Medicare Advantage Markets
When we talk about the Humana to depart 13 medicare advantage markets decision, it’s important to be precise. This exit doesn’t mean Humana is leaving Medicare entirely or that all its plans are disappearing. The company is specifically ending its Medicare Advantage Preferred Provider Organization (PPO) and/or Health Maintenance Organization (HMO) plans in certain counties.
This targeted approach affects a substantial number of people—around 560,000 beneficiaries. These members will receive official notices from Humana and will no longer be able to stay on their current plan in 2025. Understanding if your specific county is on the list is the first step toward figuring out your next move for healthcare coverage.
Which Specific Markets are Affected?
Humana has identified counties in several states where it will discontinue its MA plans. While the full, official list is being communicated directly to members, the impacted areas are spread across the country. These markets are a mix of urban and rural counties where the company has determined it can no longer operate its plans effectively from a financial standpoint.
The table below summarizes the key details of Humana’s market exit.
| Key Metric | Details |
|---|---|
| Company | Humana Inc. |
| Action | Exiting certain Medicare Advantage markets |
| Number of Markets | 13 |
| Number of Beneficiaries | Approximately 560,000 |
| Percentage of MA Membership | Roughly 10% |
| Effective Date | Beginning of the 2025 plan year (January 1, 2025) |
| Affected Plans | Specific Medicare Advantage PPO and/or HMO plans |
| Reason | Rising medical costs and changes in government payments |
What This Means for You as a Beneficiary
If you are one of the 560,000 people affected by the Humana to depart 13 markets decision, you will need to find a new health plan for 2025. Your current Humana Medicare Advantage plan will not be available next year. This means you must take action during the Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7.
If you do not choose a new plan during this time, you will likely be automatically enrolled in Original Medicare (Part A and Part B). While Original Medicare provides good hospital and medical coverage, it does not include prescription drug coverage (Part D) or the extra benefits like dental, vision, and hearing that many Medicare Advantage plans offer. This could leave you with significant gaps in your coverage and potentially higher out-of-pocket costs.
Your Options for New Coverage
You have several options to consider as you look for a new plan. It’s important to explore all of them to find the one that best fits your health needs and budget.
- Another Medicare Advantage Plan (Part C): Other insurance companies will still offer Medicare Advantage plans in your area. These plans will vary in their costs, provider networks, and extra benefits.
- Original Medicare with a Medigap Policy: You can switch to Original Medicare (Parts A and B) and purchase a separate Medicare Supplement Insurance (Medigap) policy to help cover costs like deductibles and coinsurance.
- Original Medicare with a Part D Plan: If you go with Original Medicare, you will almost certainly want to purchase a standalone Prescription Drug Plan (Part D) to cover your medications.
- Other Plan Types: Depending on your location and eligibility, you might have access to other types of plans, such as PACE (Programs of All-Inclusive Care for the Elderly).
How to Prepare for the Change
The news that Humana to depart 13 markets can be stressful, but with a clear plan, you can navigate this transition smoothly. The most important thing is to be proactive. Do not wait until the last minute to start researching your options. The Annual Enrollment Period is a busy time, and you want to give yourself plenty of time to make a well-informed decision. Start by making a list of your healthcare priorities. Consider your doctors, specialists, and preferred hospitals. Make a separate list of all the prescription medications you take. These lists will be your most valuable tools when comparing new plans.
Creating a Healthcare Checklist
To stay organized, create a simple checklist. This will help you compare different plans effectively.
- List of Doctors: Write down the names and locations of all your current doctors, from your primary care physician to any specialists you see regularly.
- List of Medications: Note the name, dosage, and frequency of every prescription drug you take.
- Health Needs: Think about your overall health. Do you have chronic conditions? Do you anticipate needing any surgeries or special treatments in the coming year?
- Benefit Priorities: What extra benefits are most important to you? Is it dental, vision, hearing aids, or a fitness membership?
- Budget: Determine how much you can comfortably afford for monthly premiums, deductibles, and other out-of-pocket costs.
Researching New Plans
Once you have your checklist, it’s time to start looking at other plans. The official Medicare Plan Finder tool on Medicare.gov is an excellent, unbiased resource. You can enter your zip code and prescription drugs to see a detailed comparison of all the plans available in your area. It will show you estimated yearly costs, provider networks, and star ratings for each plan. Pay close attention to the star ratings, as they measure a plan’s quality and performance.
Understanding Provider Networks
It’s critical to check if your current doctors are “in-network” for any new plan you consider. If you choose an HMO plan, you generally must use doctors within its network. A PPO plan offers more flexibility to see out-of-network doctors, but usually at a higher cost.
Reviewing Drug Formularies
Every prescription drug plan has a formulary, which is its list of covered drugs. Make sure all your essential medications are on a new plan’s formulary. Also, check which “tier” your drugs are on, as this will determine your copay amount.
Where to Find Help and Guidance
You do not have to go through this process alone. Many resources are available to provide free, personalized assistance. One of the best places to start is your local State Health Insurance Assistance Program (SHIP). SHIPs are government-funded programs that offer free and impartial counseling on all things Medicare. A trained SHIP counselor can sit down with you, review your specific needs, and help you compare plans without trying to sell you anything. This is a valuable service for anyone feeling overwhelmed by the Humana to depart 13 medicare advantage markets news. You can find your local SHIP office by visiting shiphelp.org.
Working with Insurance Agents
Another option is to work with an independent insurance agent. A good agent who is contracted with multiple insurance companies can present you with a variety of plans and help you enroll. However, it is important to remember that agents are paid a commission by the insurance companies. Always verify that an agent is licensed and ask them which companies they represent to ensure you are seeing a wide range of options.
Conclusion
The announcement that Humana to depart 13 markets is a significant event that will require action from hundreds of thousands of Medicare beneficiaries. While losing your current health plan can be unsettling, it is also an opportunity to re-evaluate your healthcare needs and find a new plan that may be an even better fit. The key is to start early, do your research, and use the free resources available to you. By making a list of your doctors and medications and carefully comparing your options during the Annual Enrollment Period, you can confidently transition to new coverage for 2025 and ensure your health and financial well-being are protected.
Frequently Asked Questions (FAQ)
Q1: Will I lose my Medicare coverage completely?
No. You will not lose your Medicare eligibility. If your Humana Medicare Advantage plan is being discontinued, you must choose a new plan. If you do nothing, you will be automatically moved to Original Medicare (Part A and Part B), but this will not include drug coverage.
Q2: When can I choose a new plan?
You can and should choose a new plan during the Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7. Your new coverage will then start on January 1, 2025.
Q3: How do I find out if my specific plan is affected?
Humana is legally required to send official written notices to all affected members. If your plan is being discontinued, you will receive a non-renewal notice in the mail this fall, well before the AEP begins.
Q4: What happens if I miss the December 7 deadline?
If you miss the AEP deadline, you may have another chance to enroll in a Medicare Advantage plan during a Special Enrollment Period (SEP) because your previous plan was terminated. However, it is best to act during the AEP to avoid any potential gaps in coverage, especially for prescription drugs.
Q5: Can I keep my same doctors?
It depends on the new plan you choose. When you research new plans, the most important step is to check if your current doctors and hospitals are in the new plan’s provider network. The Medicare Plan Finder tool can help you with this.
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