What is going on with Humana Medicare?
Asked by: Mr. Chadd Satterfield | Last update: September 23, 2025Score: 4.4/5 (38 votes)
What's going on with Humana Medicare?
Medicare Advantage giant Humana expects to lose a “few hundred thousand” members in its marquee business next year, after seriously shrinking its benefits and exiting markets for 2025 in a bid to boost profits, the insurer disclosed Wednesday.
Is Humana in trouble financially?
Humana shares, among the sector's most hard hit, have fallen nearly 44% so far this year, after the company withdrew its 2025 forecast previously, citing disappointing government Medicare reimbursement rates.
What states is Humana pulling out of?
Similarly, because of CVS Health Aetna's moves, Humana now feels secure with losing 5% of its Medicare Advantage plan enrollees after it exits unprofitable markets, primarily in the Southeastern states of Florida, North Carolina, Georgia, Texas, and Illinois.
Is Humana Insurance having problems?
Humana's plummeting stars continue a run of misfortune for the Kentucky-based payer. More so than most of its peers, Humana — the second-largest MA provider in the U.S. — has struggled to contain rising costs in MA and been forced to roll back its plan offerings in a bid to preserve profits.
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Why are hospitals dropping Humana Medicare Advantage plans?
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.
What is the Humana controversy?
Humana Agreed to Pay $1.8 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Prescription Drug Event Claims that Improperly Claimed Sales Tax. Humana Inc. (Humana), Kentucky, agreed to pay $1,814,000 for allegedly violating the Civil Monetary Penalties Law.
What is the downside of Humana?
High cost limits: Humana's average maximum out-of-pocket limit on plans is the highest of the major providers.
How much does Humana cost per month for seniors?
Premiums for Humana's plans start at $0 per month in addition to your Medicare Part B premium. In 2024, the standard part B premium amount is $174.70, but this number can go all the way up to $594 per month for high-earning seniors3.
Is Humana Insurance closing down?
Humana will move out of commercial plans over the next 18 to 24 months and focus more on government-funded programs and specialty businesses. Included in the business Humana is leaving are all fully insured, self-funded, and Federal Employees Health Benefits medical plans.
Why did Humana drop my Medicare Advantage plan?
The company said the main reason for that drop is that the 2025 rating for its H5216 plan, which contains about 45% of Humana's MA membership, fell to 3.5 stars from 4.5 stars in 2024. The H5216 plan also includes more than 90% of its employer group waiver plan membership.
What is the two midnight rule for Humana?
What is the two-midnight rule? The two-midnight rule, enacted in 2013, states that traditional Medicare must pay for an inpatient stay if admitting clinicians anticipate patients will remain in the hospital for at least “two midnights.” Beginning this year, Medicare Advantage insurers must also follow the rule.
Why do people say not to get a Medicare Advantage plan?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
What is the future of Humana in 2024?
But UnitedHealth leaders also have stressed that the rising costs wouldn't affect their expectations for 2024. Humana Inc. said Thursday that it expects adjusted earnings of about $16 per share for the new year. Analysts had been projecting per-share earns of $29.14, according to the data firm FactSet.
Can I drop Humana and go back to Medicare?
There are options with disenrollment. When you disenroll from your plan, you can enroll in another carrier's plan or return to Original Medicare.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
What is the best medicare plan that covers everything for seniors?
Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
What went wrong with Humana?
Humana's stock dived when it announced a sharp decline in memberships for the top-rated Medicare Advantage (MA) plan. There are serious concerns among investors that the company may not be as attractive an income investment play as it used to be. Humana earns revenue through healthcare services and health insurance.
Is Humana deducted from social security?
For most people, paying the premium is simple. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from 1 of these: Social Security.
Is Humana owned by UnitedHealthcare?
United HealthCare Corp.'s acquisition of Humana Inc., once valued at $5.5 billion, has been derailed by a plunge in United's stock price. The companies said today that they mutually agreed to scrap the deal, which would have created one of the nation's largest managed-care companies.
Is Humana insurance in financial trouble?
Analysts expect Humana's earnings to drop 38% in 2024, to $16.18 per share from $26.09 in 2023, according to FactSet. Analysts had been anticipating a recovery in 2026, with earnings climbing back to $25.77 per share.
Is Humana good or bad?
About Humana
Humana has an average rating of 1.9 from 50 reviews. The rating indicates that most customers are generally dissatisfied. The official website is humana.com. Humana is popular for Insurance, Financial Services.
Is Humana getting out of insurance?
Humana has announced that it will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs. No other Humana health plan offerings are materially affected.