What went wrong at Humana?
Asked by: Prof. Kathryne Torp II | Last update: June 14, 2025Score: 4.7/5 (14 votes)
What is the problem with Humana?
Like other health insurers, Humana has been battling with elevated costs due to higher demand for medical care, and lower-than-expected payments from the government for managing healthcare for these members.
Why did Humana lose star ratings?
More than one dozen of Humana's plans received lower stars because of the higher cut points, the payer said. Humana also accused the CMS of not giving the insurer a chance to verify regulators' calculations, in a break with historical norms.
What is happening with Humana insurance?
Unsurprisingly, Humana is exiting markets in which it did not expect to be profitable next year. It told investors in July enrollment would likely decrease, but it's not yet clear the exact impact that will have on 2025's financials.
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.
Why Is Humana Losing Medicare Advantage Plans? - InsuranceGuide360.com
Why is Humana down so much?
Shares of Humana have sunk since the CMS rating came out last week, adding to a slump that began in January when the company first warned that higher medical costs and government regulations would hurt profits. Investopedia requires writers to use primary sources to support their work.
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 a good insurance to have?
Humana received the highest Customer Experience Index scores among Health Insurers in Forrester's proprietary 2024 U.S Customer Experience Index rankings.
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 is Humana dropping my Medicare Advantage plan?
To protect profits, Humana and its peers in MA slashed their plans for 2025, cutting benefits and exiting underperforming markets.
Did UnitedHealthcare buy out Humana?
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.
Why is Humana changing its name?
Why is Humana Pharmacy changing its name? The new CenterWell name reflects the combination of patient centricity, wellness and care that is fully centered on the patient.
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.
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.
Where does Humana rank in healthcare?
U.S. News ranked Humana No. 1 nationally for its 2024 Medicare Advantage plan offerings in the following categories: 2024 Best Overall Medicare Advantage Plan Company. 2024 Best Company for Member Experience.
What is the 8 minute rule for Humana?
Put simply, the 8 minute rule dictates that healthcare providers must provide at least eight minutes of direct, face-to-face patient care to bill for one unit of a timed service. Anything less than that doesn't qualify as billable time.
Is Humana laying people off?
Humana announces 'limited' workforce reductions
"The impacted positions represented a small percentage of our total workforce and were geographically dispersed across multiple locations," said Mark Taylor, director of corporate communications, in a statement shared with Fierce Healthcare.
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.
What is the disadvantage of Humana?
Unhappy members: Humana's scores for customer satisfaction dropped in several major Medicare markets since last year, landing below the regional average in most, according to J.D. Power's latest study. 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.
Do doctors prefer HMO or PPO?
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
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.
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.
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.