Why are hospitals dropping Humana Medicare?
Asked by: Sheridan Hermiston | Last update: February 22, 2025Score: 4.1/5 (30 votes)
Why are hospitals not taking Humana Medicare Advantage?
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 going on with Humana Medicare?
Humana is committed to providing our Medicare Advantage members with access to high-quality, effective and affordable care. Humana Medicare Advantage members are being notified that our contract with Trinity Health will end if a new agreement is not reached before it expires effective Jan. 1, 2025.
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 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.
Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say
Why are people leaving Medicare Advantage plans?
But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up paying more in the long run in copays and deductibles if they develop a serious illness.
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.
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.
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.
Why are hospitals dropping 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 are the top 5 medicare supplement plans?
💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.
Why is Humana dropping Medicare?
Rising medical costs and lower reimbursements from CMS led Humana and other insurers to plan market exits in 2025.
Why are doctors dropping Medicare patients?
In recent years, physician groups and some policymakers have raised concerns that physicians would opt out of Medicare due to reductions in Medicare payments for many Part B services, potentially leading to a shortage of physicians willing to treat people with Medicare.
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.
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.
What is the biggest disadvantage of the Medicare Advantage plan?
Medicare Advantage Plan Pros And Cons
One disadvantage is that some Medicare Advantage plans may offer fewer options when it comes to doctors and hospitals, as they may have smaller plan networks than Original Medicare.
Do most doctors accept Medicare Advantage plans?
Most doctors accept Medicare. If a doctor accepts assignment, it means they have a formal agreement with Medicare to accept the Medicare-approved amount as full payment for all covered services. Non-participating providers do not have a specific agreement with Medicare.
What are the disadvantages of Humana Medicare Advantage?
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 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 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.
Why are seniors losing their Medicare Advantage plans?
Health systems and hospitals are also making the decision to cancel contracts due to excessive prior authorization denial rates and slow payments from insurers. Already 27 health systems have canceled their Medicare Advantage contracts this year.
Why are hospitals not taking Medicare Advantage plans?
Excessive prior authorization denial rates, slow payments from health insurers among the reasons. Medicare Advantage (MA) 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.
Can I drop my Medicare Advantage plan and go back to original Medicare?
Medicare Advantage Open Enrollment Period: Between January 1 and March 31 of each year, if you already have a Medicare Advantage Plan (with or without drug coverage) you can: Switch to another Medicare Advantage Plan (with or without drug coverage). Drop your Medicare Advantage Plan and return to Original Medicare.