Local physicians dropped from Humana Medicare Advantage plans

Local seniors covered by certain Humana Medicare Advantage plans may have recently received a letter notifying them that their providers would no longer be in its network. Nationwide, Humana is exiting plans that are estimated to impact 600,000 members. In a July earnings call, Humana's Chief Financial Officer Celeste Mellet said they would exit plans and "prioritize higher performing plans, including those with greater value-based care penetration." The company projected it might retain some of those members by them enrolling in other Humana plans. Locally, one of Dr. Blake Rudeseal's patients received a letter stating Rudeseal would no longer be part of the Humana Medicare Network. The letter offered the names of three other Franklin physicians that would be in-network. The letter also noted it would extend coverage through April 1, 2027, "to minimize disruption" to patient care. Mission Health spokesperson Nancy Lindell said, "Humana's decision is specific to primary care providers and does not impact Angel Medical Center's participation with Humana plans. Patients who want to remain with their current primary care physician should review their Medicare coverage options and determine whether another plan available to them includes their physician in its network." For example, on the Humana website, Rudeseal is listed as being in-network for some of the company's other plans. If you are searching for a new provider directories are available online, but it's a good idea to double check with the provider as the directories may not be up to date. Even for those seniors not impacted by the change with Humana, it is recommended that you review your plans as financial and health circumstances change from year-to-year and there could be changes to your existing plan. "We understand how concerning it can be for Medicare beneficiaries to learn that their physicians may no longer be in network, particularly when they have established relationships with their providers," said Melinda Munden, director and deputy commissioner, of the N.C. Senior Health Insurance Information Program (SHIIP) division. SHIIP counsels Medicare beneficiaries and caregivers about Medicare, Medicare supplements, Medicare Advantage, Medicare Part D, and long-term care insurance. The counselors on the toll-free line offer free and unbiased information regarding Medicare health care products. Open enrollmentMedicare Open Enrollment began Oct. 15 and continues through Dec. 7. During open enrollment, people with Medicare can: Switch from Original Medicare to Medicare Advantage, or from Medicare Advantage to Original Medicare Change Medicare Advantage plans Join, switch, or drop a Part D prescription drug plan Munden said provider networks can change annually, and those changes can affect a person's ability to continue seeing their preferred physicians at in-network rates. "That's why it's important for Medicare beneficiaries to review their coverage each year, including their plan's provider network, prescription drug coverage, costs, and benefits, to ensure their plan continues to meet their needs," she said. If someone receives notification of a network change, SHIIP recommends taking the following steps: Contact the insurance company. Confirm which providers are affected, when the change takes effect, and what options may be available. Contact the physician's office. Ask what Medicare Advantage plans will be in-network. Review plan options. The Medicare Open Enrollment Period runs from Oct. 15 thru Dec. 7. Depending on the circumstances, beneficiaries may have an opportunity to change coverage during an applicable enrollment period or if they qualify for a Special Enrollment Period. Seek assistance. Contact SHIIP or a licensed insurance agent for individualized counseling to help Medicare beneficiaries understand their coverage, compare available options, and determine the next steps for their particular situation. Contact Info:SHIIP: 855-408-1212 (toll free)Email: ncdoi.ncshiip@ncdoi.govMacon County Senior Services: 828-349-2059, ask for SHIIP help. (By appointment only.)

Local physicians dropped from Humana Medicare Advantage plans

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