Suzanne Blake reports for Newsweek on the consequences of Humana closing some of its Medicare Advantage plans in 2025 and claiming it will reduce benefits in other Medicare Advantage plans in order to increase profits. Warning: Enrolling in Medicare Advantage will always mean never being able to rely on getting care and coverage from the physicians and hospitals you want to use and having out-of-pocket costs as high as $8,850 this year for in-network care and more if you go out of network.
Today, Humana covers six million Medicare enrollees through its Medicare Advantage plans. Humana offers Medicare Advantage plans in all 50 states. Its greatest penetration is in the Southeast. Florida has nearly three quarters of a million Humana Medicare Advantage enrollees. North Carolina has more than 450,000. Georgia has 336,000, Texas has 289,000 and Illinois has 250,000.
Some people believe that many enrollees in Medicare Advantage won’t get dental, vision, or hearing benefits any longer. Truth is that though insurers tend to offer these benefits, most Medicare Advantage plan enrollees do not appear to use them. The benefits are usually quite limited, offering little coverage, difficult to access because in-network providers are few and far between, and require high out-of-pocket costs.
Humana is claiming that Medicare is not paying it enough to deliver Medicare Advantage. Truth is that Medicare is spending $83 billion more on enrollees in Medicare Advantage than it does on enrollees in Traditional Medicare. Those payments are unsustainable.
The government is giving insurers a $16 billion raise next year on top of the overpayments. Humana simply must wants to squeeze even more money out of Medicare Advantage.
UnitedHealth also is looking to see more profits from Medicare Advantage. It can do so by denying and delaying care, but it can only do so much of that. Traditional Medicare, government-administered benefits, is far more cost-effective and also makes it much easier than Medicare Advantage to get care, anywhere in the US. But, traditional Medicare lacks an out-of-pocket limit, meaning that to protect themselves financially, people need supplemental coverage, either Medicaid or Medigap, that fills gaps in traditional Medicare.
Here’s more from Just Care:
- Medicare Advantage plans get $16 billion increase in 2025
- Medicare Advantage enrollees denied post-acute care get better protections
- Medicare Advantage: Expect lots of care denials
- Need skilled nursing care? Medicare Advantage insurers often won’t cover it
- How to switch to Traditional Medicare from Medicare Advantage?
Leave a Reply