St. Charles Health will no longer be fully covered by three Medicare Advantage plans, but will be by others as seniors prepare to enroll in health coverage.
Citing administrative burdens, the Bend-based hospital system announced last week that it would no longer serve as an in-network provider for Medicare Advantage plans from Humana, HealthNet and WellCare beginning in 2024.
Need help changing plans?
Speak with trained consumer advocates at the nonprofit Council on Aging of Central Oregon (541-678-5483) or at the state's independent Oregon Senior Health Insurance Benefits Assistance (SHIBA) program: 800-722-4134, option 2.
With open enrollment starting Oct. 15, St. Charles sparked community concern when it signaled in August it was considering dropping Medicare Advantage plans altogether.
According to St. Charles, the hospital system will continue to work with traditional Medicare as well as Medicare Advantage plans offered by PacificSource, Providence, Moda and Regence Blue Cross Blue Shield.
St. Charles will drop Medicare Advantage plans with Humana on Dec. 31, as well as HealthNet and WellCare on Feb. 1. Currently, an estimated 6,000 seniors in Central Oregon belong to those plans, meaning they need to switch in order to avoid increased costs at St. Charles providers.
Kathleen Harrington is a volunteer Medicare expert who counsels seniors for the Council on Aging of Central Oregon, part of the state SHIBA program designed to help consumers. In a statement, she said, “Although starting in 2024 St. Charles will no longer accept Medicare Advantage Plans from Humana and Wellcare/HealthNet, Central Oregon Medicare beneficiaries will continue to have options with in-network St. Charles benefits. These include plans with Providence, Pacific Source, Regence Blue Cross, and Moda. Beneficiaries can also choose to return to traditional Medicare with the option of adding a Medigap plan and a prescription drug plan.”
Open enrollment ends Dec. 31.
A St. Charles announcement cited “unresolved concerns about patient care and administrative burdens” as reasons for discontinuing contracts with Humana, HealthNet and WellCare.
“We care deeply about our patients and the care they receive, which is why we are unwilling to continue with the status quo with Medicare Advantage plans that result in restrictions to patient care, longer hospital stays and administrative burdens for providers,” Dr. Mark Hallett, St. Charles chief clinical officer, said in a statement.
About 26,000 seniors in Central Oregon rely on Medicare Advantage plans, which are a version of the federally funded health insurance program for the elderly that are run by private insurers.
Medicare Advantage plans have come under recent scrutiny over fraud and deceptive marketing. Researchers have criticized the cost of Medicare Advantage plans and hospitals have complained about them restricting access to medically necessary services.
After St. Charles began considering dropping Medicare Advantage plans, insurers approached the hospital system in hopes of finding a deal. In September, St. Charles announced it had agreed to a Medicare Advantage contract with PacificSource.