Expressing worries regarding patient care, accessibility, and affordability, St. Charles Health System has indicated the possibility of discontinuing its involvement in all Medicare Advantage plans. This includes plans offered by Humana, PacificSource, HealthNet, and WellCare. The health system has encouraged participants to contemplate transitioning to traditional Medicare. This announcement has raised concerns among patients and organizations, including Summit Health Oregon.
In their statement, St. Charles Health System mentioned that if this decision is finalized, they will still be accepting Original Medicare, which is funded and operated by the federal government. It’s important to note that Medicare Advantage plans, while government-funded, are administered by private insurance companies.
Why are they dropping these Medicare Advantage plans?
Chief Financial Officer Matt Swafford stated, “Frequently, the Medicare Advantage plan creates obstacles between the patient and the provider, leading to decisions that can either prolong a discharge, restrict access, or retroactively alter the financial situation after care has been given.”
St. Charles also pointed out additional reasons for considering the possibility of discontinuing Medicare Advantage coverage, including the heavy paperwork burden, shortages in staffing, and delays in patient transfers.
What are their options?
Once Medicare open enrollment commences on October 15, senior citizens in the area will have choices if they wish to stay within St. Charles’ network. Besides the conventional Medicare and PacificSource, St. Charles will be welcoming the following Medicare Advantage plans at the beginning of the year: Providence, Moda, and Regence Blue Cross Blue Shield.
The healthcare system stated that the decision would impact approximately 6,000 patients enrolled in the three plans that are being discontinued — 5,000 with Humana and a combined total of 1,000 with WellCare or HealthNet.
PacificSource’s Medicare Advantage plan covers an estimated 15,000 residents in Central Oregon, while Providence serves around 1,400 individuals, Regence Blue Cross Blue Shield covers 1,200, and Moda has 800 beneficiaries.
Individuals enrolled in Medicare Advantage plans through Humana, HealthNet, and WellCare will receive communication from their respective insurance providers regarding modifications to their health plan options and the availability of in-network providers.
Important Dates:
- October 15, 2023: Start of Medicare open enrollment
- December 7, 2023: End of Medicare open enrollment
- December 31, 2023: End of Humana coverage
- February 1, 2024: End of HealthNet and WellCare coverage
Residents of Central Oregon seeking information about insurance options can reach out to Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
