Health system will no longer be in-network for Humana, HealthNet and WellCare

Citing continued, unresolved concerns about patient care and administrative burdens, St. Charles Health System announced today it will no longer be an in-network provider for Medicare Advantage plans from Humana, HealthNet and WellCare starting in 2024. Seniors and others on Medicare plans will continue to have options for insurance coverage at St. Charles, as the health system continues to accept traditional Medicare and some Medicare Advantage plans.

“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,” said Dr. Mark Hallett, chief clinical officer. “We are grateful that some insurance partners were willing to come to the table and try out innovative solutions to these complex problems.”

St. Charles joins many other hospitals and health systems around the country that are reevaluating their participation in Medicare Advantage plans, which are publicly funded, but privately run (“Hospitals are dropping Medicare Advantage left and right”).

“The conversation about Medicare Advantage continues at St. Charles and at health systems around the nation,” said Matt Swafford, chief financial officer. “We hope the innovative solutions we are piloting with PacificSource that we announced last week will serve as a model for future discussions.”

When Medicare open enrollment begins Oct. 15, local seniors will have options should they want to remain in-network for St. Charles. In addition to traditional Medicare and PacificSource, St. Charles will start the year accepting the following Medicare Advantage plans: Providence, Moda and Regence Blue Cross Blue Shield.

Individuals on Medicare Advantage plans from Humana, HealthNet and WellCare should receive a communication from their insurance provider about the changes to their health plan offerings and in-network provider availability.

Key dates:

• Oct. 15, 2023: Medicare open enrollment begins

• Dec. 7, 2023: Medicare open enrollment ends

• Dec. 31, 2023: Humana coverage ends

• Feb. 1, 2024: HealthNet and WellCare coverage ends

Central Oregonians who wish to explore insurance options, can contact:

• Oregon Senior Health Insurance Benefits Assistance (SHIBA) at 800-722-4134, option 2,
• 800-MEDICARE (800-633-4227),
• Council on Aging of Central Oregon at 541-678-5483,
• or an insurance broker of your choosing.

Additional information can be found on the St. Charles Medicare Advantage FAQ webpage or individuals can call 541-612-8378.