ChristianaCare drops top rated Medicare Advantage insurer. What options do members have?

Humana was recently named the "Best Overall Medicare Advantage Plan Company" by U.S. News & World Report. ChristianaCare announced that as of January, it would no longer accept plans from this Medicare Advantage carrier as in-network.

Delaware's largest health care system said contract negotiations between it and the country's top-rated Medicare Advantage insurance carrier were unsuccessful. Beginning in September, ChristianaCare began sending letters to Delaware's 5,656 Humana Medicare Advantage plan participants, informing them that the plans offered by Humana would not be in-network as of Jan. 1.

The notice caught some impacted plan participants off guard, especially because regular open enrollment ended Dec. 7. However, Humana Medicare Advantage plan enrollees have an opportunity to select a new plan.

Humana Medicare Advantage plan members have until March 31 to consider these options:

• Switch to another Medicare Advantage plan

• Drop Medicare Advantage and go back to original Medicare

• Join a Medicare drug plan

What is Medicare Advantage?

Medicare is a health insurance program for people 65 and older. There are several names for the multitude of plans that cover a wide range of services and coordinated benefits. Upon enrolling, individuals must choose between Original Medicare and Medicare Advantage.

Original Medicare is known as Part A and Part B. It is a fee-for-service insurance managed by the federal government. Part A refers to coverage for hospital service and Part B is coverage for medical care.

Medicare Advantage plans, also known as Part C, are provided by private insurers and offer a range of services that can vary by state and plan. In addition to the benefits available through Original Medicare, some Medicare Advantage plans include extras such as routine vision, hearing, and dental care, as well as options like gym memberships and transportation. When weighing costs, enrollees must choose between an HMO, PPO or a private fee-for-service plan.

Stand-alone Medicare prescription drug plans are called Part D. Most original Medicare plans and Medicare Advantage plans offer Part D.

'A REVOLUTIONARY LEGAL THEORY': ChristianaCare agrees to pay $47.1M to settle whistleblower lawsuit claiming kickbacks

The challenge of choosing a new plan

Deciding which option to pick can be difficult because there are benefits and drawbacks the average person may not consider, according to Lakia Turner, director of the Delaware Department of Insurance Medicare Assistance Bureau.

As an example, Turner pointed out that as former Medicare Advantage plan participants, new Medicare enrollees may not be eligible for a Medicare supplement policy called Medigap. Medigap pays the 20% of costs that Medicare doesn't cover. Pre-existing health conditions cannot be used to deny coverage. However, these limitations are only available to seniors within the first six months of a Medicare Part B plan.

Now, if a Humana Medicare Advantage plan member chooses to switch to original Medicare and opts for a supplemental policy to cover gaps in Medicare coverage, they'll likely face increased costs, fewer coverage options and "they'll go through medical underwriting, which means that the insurance company will look at their age and their health and determine whether or not to sell them a policy," Turner said.

To help seniors navigate the complexities of Medicare, the Delaware Department of Insurance Medicare Assistance Bureau offers free, one-on-one assistance by federally trained state employees and volunteers who can help enrollees determine which option is the right choice.

Call the department at 302-674-7364 to schedule a phone, virtual or in-person appointment.

Additional questions to ask about Medicare Advantage plan options

When contacting the Delaware Department of Insurance Medicare Assistance Bureau, enrollees should be prepared to discuss factors that may affect their choice of plan, Turner advised. These include:

• Whether all their doctors, including those outside of the ChristianaCare health system, are covered by the plan they choose.

• Understanding of the costs involved with Medicare Advantage plans because they typically include co-pays for doctor visits.

• Providing counselors with a list of medications to ensure that the prescriptions are covered by the preferred plan.

Does ChristianaCare accept any Medicare Advantage plans?

Yes. The healthcare provider's website listed these carriers offering in-network plans for the 2024 Medicare benefit year:

• Aetna Medicare Advantage.

• United Healthcare Medicare Advantage.

• Highmark Medicare Advantage (Delaware only).

• WellCare Medicare Advantage (Delaware only).

• Cigna Medicare Advantage (Delaware and Pennsylvania).

• Alterwood Medicare Advantage (Maryland only).

Also according to the health care provider's webpage, in-home nursing care through ChristianaCare HomeHealth continues to be in-network with Humana Medicare Advantage.

In an email sent to Delaware Online/The News Journal after the original publication of this story, ChristianaCare stated it "remains committed to expanding access to high-quality, affordable health care for everyone in the communities we serve." The company said it is still willing to engage in negotiations with Humana for potential coverage offerings.

Contact reporter Anitra Johnson at ajohnson@delawareonline.com. Join her on the Facebook group Delaware Voices Uplifted. Support her work and become a subscriber.

This article originally appeared on Delaware News Journal: ChristianaCare drops Humana Medicare Advantage. Here are other options