NMHS cuts ties with Humana over Medicare Advantage contract

North Mississippi Health Services says it will soon no longer accept coverage for Humana customers enrolled in the insurer’s Medicare Advantage plan.

Posted: Dec 6, 2018 2:11 PM

TUPELO, Miss. (WTVA) - North Mississippi Health Services says it will soon no longer accept coverage for Humana customers enrolled in the insurer’s Medicare Advantage plan.

This takes effect January 1, and this applies to all NMHS hospitals, including North Mississippi Medical Center in Tupelo, and its other clinics and imaging centers.

The hospital system describes the move as a business decision.

Below is a description of how this will affect people with Humana Medicare Advantage coverage:

Impact of the Change to Out of Network Status

With NMHS moving to Out-of-Network status, Humana MA members will no longer be able to schedule elective procedures at NMHS locations or with NMHS providers. For elective procedures, Humana MA members will need to locate an in-network Humana provider.

Continuity of Care and Waiver Situations

For some Humana members, Continuity of Care scenarios may exist (such as a member undergoing an existing treatment plan with an NMHS provider). NMHS has received confirmation from Humana that Continuity of Care letters were mailed to some 4,600 Humana MA members in the region. Humana also informed NMHS that since NMHS will be an Out of Network provider, Humana will be unable to share any internal documents specific to this detail item, including the actual member letter itself. As such, it is very important that the Humana MA members understand that the obligation for providing any requested information to Humana will be the responsibility of the member. NMHS will no longer be in a position to assist in this documentation requirement process.

In addition, NMHS received notice from the Humana Clinical Intake team that members may potentially qualify for a “Waiver” if a health care provider (such as NMHS) is outside a specific mileage radius determined by the Center for Medicare (CMS). Completing the details tied to this waiver documentation requirement will also be the responsibility of the member.

Members requiring assistance in completing either form (Continuity of Care or Waiver) will be routed to Humana Customer Service in both of these situations.

What Options Exist for Medicare Members in the Community

With NMHS providers exiting the Humana Medicare Advantage PPO network, members are faced with two choices (1) drop their coverage with Humana and enroll in traditional Medicare and add a Medicare Supplement, plus consider adding a Part D prescription drug plan or (2) find another provider who participates in the Humana Medicare Advantage PPO network.

NMHS is a Medicare provider and accepts a wide range of Medicare Supplement plans. A listing of Medicare Supplement plans is located on the Mississippi Department of Insurance website www.mid.ms.gov

Feedback from the Insurance Agents in the Region

Many local community Medicare eligible members have already taken the steps necessary to address this required change during the Annual Medicare Open Enrollment process.

Local insurance agents have seen a large turnout of members seeking information and guidance on the steps in moving to a Medicare Supplement plan. Reports of 50 individuals per day requesting information from local brokers have been very common. Plus, the actual transition rate of current Medicare Advantage members to traditional Medicare and Medicare Supplement carriers has been very high.

Details for the Annual Open Enrollment period can be located on www.cms.gov

When’s the Medicare Open Enrollment Period?

Every year, Medicare’s open enrollment period is October 15 - December 7.

What’s the Medicare Open Enrollment Period?

Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

Where can people find Medicare plan information or compare plans?

1-800-MEDICARE or Medicare.gov

What can Members do who missed the opportunity to change plans during the Annual Open Enrollment Window – What’s next?

Medicare Open Enrollment Period Returns in 2019

In 2019, you have a “grace period” within Medicare. Usually, when it comes to Medicare Part D and Medicare Advantage Plans, you can only switch your plan once a year. That is changing in 2019 with the return of the Medicare Open Enrollment Period (OEP).

• The 2019 Medicare Open Enrollment Period will run from January 1st through March 31st.

This return of this enrollment period will allow Medicare Beneficiaries that are currently “locked in” to their Medicare Advantage Plan an additional opportunity to change their plan after the effective date. This turnabout is a substantial comfort for Medicare Beneficiaries on Medicare Advantage Plans.

Those on a Medicare Advantage plan will have a one-time chance to:

• Drop your Medicare Advantage Plan and return to Original Medicare, Part A and Part B

• Sign up for a stand-alone Medicare Part D Prescription Drug Plan. Usually a Medicare Advantage Plan includes drug coverage.

Once you sign up with a Part D Prescription Plan it will drop you from your Medicare Advantage Plan and return you to Medicare Part A and Part B. You can enroll in a Medi-gap (Medicare Supplement Plan) once you are no longer on a Medicare Advantage Plan, if you can medically qualify.

I Just Signed Up for my Medicare Advantage Plan: Why Would I Want to Change Already

• Medicare Advantage Plans must cover at least the same benefits as Original Medicare. However, some Medicare Advantage Plans provide extra benefits, and these extras can change on a yearly basis.

• One of the biggest reasons people choose Medicare Advantage Plans is they think they have some dental, vision, and hearing benefits included.

• Another crucial reason people want to drop their Medicare Advantage Plan is due to the provider network changes with hospitals and doctors.

Who can I talk with to get help with the Medicare Open Enrollment process?

• Talk to a local Insurance Agent of your choice about the upcoming 2019 Medicare Annual Election Period today.

• It’s important to be aware of all the options available to you during the Medicare Annual Election period.

• There are a great number of different plans available, but only certain ones will give you the coverage you need.

• Or, you can actually compare benefits and enroll online at www.cms.gov

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 512632

Reported Deaths: 10262
CountyCasesDeaths
Harrison34853555
DeSoto33162432
Hinds32556641
Jackson24830389
Rankin22442402
Lee16238242
Madison14874283
Jones14086247
Forrest13741259
Lauderdale12249324
Lowndes11286193
Lamar10644140
Pearl River9707244
Lafayette8827143
Hancock7835132
Washington7550169
Oktibbeha7204138
Monroe6989179
Pontotoc6970109
Warren6849178
Panola6746134
Neshoba6726210
Marshall6653141
Bolivar6440151
Union633897
Pike5924156
Alcorn5862107
Lincoln5525136
George510180
Prentiss500884
Tippah490282
Itawamba4829107
Scott477499
Adams4766125
Tate4748116
Leflore4723144
Copiah455895
Yazoo455591
Simpson4543117
Wayne442772
Covington432895
Sunflower4299106
Marion4265112
Coahoma4227109
Leake413790
Newton395581
Tishomingo381793
Grenada3775109
Stone365666
Jasper340166
Attala337790
Winston317792
Chickasaw313367
Clay311878
Clarke301195
Calhoun284449
Holmes271289
Smith268952
Yalobusha243747
Tallahatchie231453
Greene224749
Walthall221366
Lawrence217840
Perry213356
Amite209557
Webster205148
Noxubee188642
Montgomery181557
Carroll174441
Jefferson Davis173643
Tunica163239
Benton152639
Kemper144941
Choctaw136527
Claiborne134238
Humphreys131139
Franklin124929
Quitman107528
Wilkinson105939
Jefferson96834
Sharkey65121
Issaquena1957
Unassigned00

Alabama Coronavirus Cases

Cases: 844951

Reported Deaths: 16115
CountyCasesDeaths
Jefferson1161002006
Mobile741871379
Madison53279732
Shelby38325368
Baldwin38068589
Tuscaloosa36009641
Montgomery34482781
Lee25550263
Calhoun22585518
Morgan22451406
Etowah20013517
Marshall18777316
Houston17727425
St. Clair16875358
Limestone16135218
Cullman16044303
Elmore15904294
Lauderdale14968306
Talladega14189299
DeKalb12967269
Walker12020380
Blount10714192
Autauga10517157
Jackson10157194
Coffee9414192
Colbert9334208
Dale9018191
Tallapoosa7254201
Russell707765
Chilton7018170
Escambia6955143
Covington6932195
Franklin6340108
Chambers5783142
Marion5401130
Dallas5285209
Pike5118109
Clarke484986
Lawrence4826129
Winston4780110
Geneva4642136
Bibb434094
Barbour369480
Butler3434100
Marengo342393
Monroe337066
Randolph334367
Pickens333188
Fayette330085
Henry320666
Hale318189
Cherokee317563
Crenshaw260477
Washington256952
Cleburne254460
Lamar251253
Clay250869
Macon244764
Conecuh192762
Coosa184947
Lowndes178168
Wilcox177438
Bullock152645
Perry141840
Sumter139241
Greene130245
Choctaw93228
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