Attorney General Ellison urges Humana to correct misinformation regarding Medicare Advantage
Major health care providers no longer accepting certain Medicare Advantage Plans, dramatically changing care options for over 60,000 Minnesotans
Humana reportedly advertised to consumers that certain providers would be in-network when that is not the case
Ellison urges any Minnesotan with questions about their Medicare to call 1-800-MEDICARE or 800-333-2433
November 26, 2024 (SAINT PAUL) — Attorney General Keith Ellison sent a letter to health insurer Humana, Inc. requesting that Humana correct alleged misinformation they reportedly shared with consumers about Medicare Advantage. The letter also asked Humana to provide information about the extent to which misinformation was shared with consumers and what steps were taken to correct this issue.
This year, a number of health care providers in Minnesota have decided to not accept specific Medicare Advantage plans. Seeing a provider that does not accept your Medicare Advantage plan could result in care with either a much higher out of-pocket cost or care that is not covered at all. More information on these changes can be found here.
According to reporting in the Minnesota Star Tribune, during the Medicare enrollment period that started October 15, Humana listed certain providers, including Essentia Health, Avera Health, North Memorial Health, and Sanford Health, as being in-network for their Medicare Advantage plans in 2025, despite announcements by these providers that they will no longer be in-network with Humana’s plans. This alleged misinformation, if not corrected, could result in Humana customers paying much more for the health care they receive if their preferred provider ends up no longer being in-network. Furthermore, Minnesotans on Medicare only have until December 7 to select their health insurance plans for 2025, and Minnesotans switching between Medicare Advantage plans in early 2025 might experience a gap in coverage.
“It’s my goal to help Minnesotans afford their lives and live with dignity, safety, and respect, and that becomes far more difficult when folks cannot afford the medical care they require,” said Attorney General Ellison. “If Humana did indeed share this misinformation, I urge Humana to make all possible haste and take all efforts possible to correct it. It is essential that Minnesotans considering a Medicare Advantage plan have accurate information about what that plan will and will not cover.”
In the letter, Attorney General Ellison requested that Humana take the following steps:
- Explain the extent to which Humana listed out-of-network providers as “in-network” during open enrollment for its 2025 Medicare Advantage plans,
- Identify and describe each step Humana has taken to correct this issue, including what plans, if any, Humana may have to reimburse consumers for care at out-of-network providers through March 2025, for those consumers who signed up for a Humana Medicare Advantage plan based on a misunderstanding of Humana’s in-network coverage, and
- Immediately send correspondence to
- (a) each patient which Humana knows—or should know—utilized a provider who was in-network in 2024 under a Humana Medicare Advantage plan but will be out-of-network in a 2025 Humana Medicare Advantage plan; and
- (b) each patient who enrolled in a Humana Medicare Advantage plan for the first time in 2025 but identified a provider that will be out-of-network.
- The correspondence should:
- (1) alert the patient to Humana’s error in misidentifying facilities or providers as in-network in 2025, and clearly and conspicuously disclose providers that will be transitioning to out-of-network in 2025, including but not limited to Essentia Health, Avera Health, North Memorial Health, and Sanford Health;
- (2) provide an accurate list of facilities or providers that will be in-network in 2025; and
- (3) inform the patient of the upcoming Medicare Advantage enrollment period during which they may switch coverage to ensure they are enrolled with an in-network provider for 2025
Attorney General Ellison’s Office sent the letter on Friday and requested a response from Humana within 5 days.
Non-Participating Providers and Plans
Below is a list of health care providers who have decided not to participate in particular Medicare Advantage Plans, along with the plan or plans they are not participating in and the areas of Minnesota they serve. Senior LinkAge Line has estimated that more than 60,000 Minnesota Medicare beneficiaries are impacted by these changes.
| Name of provider | Area served by provider | Medicare Advantage Plan |
|---|---|---|
| Allina | Statewide | Humana |
| Avera | Southwest Minnesota | Humana |
| Essentia Health System | Northern Minnesota and Northern Wisconsin | Humana |
| M Health Fairview Health Care System | Statewide | Aetna, Humana |
| Mayo Clinic | May be statewide | HealthPartners |
| North Memorial Medical Center and providers | Primarily Metro area | Humana |
| Sanford Health | Western Minnesota | Humana |
Advice from Senior LinkAge Line on Actions Minnesotans on Medicare Should Take Immediately
- Decide if it’s important to you to continue to see your current health care provider. If it isn’t important to you, you still should review your current plan in the Medicare Plan Finder to ensure your coverage and costs have not changed. If they have changed and you are concerned about this, review other plan options in the Medicare Plan Finder to find the best coverage for you in 2025.
- If you do want to continue to see your current health care provider, you also need to visit the Medicare Plan Finder at https://www.medicare.gov/ to review other plan options and consider enrolling in a new plan.
- Create an account with a username and password.
- Enter in your current prescriptions.
- Enter in the pharmacy you use.
- Decide which plan(s) you want to explore further.
- Go to those plans’ websites and search the provider list to make sure your provider(s) participate with the new plan(s) you are interested in.
- Enroll in the plan you choose by either calling the plan directly or enrolling online on the Medicare Plan Finder tool.
- If you have questions or need more help, you can call 1-800-MEDICARE 24/7, or you can call the Senior LinkAge Line at 800-333-2433.
Please note the Senior LinkAge Line is experiencing very high call volume and wait times may be longer than normal.
Why Is This Happening?
Providers have given a variety of reasons for no longer accepting specific Medicare Advantage Plans, including:
- Reimbursement is too low and does not cover the costs of care.
- Plans frequently deny services and care that providers believe are medically necessary.
- Plans do not pay the providers in a timely manner.
About Senior LinkAge Line
The Senior LinkAge Line is a free, statewide service of the Minnesota Board on Aging in partnership with Minnesota’s area agencies on aging. The Senior LinkAge Line helps older Minnesotans and caregivers find answers and connect to the services and support they need. It is Minnesota’s federally designated State Health Insurance Assistance Program (SHIP), offering unbiased help with Medicare statewide.
