Humana Medicare Advantage Plans Fact Sheet and FAQs

• After careful evaluation and discussion with Humana, Hendrick Medical Center and Hendrick Medical Center South in Abilene, and Hendrick Medical Center Brownwood, are out-of-network with Humana Medicare Advantage plans (Humana MA), effective 1/1/2025.

• Hendrick Clinic and Hendrick Anesthesia Network will remain in-network for Humana Medicare Advantage plans.

• Even though Hendrick Health hospitals are out-of-network with Humana MA plans, Humana’s MA plan members still have the option to choose Hendrick for services.

• No one will be turned away or not provided care because Humana Medicare Advantage is an out-of-network plan with Hendrick Health hospitals.

• All Medicare Advantage plans are required to provide coverage for a range of medical facilities and specialties to members within a reasonable distance and travel time from their homes. When those facilities and/or specialties aren’t available in the community, Medicare rules direct plans to allow services to be performed at a Medicare beneficiary’s closer local hospital, even if that hospital isn’t in-network. Hendrick will work with Humana MA plans to ensure services are available to Humana MA plan members according to these Medicare requirements.

• Humana MA plan members still may choose to receive services from Hendrick Health facilities as an out-of-network provider, and Humana is expected to approve and pay those member’s claims to Hendrick at 100% of original Medicare benefit levels.

FAQs

Q: Will I have to travel somewhere else to access hospital services?

A: No. For Humana MA members who reside in the Hendrick market area, Medicare rules expect Humana to pay out-of-network providers at original Medicare rates as part of its efforts to ensure that MA enrollees don’t have to travel two or three hours from Abilene or Brownwood for care.

Q: If my physician is in-network with Humana, do I need to receive prior authorization for procedures?

A: Yes. Hendrick Health hospitals’ out-of-network status will not eliminate a physician’s routine duty to secure prior authorization.

Q: Do Hendrick Health hospitals have to get prior authorization from Humana to perform services after 12/31/2024?

A: Hendrick will defer to following original Medicare protocols for Humana members (which require preauthorization for a limited set of services).

Q: How will I be affected by Hendrick Health hospitals out-of-network status with Humana MA plans?

A: Hendrick will not hold Humana member MA plan members who reside in the Hendrick Health market area responsible for more than the amounts they would have to pay under original Medicare.