Humana Medicare Advantage Plans Fact Sheet and FAQs

• After engaging with Humana in careful discussion and deliberations regarding access and administrative barriers, Hendrick Health hospitals in Abilene and Brownwood will no longer be participating as in-network hospitals for Humana Medicare Advantage plans, effective Jan. 1, 2025.

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

• Although Hendrick Health hospitals will be out-of-network with Humana Medicare Advantage plans on Jan. 1, 2025, all patients with Humana Medicare Advantage coverage can still use their plan at all Hendrick Health hospitals and facilities.

• No one will be turned away or not provided care when Humana Medicare Advantage becomes an out-of-network plan with Hendrick Health hospitals, Jan. 1, 2025.

• All Medicare Advantage plans are required to provide a range of medical facilities and specialties to members within a reasonable distance from their community. When they are unable to do that, the Medicare Advantage plan must pay for services performed at a Medicare beneficiary’s chosen hospital, even if that hospital is not in-network.

• Patients enrolled in Humana Medicare Advantage plans are encouraged to consider potential cost differences during the 2025 Medicare Open Enrollment period, Oct. 15 – Dec. 7, 2024. For more information about coverage options, visit medicare.gov.

• Humana members still may choose to receive care at Hendrick Health facilities, and those member visits will result in traditional Medicare benefits and payments.

FAQs

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

A: No. CMS requires Humana to pay out-of-network providers at regular 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.

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

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

Q: Do Hendrick 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 hospitals going out of network with Humana?

A: Hendrick will not bill any Humana member for more than their in-network cost share.