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St. Charles Health System dropping three Medicare Advantage plans; four remain in place for 2024


(Update; Adding estimates of people with the plans)

Chief medical officer says they are 'unwilling to continue with the status quo' plans that have issues

Citing "continued, unresolved concerns about patient care and administrative burdens," St. Charles Health System announced Thursday it will no longer be an in-network provider for Medicare Advantage plans from Humana, HealthNet and WellCare, starting in 2024, but will still be a provider for four others.

"Seniors and others on Medicare plans will continue to have options for insurance coverage at St. Charles, as the health system continues to accept traditional Medicare and some Medicare Advantage plans," the announcement said

“We care deeply about our patients and the care they receive, which is why we are unwilling to continue with the status quo with Medicare Advantage plans that result in restrictions to patient care, longer hospital stays and administrative burdens for providers,” said Dr. Mark Hallett, chief clinical officer. “We are grateful that some insurance partners were willing to come to the table and try out innovative solutions to these complex problems.”

St. Charles said it "joins many other hospitals and health systems around the country that are reevaluating their participation in Medicare Advantage plans, which are publicly funded, but privately run" and provided a link to this article, published Monday in Becker's Hospital CFO Report (“Hospitals are dropping Medicare Advantage left and right”).

“The conversation about Medicare Advantage continues at St. Charles and at health systems around the nation,” said Matt Swafford, chief financial officer. “We hope the innovative solutions we are piloting with PacificSource that we announced last week will serve as a model for future discussions.”

When Medicare open enrollment begins Oct. 15, local seniors will have options, should they want to remain in-network for St. Charles. In addition to traditional Medicare and PacificSource, St. Charles will start the year accepting the following Medicare Advantage plans: Providence, Moda and Regence Blue Cross Blue Shield.

The health system said the decision affects about 6,000 patients on the three plans being dropped -- 5,000 with Humana and 1,000 total with WellCare or HealthNet.

They said PacificSource has an estimated 15,000 Central Oregonians in its Medicare Advantage plan, while about 1,400 are with Providence, 1,200 with Regence BCBS and 800 with Moda.

Individuals on Medicare Advantage plans from Humana, HealthNet and WellCare should receive a communication from their insurance provider about the changes to their health plan offerings and in-network provider availability.

Key dates:

  • Oct. 15, 2023: Medicare open enrollment begins
  • Dec. 7, 2023: Medicare open enrollment ends
  • Dec. 31, 2023: Humana coverage ends
  • Feb. 1, 2024: HealthNet and WellCare coverage ends

Central Oregonians who wish to explore insurance options can contact:

  • Oregon Senior Health Insurance Benefits Assistance (SHIBA) at 800-722-4134, option 2,
  • 800-MEDICARE (800-633-4227),
  • Council on Aging of Central Oregon at 541-678-5483,
  • or an insurance broker of your choosing.

Additional information can be found on the St. Charles Medicare Advantage FAQ webpage, or individuals can call 541-612-8378.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, nonprofit Oregon corporation and is the largest employer in Central Oregon with more than 4,800 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

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