Ephraim McDowell warns of network change

DANVILLE, Ky. — Patients with Humana Medicare Advantage plans could face changes in their health care coverage at Ephraim McDowell Health beginning next year if the health system and insurer are unable to reach a new agreement.

Ephraim McDowell Health announced that its hospitals, clinics, and providers could become out of network for Humana Medicare Advantage plans effective Feb. 1, 2027. The potential change is the result of ongoing negotiations over reimbursement between the health system and Humana.

The change would apply specifically to Humana Medicare Advantage plans and would not affect every Humana insurance product.

For patients enrolled in an affected plan, going out of network could result in higher costs or changes in where they receive covered nonemergency care. The impact would depend on the patient's individual plan.

Ephraim McDowell Health serves more than 150,000 residents across seven central Kentucky counties. Its hospitals include Ephraim McDowell Regional Medical Center in Danville, Fort Logan Hospital in Stanford, and James B. Haggin Hospital in Harrodsburg.

Ephraim McDowell Regional Medical Center is a nonprofit hospital licensed for 197 beds.

The warning comes during Medicare's annual open-enrollment period, which runs from Oct. 15 through Dec. 7. During that period, beneficiaries can change Medicare Advantage or prescription drug plans or switch between Medicare Advantage and Original Medicare. Changes generally take effect Jan. 1.

Medicare Advantage plans are offered by Medicare-approved private insurers. Network requirements vary, with some plans generally requiring patients to use in-network providers and others allowing out-of-network care at a higher cost. Medicare advises patients to check with their insurer to determine how their individual coverage would be affected.

Patients already receiving treatment when a network change occurs may qualify for temporary continuity-of-care protections. Ephraim McDowell Health advises those patients to ask Humana whether they are eligible because coverage depends on their plan and circumstances.

The health system also urges patients to speak with their provider and insurer before canceling or delaying care. Emergency treatment should not be postponed because of network concerns.

"We will continue working toward an agreement and will provide updates if the situation changes," the health system said in its notice.

Medicare beneficiaries are encouraged to review their plan documents for changes in costs, benefits, and provider networks for the coming year. Those considering a switch to Original Medicare may also need to make separate decisions about prescription drug and supplemental coverage.

Free, personalized counseling is available through State Health Insurance Assistance Programs, which operate independently of insurance companies and health plans.

Patients can contact Ephraim McDowell Health's financial services team at 859-239-3499 for additional information.

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