Humana is cutting Medicare benefits for hundreds of thousands in GA. Here's who will be affected

The federal government's decision on how much to pay insurers is at the center of Humana's move to cut Medicare Advantage benefits in 2027. The Centers for Medicare & Medicaid Services (CMS), now led by Dr. Mehmet Oz, finalized a 2.48% payment increase for Medicare Advantage plans next year.

Humana is the second-largest Medicare Advantage insurer in the country and says this payment increase falls short of covering rising medical costs. As a result, the insurer has announced large-scale cutbacks and Georgia will be among the states hit the hardest.

Because the state has one of the highest Medicare Advantage enrollment rates in the country, a large share of Georgia seniors could feel this directly. Why now?

Humana had been a holdout on benefit reductions compared to other major insurers, but CEO Jim Rechtin told Wall Street analysts the company would streamline its offerings to close the gap between expenses and federal payments.

The move follows a federal decision to raise 2027 payments to Medicare Advantage insurers by an average of 2.48%. According to insurance executives, this number doesn't come close to covering the rising costs. What is Humana cutting?

Specific plan changes won't be finalized until June, but based on its investor-facing comments and industry reporting the categories at risk are well established. Core benefit reduction or cuts: * Gym or fitness memberships * Enhanced dental and vision coverage (beyond basic exams) * Meal-delivery or grocery-allowance benefits * Lyft-type or ride-sharing transportation credits * Some non-emergency medical-transport benefits * OTC benefit cards Fewer plan options and "streamlined" formularies: * Cutbacks on the number of distinct Medicare Advantage plan designs available * Forcing some onto simpler, less-rich benefit structures. * Some specialty-drug or high-cost benefit designs may be eliminated * May be merged into narrower formularies with higher member cost-sharing. What is not going away * Hospitalization * Physician visits * Essential Part A/B services How many Georgians will be affected?

According to the Georgetown University Center on Health Insurance Reforms, Georgia's Medicare Advantage (MA) enrollment is substantial and heavily concentrated in the private plan market.

Georgia's percentage of patients in MA plans is above the national percentage 50.1%, and it is the third-highest state with Humana MA memberships, making it especially sensitive to any cuts. Residents affected: * More than 760,000 in Medicare Advantage plans * 55.3% of Medicare-eligible are in MA plans, * Humana covers ~336,617 MA enrollees * One-third of MA enrollees could be directly affected in one form or another. What can patients do now?

Experts warn that even those not on Humana may be affected if other insurers follow with similar cuts or if some companies exit markets. This could force members to switch plans and lose benefits or networks

Open enrollment doesn't start until October, but there are steps to take before then. * Review your current plan's Summary of Benefits to get a baseline of coverage * Watch for your Annual Notice of Change (ANOC) which has to be mailed by Sept. 30 * Go to the Georgia State Health Insurance Assistance Program (SHIP) website * Use Medicare.gov's Plan Finder during open enrollment * File a complaint at the Georgia's Office of the Commissioner of Insurance and Safety Fire if you believe a plan change violates your coverage terms

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