INTEGRIS may not honor Humana Advantage after this year

While INTEGRIS is still attempting to negotiate with Humana Advantage, it appears they may not come to an agreement before the end of the year. If it is not resolved, the INTEGRIS health providers (physicians and advanced practice providers) will no longer honor Humana's Medicare Advantage starting Jan. 1, 2025, throughout their system.

INTEGRIS Health hospitals will follow suit by March 1, 2025. The INTEGRIS Pharmacy in Grove does not honor Humana currently.

This only applies to Humana Medicare Advantage and does not apply to regular Humana or SoonerSelect Medicaid. Open Enrollment for Medicare eligible patients is ongoing, but it is only open until Dec. 7.

A growing number of hospitals and health systems nationwide are pushing back and dropping the Medicare Advantage private plans altogether.

Among the most cited reasons are: The company requiring excessive prior authorization, denial rates, and slow payments from insurers.

In Oklahoma, the Stillwater Medical Center ended all in-network contracts with Medicare Advantage plans in January 2023, amid financial challenges at the 117-bed hospital. Humana and Blue Cross and Blue Shield of Oklahoma were notified their Medicare Advantage members would no longer receive in-network coverage at that time. The hospital said it made the decision after facing rising operating costs and a 22% prior authorization denial rate for Medicare Advantage plans, compared to a 1% denial rate for traditional Medicare.

Original Medicare includes Medicare Part A (hospital insurance) and Part B (medical insurance). After paying a deductible, Medicare pays its share of the Medicare approved amount, and a person or coinsurance pays the remainder.

Medicare drug coverage (Part D) coverage is for medicine.

Medicare Advantage (also known as "Part C") is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health coverage. These "bundled" plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that original Medicare doesn't.

In many cases patients can only use doctors who are in a plan's network and need to get approval from the plan before it covers certain drugs or services. Plans often have different out-of-pocket costs than original Medicare or supplemental coverage like Medigap.

When a patient joins a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the private company offering your Medicare Advantage Plan. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how a patient gets services.

There are different types of Medicare Advantage Plans: Health Maintenance Organization (HMO) Plan; HMO Point-of-Service (HMOPOS) Plan; Preferred Provider Organization (PPO) Plan; Private Fee-for-Service (PFFS) Plan; Special Needs Plan (SNPs; and Medical Savings Account (MSA) Plan.

The Humana Advantage Plan is a PPO Plan.

Humana is the country's second largest Medicare Advantage insurer and is aggressively culling its plan offerings after several quarters of spending more than expected on its members' medical care.

The company announced in September it will stop offering Medicare Advantage plans in 2025 that currently cover about 560,000 members, which is about 10% of their members.