Queen’s shuns HMSA’s new Medicare HMO plan

Hawaii’s largest insurer is rolling out a new, lower-cost plan for its Medicare Advantage patients, but The Queen’s Health Systems is not participating in it.

The Hawaii Medical Service Association’s new Select Plus HMO plan, for Oahu members only, is part of a revamp of its Akamai Advantage plans to take effect next year.

HMSA began sending notification letters this month to about 16,000 members, informing them their current Akamai Advantage Complete Plus and Standard Plus PPO plans would be closing Dec. 31 and that they would lose prescription coverage unless they choose a new plan.

HMSA is offering new Akamai Advantage PPO (preferred provider organization) plans in 2027 but at higher premiums.

At $45 per month, the HMO (health maintenance organization) option is the least expensive of the plans for Oahu members compared to the new Complete PPO plan at $55 per month and new Complete Plus plan at $240 per month.

But Queen’s, the state’s largest private, nonprofit hospital and only Level 1 trauma center, is not participating in the Select Plus HMO plan, as the state experiences further disruption in its healthcare landscape.

Seniors will need to weigh all their options and decide soon, as open enrollment for Medicare begins Thursday and runs through Dec. 7.

Dr. Whitney Limm, Queen’s chief physician executive, said the decision was due to lack of clarity but did not elaborate further.

“The new Select Plus HMO plan is built on a limited network that HMSA developed,” Limm said in a statement. “Until there is greater clarity about how the network will operate and what it means for Queen’s and our community, we believe this is the right decision. If a patient remains enrolled in or chooses an HMSA Akamai Advantage PPO plan in which Queen’s participates, Queen’s hospitals, clinics, and employed physicians will continue to be in-network.”

HMSA, meanwhile, said its decisions are guided by a long-term commitment to Hawaii and that it would continue to support its members in finding a new plan.

Member outreach

The changes come as millions of U.S. seniors with private Medicare coverage are being e their insurance due to policy cancellations and drastic changes in 2027. National health insurers such as UnitedHealthcare, Humana and Centene are scaling back Medicare Advantage plans and pulling out of certain markets to preserve their profits.

HMSA, an independent licensee of Blue Cross Blue Shield, said it does not plan to end its Medicare Advantage offerings as some other Blue Cross plans have done, but had to revamp them to remain sustainable.

“We needed to make a change in these plans because our commitment is that HMSA is going to stay,” said HMSA CEO Dr. Mark Mugiishi in an earlier interview. “We are going to stay in the state, we’re going to stay in Medicare Advantage, we’re going to stay on all islands.”

HMSA said a follow-up packet of information, including enrollment forms, has been sent to impacted members with easier-to-­understand details on the new plans and rates. The earlier notice, HMSA said, was written as required by the U.S. Centers for Medicare & Medicaid Services, which oversees Medicare.

HMSA representatives are also calling every Akamai Advantage member impacted by the changes.

“We understand that Medicare Advantage members may have questions about HMSA’s Akamai Advantage Select Plus HMO network and how Queen’s decision relates to this new plan option,” said Kimberly Takata Endo, HMSA vice president of Medicare, in a statement. “Queen’s continues to be a participating HMSA provider and are in network for HMSA’s Medicare Advantage PPO and Dual Care plans. This means that members in the broader HMSA Medicare Advantage PPO population can continue seeing Queen’s providers as they do today.”

While Queen’s is not included in the Select Plus HMO network, she said, emergency and urgent care remain covered for all HMSA Medicare Advantage members, including Select Plus enrollees.

The Select Plus HMO network includes more than 60% of the providers in HMSA’s Medicare PPO network.

While it is not expected to be the highest membership plan in the portfolio, Endo said: “Our intent was to offer more choice, and diversify the plan options available.”

The HMO Select Plus directory of providers includes their affiliations with various hospitals, which includes Queen’s, even though it is not included in the Select Plus network. HMSA clarified these are affiliations, and many providers are affiliated with multiple hospitals, including Queen’s.

Queen’s, meanwhile, sent memos Oct. 1 to its providers and staff, along with letters to its patients, informing them it will not be a participating provider in the new Select Plus HMO plan.

In its letter to patients, Queen’s said: “If you enroll in the new HMSA Select Plus HMO plan, Queen’s hospitals and clinics will be out of network, and services provided at Queen’s would be subject to your plan’s out-of-network benefits and requirements.”

If an HMSA Select Plus patient visits Queen’s, the hospital will follow its out-of-network procedure at the time of registration.

Queen’s said it would place posters at patient access points, send information to health insurance brokers and set up a call center to answer questions.

Patient reaction

Marla Malinski, a lung cancer survivor in Hilo, is stressed about losing her Standard Plus PPO plan and having to reenroll. She said she got the initial disenrollment notice, followed by a letter from HMSA “basically saying that prices went way up.”

Malinski, 72, would not be able to enroll in the HMO plan, as it is only available to members on Oahu, and has questions about what Medicare supplemental coverage will cover.

She also got a letter from Queen’s informing her of its decision not participate in it. Malinski had surgery at Queen’s two years ago to remove the lower lobe of one of her lungs and still goes in every six months for follow-up appointments.

“My surgeon is there, and she’s the best,” she said.

Dr. Katie Min, an independent doctor whose office is at Queen’s Physicians Office Building 1 in Honolulu, said she accepts original Medicare, along with many Medicare Advantage plans by Humana, Devoted and UnitedHealthcare, and would accept those opting for HMSA’s new HMO plan.

Her main concern is the ability to make referrals to Queen’s specialists for patients who might not be covered under the new plan.

“A lot of my patients like Queen’s,” she said, “so I have a feeling a lot of my patients won’t do that plan.”

Kathy Ginoza-Arakaki of Honolulu said she wishes HMSA would have been more up-front informing members of the major changes. She helps her 99-year-old aunt and panicked when she saw the letter saying the plan was ending.

“I’m really upset with them,” she said. “I used to work with a lot of elderly and I feel bad they’re going to get this cancel (notice) and not know what to do.”

Details on new plans should have been sent the same day or next day, she said, so people were reassured of not being dropped altogether. She called for more transparency on details, including that Queen’s will not be part of the HMO plan.

Although Queen’s said it was opting out of the plan until there is more clarity, it said in a FAQs section of its memo it has no plans to participate in HMSA Select Plus HMO at a later time.

Queen’s also said the decision was not related to HMSA contract negotiations, referring to the insurer’s plans to vertically integrate with Hawai‘i Pacific Health. Queen’s CEO Jason Chang has been a vocal opponent of the merger, saying it would reduce competition, raise costs and narrow access to care.

Additionally, Queen’s emphasized it does not sell or recommend insurance plans and encouraged patients to carefully review their plans to make a fully informed decision.

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