St. Luke's decision could affect Baker County residents who have Medicare Advantage plans

The more than 650 Baker County residents who are covered by a Humana Medicare Advantage health insurance plan might have to pay more than in the past for care at St. Luke’s hospitals and clinics in Idaho, including St. Luke’s Clinic-Eastern Oregon Medical Associates in Baker City.

Starting Jan. 1, 2026, St. Luke’s will no longer be an in-network provider for Humana, the only company that sells Medicare Advantage plans in Baker County, said Christine Myron, a St. Luke’s spokesperson in Boise.

Although patients covered by Humana can still get treatment through St. Luke’s, their out-of-pocket costs could be higher when St. Luke’s is no longer part of Humana’s network.

“Humana members may continue to seek care at St. Luke’s but should consider contacting Humana to understand their out-of-pocket costs,” Myron said.

Meanwhile Saint Alphonsus, which owns Baker County’s only hospital, has returned Humana to its network. Trinity Health, the Michigan company that owns Saint Alphonsus, dropped Humana from its network on Jan. 1, 2025.

As of Friday morning, Nov. 7, Myron hadn’t responded to a question about what led St. Luke’s to drop Humana from its network.

Humana send this statement to the Baker City Herald on Friday, Nov. 7: “St. Luke’s Health System will be out-of-network for Humana Medicare Advantage members beginning Jan. 1, 2026. Affected members are being notified of the change. We are providing clear guidance and personalized assistance to help members continue receiving the care they need. If members have questions or need assistance, they can call Humana’s toll-free customer support line found on the back of their insurance cards. Humana remains deeply committed to supporting our members’ health and well-being by ensuring they have access to high-quality, affordable care. Our partnerships with healthcare providers play a vital role in delivering that care. We worked in good faith to reach an agreement, however we were unable to find a path forward with St. Luke’s that balanced affordability, care quality, and long-term sustainability for our members.”

Humana also is in the network for Treasure Valley Hospital in Boise, according to Humana’s statement.

Medicare Advantage plans are sold by private insurance companies as an alternative to standard Medicare, the federal health insurance programs for older and disabled Americans. Some Medicare Advantage plans have more benefits than traditional Medicare, such as dental and vision coverage, as well as lower co-pays.

About 200,000 Oregonians have Medicare Advantage plans. According to the U.S. Centers for Medicare & Medicaid Services, 679 Baker County residents were enrolled in such plans as of September 2025.

The St. Luke’s decision to remove Humana from its network is part of a national trend as well as a continuation of a local issue.

Over the past year, more than 30 hospital systems have removed Medicare Advantage plans from their networks, according to Becker’s Hospital Review.

Among the reasons often cited, according to Becker’s, are “excessive prior authorization denial rates and slow payments from insurers.”

With Humana having returned to Saint Alphonsus’ network, Baker County residents with Humana Medicare Advantage plans have regained one local option two months before they lose another when St. Luke’s removes Humana from its network.

A statement on Saint Alphonsus’ website posted Thursday, Nov. 6: “We are pleased to share that Saint Alphonsus and Humana have reached a new multi-year agreement that will reinstate your in-network access to the Saint Alphonsus hospitals, facilities, and health care providers you trust. You may once again schedule appointments and seek care at Saint Alphonsus without any disruption.”

Richland resident leaving Medicare Advantage

St. Luke’s announcement regarding Humana came at a difficult time for April Abreu.

The 53-year-old moved from Arizona to Richland about six weeks ago. Abreu, who has had a Humana Medicare Advantage plan for the past four years, said she has suffered from autoimmune issues for years and was recently diagnosed with a cancerous tumor on her pituitary gland.

Abreu said she planned to continue with the Humana Medicare Advantage plan, signing up during the open enrollment period that runs from Oct. 15-Dec. 7.

But Abreu, who said she has qualified for Medicare since she was disabled in 2012, said she received a letter on Oct. 24 from Humana, alerting her to St. Luke’s decision to remove the company from its network starting in 2026.

Abreu said all of her medical appointments are with St Luke’s facilities, including in Baker City, Meridian and Fruitland, Idaho.

The situation has prompted her to switch to traditional Medicare.

“I will have better coverage,” Abreu said on Thursday, Nov. 6.

Despite its name, Medicare Advantage is “not an advantage at all,” she said.

“It’s a horrible thing to find out when you’re hurting,” Abreu said.

She said she was fortunate that a Medicare official she talked with on the phone helped “walk her through” the process of switching to traditional Medicare.

More information is available at Medicare.gov and at the Oregon Senior Health Insurance Benefits Assistance website — shiba.oregon.gov/Pages/index.aspx.

© 2025 the Baker City Herald (Baker City, Ore.). Visit www.bakercityherald.com. Distributed by Tribune Content Agency, LLC.