The decision places these patients in a situation where they could become out-of-network at their local hospitals with the options they are now being presented with.
BCBS announced in October that they were withdrawing from the Medicare Advantage Plan Market in 30 of Montana’s rural counties where the insurer was the only company selling that product that also had a contract with a local provider, according to Greg Drapes, Monida HealthCare Network executive director.
This created an opening in the Medicare Advantage Plan market that another insurance company is now trying to fill.
Humana, an insurance company that is currently in other counties and markets in Montana is now trying to secure a contract with several of these rural hospitals left without a Medicare Advantage payer through Monida HealthCare Network, a non-profit contract negotiating group.
In some of the counties where they are selling their Medicare Advantage plan products, they do not yet have a contract with the local provider, and that leaves patients out of network at their local hospital.
Drapes says that group includes eight rural hospitals statewide -- Broadwater Health Center in Townsend, Granite County Medical Center in Philipsburg, Deer Lodge Medical Center in Deer Lodge, Ruby Valley Hospital in Sheridan, Mineral Community Hospital in Superior, and Clark Fork Valley Hospital in Plains.
The patients using those hospitals now have no other alternative Medicare Advantage plan to purchase that is in-network with their local hospital.
Barrett Hospital and Healthcare in Dillon is also a part of the group but is currently contracted with Humana to provide the advantage plan coverage in-network. A hospital in Ronan is also in their group, but BCBS did not withdraw from the Medicare Advantage plan market in Lake County.
Mineral Community Hospital CEO Ron Gleason told MTN News that in order to keep Advantage plan patients in-network and covered by Jan. 1, Humana and this group had only three months to negotiate a contract after BCBS announced their withdrawal.
“It is kind of difficult when somebody pulls out of county like this with this kind of notice. It is difficult to get those contracts in place. It leaves people kind of scrambling for coverage,” he said.
Going out-of-network at the only local hospital means patients would end up driving long distances for their healthcare. Polson and Missoula are the closest in-network Humana Medicare Advantage plan options for people in Mineral and Sanders counties if a contract is not secured.
Gleason said that when they are unable to keep their patients in-network, it threatens the health of the hospital as well.
“Possible loss of patients, possible uninsured patients, when they do come in...it could have a financial impact on our facility if those patients are going elsewhere, and this hospital is very much needed in this community,” he said.
Patients do have options, according to Gleason. They could switch back onto regular Medicare and purchase supplements and additional parts which are for sale by multiple companies in every Montana county.
Supplement products are generally considered to have better coverage but come with a higher premium, versus Advantage plan products that have higher out of pocket costs but are cheaper monthly. However, this varies for each patient depending on the plan they are on.
The alternative leaves patients switching their insurance coverage back onto regular Medicare to stay in network locally and purchasing supplements and the additional parts.
There are options, but patients are left weighing long distance travel, premium and out-of-pocket costs.