The Maine delegation asked the federal agency that oversees Medicare and Medicaid coverage on Friday to create a special enrollment period for thousands of Humana Medicare Advantage beneficiaries who may pay more for care after a recent decision by Northern Light Health.
The plea from U.S. Sens. Susan Collins, a Republican, and Angus King, an independent, and U.S. Reps. Chellie Pingree and Jared Golden, both Democrats, was spurred by Northern Light ending its Medicare Advantage network contract with Humana due to a series of “administrative issues,” the health care provider said in August.
The change, effective Sept. 30, meant that as many as 4,000 Northern Light patients covered by Humana could pay higher out-of-pocket costs for the same health care services. Lawmakers worry Mainers may drive long distances to seek in-network treatment or forego care altogether to avoid paying more care.
Brewer-based Northern Light Health has 10 hospitals and more than 120 locations in seven of Maine’s 16 counties. Though the health care provider has scaled back services over the last several months to recover the financial losses the pandemic inflicted, the agency’s facilities provide care to some of the state’s most rural communities.
The delegation wrote that Humana shared recommendations for alternative in-network care with Northern Light patients, but many of the suggested facilities are inconvenient for people or may not have the capacity to accept new patients.
“For example, of the seventeen facilities to which our constituents are being directed, only two are a mile or less away from the current Northern Light Health facility,” the letter reads. “The vast majority of suggested alternative in-network facilities are at least 20 miles away, with some as far as 50 miles and one nearly 100 miles away.”
Furthermore, if patients in rural areas need emergency care, driving 20 or more miles to reach an in-network provider may not be an option.
While all beneficiaries can make changes to their coverage between Oct. 15 and Dec. 7, those new plans wouldn’t take effect until Jan. 1, 2025.
Instead, lawmakers wrote a letter to the Centers for Medicare and Medicaid Services requesting a special enrollment period, beginning on Oct. 15, so Humana Medicare Advantage patients can switch to a new coverage plan sooner.
Those new plans could become effective as early as Nov. 1 rather than Jan. 1, giving thousands of Mainers an additional 60 days of coverage.
In a statement Friday, Northern Light Health said it worked with the delegation and supports the request. The health care provider also thanked the lawmakers for their effort and remains committed to providing “continuity of care to our patients while they consider their options,” said Lisa Harvey-McPherson, Northern Light Health’s vice president of government relations.
