Why hospitals are terminating Medicare Advantage contracts

Several hospitals across the country have decided to end their contracts with Medicare Advantage (MA) insurers, citing various reasons such as payment disputes, slow claims processing, and financial challenges. The move will affect thousands of MA members who will lose in-network access to these hospitals and their affiliated providers.

Some recent contract terminations:

• Southeast Georgia Health System will terminate its contract with Centene’s WellCare MA plan on Dec. 8, after years of “inappropriate payment claims and unreasonable denials.”
• Adena Regional Medical Center will terminate its contract with Anthem BCBS MA and managed Medicaid plans in Ohio, effective Nov. 2, due to unproductive rate negotiations.
• Samaritan Health Services ended its commercial and MA contracts with UnitedHealthcare. The five-hospital, nonprofit health system blamed slow “processing of requests and claims” for the decision. UnitedHealth’s members will be out of network with Samaritan’s hospitals on Jan. 9 and with Samaritan’s physicians and provider services on Nov. 1, 2024.
• Cameron Regional Medical Center stopped accepting Cigna’s MA plans in 2023 and plans to drop Aetna and Humana in 2024. The hospital cited delayed reimbursements as the reason. It will continue MA contracts with UnitedHealthcare and BCBS.
• Stillwater Medical Centerended all in-network contracts with MA plans amid financial challenges at the 117-bed hospital. Humana and BCBS of Oklahoma were notified that their MA members would lose in-network coverage after  Jan. 1, 2023. The hospital said it faced rising operating costs and a high prior authorization denial rate for MA plans.
• Brookings Health System will no longer be in network with any MA plans in 2024, the Brookings Register reported. The 49-bed, municipally owned hospital said the decision was made to protect its financial sustainability.
• Baptist Health Medical Group went out of network with Humana’s MA and commercial plans on Sept. 22, Fox affiliate WDRB reported.

The contract terminations will have implications for physicians and patients who are enrolled in or work with MA plans. Physicians may face lower reimbursement rates, higher administrative burdens, and reduced patient volume. Patients may face higher out-of-pocket costs, reduced access to care, and disruption in continuity of care. They may also have to switch to other MA plans or traditional Medicare to retain in-network benefits.