Humana, UnitedHealthcare post inaccurate network lists for Medicare Advantage plans

UnitedHealthcare says in online materials that Regions Hospital in St. Paul is in-network for the health insurer’s Medicare Advantage health plans in 2025.

Similarly, on the other side of the Mississippi River, North Memorial’s large medical center in Robbinsdale is listed as in-network for Medicare Advantage plans from Humana.

Yet the nonprofits that run these hospitals insist their facilities will not be in-network next year with those health plans. They’ve even asked Humana and UnitedHealthcare to change the online listings.

Since Medicare open enrollment started more than two weeks ago, the Minnesota Star Tribune has found numerous examples where online materials from these health insurers list hospitals and clinics as “in-network” for 2025 even though they’re operated by five health systems that have announced they’ll be going out-of-network next year.

“It’s definitely misleading to the consumer, and I think it’s going to create a problem for consumers, who typically are going to look at a plan’s website for their provider directory,” said Jack Hoadley, a health policy researcher at Georgetown University.

After checking the listings, seniors might unknowingly pick a health plan that will have them pay higher out-of-network rates next year to keep seeing their doctors, or effectively block them from scheduling appointments — unless the insurers and health care providers agree to network contracts in coming months.

“Unfortunately, these listings are not providing accurate information based on the withdrawal of the providers from the plans,” Kelli Jo Greiner of the Minnesota Board on Aging said in a statement. “We have notified [the federal government] that the provider results do not appear to be accurate.”

The Star Tribune sent Kentucky-based Humana and Minnetonka-based UnitedHealthcare screenshots showing examples of online network searches.

UnitedHealthcare, the nation’s largest Medicare Advantage insurer, insisted it’s in compliance with all rules from the federal Centers for Medicare and Medicaid Services. The company said it is negotiating in good faith with Bloomington-based HealthPartners, which runs Regions Hospital, as well as Duluth-based Essentia Health, which also has said it will go out-of-network next year.

“We continue to meet with both health systems and are actively exchanging proposals,” UnitedHealthcare said in a statement. “Our top priority is to reach an agreement that ensures continued, uninterrupted network access to these providers.”

Humana, another large Medicare Advantage insurer, said Wednesday that it is updating its online directory showing which health care providers will be in-network for 2025.

Jeannie Fuglesten Biniek, a health policy researcher with California-based KFF, said Humana and UnitedHealthcare listings may not run afoul of any rules because what’s shown on websites likely draws from a source document that contains caveats about how the information is accurate only as of a certain date.

”Regardless, I can understand why people would interpret it as being in-network for next year because they’re searching for 2025 plans,” Fuglesten Biniek said. “It definitely seems like a problem.”

For North Memorial and four other health systems that have decided to go out-of-network for Humana Medicare Advantage members, the changes will take effect Jan. 1. Humana says that’s also the beginning of a second sign-up period — officially called Medicare Advantage Open Enrollment — that gives seniors the chance to change plans up until March 31.

Currently, seniors are shopping for Medicare health and drug plans during the more widely publicized Medicare Annual Enrollment Period that runs Oct. 15 through Dec. 7.

The health insurers’ answers are not satisfying for seniors, said Joshua Haberman, owner of Alexander & Haberman, an insurance agency based in Bloomington.

In the case of Humana, it shouldn’t be hard for the health insurer to quickly update its online search tool for provider networks, Haberman said. For UnitedHealthcare, he said, its website should just be honest about the current uncertainty.

“It should say: ‘We do not have a contract, and we are working hard to get one,’” Haberman said. “The consumer deserves that. If you want to deliver a win later — and tell us, ‘Oh, they’re in-network’ — then do that. … But I’m doing my search now. What is the true answer now?”

Officials at HealthPartners said in a statement that they notified UnitedHealthcare “of the inaccuracy as it is confusing for consumers. We asked them to change and update it to reflect that HealthPartners is not in-network for 2025.”

North Memorial said the online information published by Humana is not accurate. “We identified this issue in early October and asked Humana to update the online provider directories,” the health system said.

Medicare is a government health insurance program for seniors and younger people with disabilities that covers hospitalization and doctor visits, but not all costs. To handle these gaps, many seniors buy a Medicare Supplement from a private insurer to expand the coverage, plus a separate policy from an insurer for prescription drugs.

Over the past 20 years, however, more beneficiaries are opting instead for Medicare Advantage health plans from private insurers, which the federal government has hired to provide for members’ care. These plans typically bundle together coverage for hospital, physician and pharmacy care at a lower monthly premium with annual limits on out-of-pocket costs.

A key tradeoff is that Medicare Advantage plans generally have fewer providers in their networks — and networks can change from year to year.

HealthPartners and Essentia Health announced this year that they’ll be going out-of-network in 2025 with UnitedHealthcare Medicare Advantage plans. For Humana Medicare Advantage plans, Essentia also plans to go out-of-network next year, along with Avera Health, North Memorial Health and Sanford Health.

The announcements have created a dilemma for seniors deciding whether to stick with their health plans or their doctors. It’s one reason, Greiner said, that call volumes are up and length of time per call has increased substantially at the state’s Senior LinkAge Line, which fields questions about Medicare health insurance options.

Part of the problem is that seniors are being asked to buy health plans at a time when insurers are still negotiating contracts with certain health care providers, said Eric Ellsworth, the director of health data strategy at Checkbook Health. At the Senior LinkAge Line, counselors advise seniors who want to stick with these providers to make health plan changes now, since they can later switch back to Humana and UnitedHealthcare if their health system ultimately renews its network agreement for next year.

For now, however, “it’s like shopping for the new model year of cars, but nobody knows exactly what they’re going to make next year,” Ellsworth said.

“We need to have the regulators bring accountability to the insurers and the health systems, so that they are making these negotiations outside of the time of open enrollment,” he said. Change is needed “so that consumers have a stable and clear choice.”

Open enrollment runs Oct. 15 through Dec. 7. The Medicare Plan Finder tool is available online at Medicare.gov. The federal government assists consumers over the phone at 800-MEDICARE (800-633-4227). Health insurance agents can help individual seniors, as well. Minnesota seniors can get help exploring options by calling the state’s Senior LinkAge Line at 800-333-2433.