photo by: LMH Health

LMH Health, 325 Maine St., is pictured in May 2021.

About 4,000 area residents still are facing an insurance conundrum as LMH Health ends its participation in a pair of Medicare Advantage programs in January, but hospital officials expressed optimism that residents are better understanding their options.

The LMH Health Board of Trustees on Wednesday received an update on how plans are progressing to end their relationships with the Aetna Medicare Advantage and Humana Medicare Advantage programs at the beginning of 2025.

“Every citizen in our service area that was Medicare eligible received a letter from us,” Rob Chestnut, chief financial officer for LMH Health, told the board.

And about 800 people already have directly reached out to a hospital staff person who has been assigned to help residents one-on-one to help understand what the insurance change likely would mean for them.

The pending change has left several thousand area residents who have coverage under the two insurance plans wondering how they’ll pay for health care costs in 2025. LMH Health operates the only hospital in Lawrence, and owns many of the physician practices in the community too. That means people with Aetna or Humana Medicare Advantage plans would either need to change doctors and hospitals or would be faced with paying higher out-of-network costs for their health care in 2025.

But trustees on Wednesday were told that every patient’s situation is unique, which is why LMH Health is urging residents to directly call LMH insurance specialist Mary Goodlett at 785-505-5788. Since LMH has insurance information on all of its patients, Goodlett can look at specific details about a patient’s current insurance plan. Goodlett also has information about what the Aetna and Humana plans will cover for patients who are out-of-network. While LMH can’t make a recommendation about what path you should take, Goodlett can provide specific information about how your health insurance would change come Jan. 1.

For many people, paying out-of-network fees will be significantly more expensive than their current coverage. However, that is not the case for everyone. Chestnut said LMH is finding that many people who have one of the Medicare Advantage plans through a company retirement plan are still fairly well covered even though they are out of network. In other words, the out-of-pocket costs between in-network and out-of-network is not too great, in some instances. Chestnut said that seems to be most often true for the retirement plans of large, national companies who have employees spread across the country.

For people who are facing a big increase, LMH can provide them a list of other Medicare Advantage plans that are offered by other insurance companies that will continue to be accepted by LMH Health in 2025. LMH also can provide people information on how to apply for traditional Medicare insurance through the federal government. People who have traditional Medicare insurance don’t need to have a Medicare Advantage plan.

Time is of the essence, though. Generally, people need to enroll in traditional Medicare by Dec. 7, although some extensions in enrollment are possible but could result in people being temporarily uncovered.

In addition to the assistance LMH Health is providing, the Senior Resource Center of Douglas County also has trained insurance specialists who are offering free assistance. Trustees were told that service also is being heavily used. Chestnut said senior service officials had told him about 800 of the 1,000 available appointment slots had been filled. People can find out information about that program at yoursrc.org

LMH Health has set up a special website that people can find general information about the pending change at lmh.org/medicare-advantage

At Wednesday’s meeting, LMH President and CEO Russ Johnson told the board that the hospital did not take lightly the decision to drop the Aetna and Humana Medicare Advantage plans.

He said the amount of money the two insurance plans would reimburse LMH Health for services provided was a factor, but was not the only one. He said the plans were denying coverage for services at a much higher rate than other insurance companies that LMH Health works with, and he said the amount of pre-approvals required for services was impacting how doctors could treat some patients.

One positive to come out of the LMH decision — and other similar decisions made by other hospitals in the region — is that state legislators and the governor have started to take notice of some of the issues with the Medicare Advantage plans. Currently, the plans are lightly regulated. Johnson and others thinks state governments will get more serious about regulating the Medicare Advantage plans in the future, which could address some of the issues LMH Health has experienced.

“This pressure is being applied all over the country,” Johnson said. “Our legislature is picking up on it. I think these kind of things will result in the Medicare Advantage programs moving in a healthier direction.”