2025 Medicare Advantage Updates and Open Enrollment
It's Time to Review Your Medicare Advantage Plan
Medicare Open Enrollment for 2025 coverage runs from October 15 to December 7, 2024. During this period, individuals eligible for Medicare can review and make changes to their Medicare Advantage and Prescription Drug Plans. It's an important time for you to evaluate your healthcare needs and choose coverage options that work for you. Any changes made during open enrollment will take effect on January 1, 2025.
Medicare Advantage Plans In-Network with Southwest General
Southwest General participates in the following Medicare Advantage plans. Under these plans, visits to your Southwest General Medical Group provider or care received at a Southwest General facility will be considered “in network” services:
Preferred Providers:
Southwest General is proud to work with CIGNA as our Preferred Medicare Advantage Partner. This plan works with us to offer our mutual patients excellent benefit coverage, ease in scheduling and prior authorization, fast approval for skilled nursing and other post-acute care needs and coordinated care with your Southwest General provider.
Southwest General is also Contracted with the Following Medicare Advantage Providers:
- Aetna Medicare Advantage
- Anthem Medicare Advantage
- Caresource Medicare Advantage
- Devoted Health Medicare Advantage
- Medical Mutual Medicare Advantage
- SummaCare Medicare Advantage
- United Healthcare Medicare Advantage (including AARP Medicare Advantage)
Medicare Advantage Update for Humana Patients
What is Changing?
Effective January 1, 2025, Southwest General will no longer be part of the Humana Medicare Advantage network. This change may impact your healthcare coverage, and we are committed to guiding you through the transition. We know that your relationship with your doctor is important to you, and it's important to us, too. We're here to help you navigate your options and ensure you can keep seeing your providers at Southwest General.
Why is This Change Taking Place?
Recently, Southwest General reviewed all of its Medicare Advantage relationships to ensure each contract accurately reflects the rising costs and increased administrative burden of healthcare delivery. Unfortunately, we have determined we can no longer remain in contract with Humana Medicare Advantage. As a result, starting January 1, 2025, Humana Medicare Advantage patients will be considered "out-of-network," which may lead to higher co-pays and co-insurance costs for your services at Southwest General.
Next Steps for Humana Patients
The good news is that Medicare Open Enrollment is approaching. This is a period in which Medicare-eligible patients can make sure they are covered by an in-network Medicare plan. Humana patients have options to continue receiving in-network care at Southwest General:
- Enroll in Traditional Medicare, which will continue to cover Southwest General services.
-
Switch to a Medicare Advantage Plan that remains in-network with Southwest General.
To find in-network plans that fit your needs, see the list above or visit our Insurance Plans Accepted page.
Frequently Asked Questions
Q: What is happening with Humana Medicare Advantage at Southwest General Health Center?
A: As of January 1, 2025, Southwest General Health Center will no longer be in-network with Humana Medicare Advantage plans. This means that Humana Medicare Advantage members will have out-of-network benefits when receiving care at Southwest General, which may lead to higher co-pays and/ or co-insurance.
Q: How does this affect my relationship with my Southwest General doctors?
A: Your health is our top priority. You can still keep your Southwest General doctors. However, starting January 1, 2025, if you have a Humana Medicare Advantage plan, your care at Southwest General will be considered out-of-network. This could result in higher out-of-pocket costs, but you have options to switch to a plan that offers in-network coverage at Southwest General. To find in-network plans that fit your needs, see the list above or visit our Insurance Plans Accepted page.
Q: What options do I have to avoid paying out-of-network costs?
A: During the Medicare Open Enrollment period (October 15 - December 7), you have the option to:
- Switch to traditional Medicare, which will continue to cover Southwest General services.
- Enroll in a Medicare Advantage plan that remains in-network with Southwest General.
We're here to help you navigate your options and make the best decision for your healthcare needs. Call us at 440-816-5142 or email us at InsuranceQuestions@swgeneral.com for assistance with understanding alternative plans.
Q: What is Medicare Open Enrollment?
A: Medicare Open Enrollment is the annual period when individuals can make changes to their Medicare coverage. During this time, you can switch from Humana Medicare Advantage to traditional Medicare or choose a different Medicare Advantage plan that remains in-network with Southwest General. Again, this year, Open Enrollment runs from October 15 to December 7, 2024. Changes made during this period will take effect on January 1, 2025.
Q: I have Humana Medicare Advantage through my retiree/pension plan, and I cannot make a change. What options do I have? (Note: If you are an OPERS retiree, please see the next question below.)
A: We understand that those who have Humana Medicare through their employer or retiree plan cannot change plans. However, for most of the area’s large retiree plans, your out-of-network benefits are often the same as in-network, and, therefore, you would not be affected.
We are happy to report that the following unions/retiree plans have the same benefits for both in- and out-of-network and you will have no change in your patient out-of-pocket amounts:
- Pipe Fitters Local #120
- IBEW Local 1377
- OCPCM Cement Masons
- Ohio Operating Engineers
- Ohio Carpenters
- Sheet Metal Workers Local 33
If your employer/union is not listed above, you will need to check with your plan’s administrator or email us your plan specifics at InsuranceQuestions@swgneral.com and we can help you research it.
Q: I am an OPERS (Ohio Public Employee Retirement System) retiree (or OPERS spouse) and I have Humana Medicare Advantage. What options do I have and how do I make a change if I want?
A: With OPERS, you have the option of selecting from many Medicare Advantage Plans. OPERS partners with Via Benefits and they serve as the OPERS Connector for Medicare-eligible OPERS benefit recipients. When you select an individual plan through Via Benefits, you can use Via Benefits' ongoing support for HRA administration, carrier claim resolution and medical plan questions. All OPERS benefit recipients are welcome to use the OPERS Connector to find a medical plan, even if they don’t qualify for the HRA. Dependents also can enroll in a plan with the help of Via Benefits. Contact Via Benefits for more assistance at 844-287-9945 or visit my.viabenefits.com/opers
Q: What happens if l choose to stay with my Humana Medicare Advantage plan?
A: If you choose to stay with Humana Medicare Advantage, you can still access care at Southwest General, but it will be on an out-of-network basis. This means that your co-pays and co-insurance amounts may be higher than what you paid when Southwest General was in-network. You will need to check your Humana coverage to determine how it will affect you.
Q: I need more help understanding my options and I would like someone to help me choose a plan that's right for me. Can you recommend an insurance broker to help me?
A: Many area insurance brokers are licensed and able to help you make the best decision for you. In the past, some of our patients have used the following brokers and we are confident they can help you:
Larry Riddell Insurance
490 Cleveland St.
Elyria, OH 44035
440-309-8498
https://riddellinsurance.com/contact/
KAZ Company
4807 Rockside Rd. (Suite 660)
Independence, OH 44131
216-901-9300
https://medicareplansneo.com/
Q: When does the change take effect?
A: The change will take effect on January 1, 2025. Until then, your care at Southwest General will continue to be covered at in-network rates under your Humana Medicare Advantage plan.
Q: What should I do if I'm concerned about my costs increasing?
A: If you're concerned about potential increases in co-pays or co-insurance, you can:
- Contact Humana's Customer Service using the phone number on the back of your insurance card.
- Reach out to Southwest General at 440-816-5142 or email us at InsuranceQuestions@swgeneral.com and we can help guide you through your options during Medicare Open Enrollment.
Q: Can Southwest General help me choose a new plan?
A: Yes! We're here to support you. If you'd like assistance in understanding your Medicare options or switching to a plan that remains in-network, please contact us at 440-816-5142 or email us at InsuranceQuestions@swgeneral.com. Our team can help you find an option that keeps your Southwest General doctors and minimizes your out-of-pocket costs.
Q: How can I stay informed about any future changes?
A: We'll make sure you're informed of any important changes regarding your healthcare coverage, and we encourage you to contact us directly at 440-816-5142 or email us at InsuranceQuestions@swgeneral.com with any questions.
Q. I have traditional Medicare and then a Supplemental Plan with Humana. Is that still accepted?
A. Yes. Southwest General and the SGMG Medical Group will still accept any Medicare Supplemental plan (also sometimes called Select or GAP plans), including Humana plans, as supplement to your traditional Medicare coverage. The change only affects the Humana Part C Medicare Advantage products, and not the Medicare Select/Supplement products.
Southwest General Health Center and your healthcare provider want to continue providing you with the best care possible, and we're here to help you navigate this transition. Please reach out to us if you have any questions or concerns.
Still have questions? We're here to help. Call us at 440-816-5142 or email InsuranceQuestions@swgeneral.com.