WNH Not Participating in Medicare Advantage in 2024

Dec 06, 2023

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William Newton Hospital (WNH) would like to ensure patients are aware of a change to our participation in Medicare Advantage plans:

In 2024, WNH will not be a contracting (in-network) provider for any Medicare Advantage plans.

Access to Care at WNH

All Medicare Advantage enrollees, regardless of plan, will have 24/7/365 access to emergency care. Medicare Advantage enrollees can also still receive care at WNH for other healthcare services. WNH does accept Medicare Advantage; however, enrollees may have higher out-of-pocket expenses due to WNH not being in-network. (see exception below)

Patients who continue with their Medicare Advantage plans will likely experience a change to coinsurance, copays, and deductibles. WNH will work with Medicare Advantage enrollees to take the proper steps to assess coverage for healthcare services.

Why this Change?

We understand this change may create a burden, but we believe it is the right move for our patients and our hospital and clinics. Seniors are being bombarded by multimillion-dollar marketing campaigns with promises of seamless coverage and several additional benefits to entice them to select a Medicare Advantage plan. In reality, many of our patients have encountered numerous issues when dealing with Medicare Advantage plans including excessive prior authorization and medical necessity denials, and a limited network of providers.

WNH also receives inadequate reimbursement rates for the patient services provided and unnecessarily slow payment from insurers. Our hospital must ensure financial and operational sustainability to continue providing essential healthcare services for our entire community. Continuing to sustain financial losses from Medicare Advantage plans puts our hospital in jeopardy.

Choosing a Plan

We understand patients must choose the plan that best fits their circumstances, and urge everyone to carefully evaluate options during open enrollment. Patients can go back to Original Medicare once they’ve enrolled in a Medicare Advantage plan; however, they may pay more for or lose Medigap Supplemental coverage. If patients elect a Medicare Advantage plan for a year and then return to Original Medicare, the Medigap plan can consider pre-existing conditions in setting rates or denying coverage.

For patients choosing to switch, the Medicare Advantage enrollment period is January 1 through March 31. During this period, enrollees are allowed to:

1. Switch to another Medicare Advantage plan, or
2. Drop it and go back to Original Medicare, and join a Medicare drug plan (also known as Medigap).

For assistance, schedule a FREE session with a certified Senior Health Insurance Counseling for Kansas (SHICK) health counselor at your local Council on Aging. The counselor will evaluate individual health needs and medical budget. SHICK can be reached at 1-800-860-5260.

Our hospital website also has helpful resources including step-by-step guides to evaluating your Medicare options.

Unfortunately, as a healthcare provider, we cannot advise patients on their decision. We do encourage patients to make sure the individual healthcare providers they know and trust are in the network being considered. NOTE: All WNH facilities, providers, and clinics accept Original Medicare. To confirm if a plan is in-network, please contact us.

Exception: Rural health clinics and specialty clinics within the WNH network do not accept Medicare Advantage HMO plans. These patients will be considered Private Pay.