Moffitt Cancer Center Excluded from Humana and Aetna's Medicare Advantage Plans

Effective July 1, Moffitt Cancer Center will no longer be part of the network for Humana's Medicare Advantage PPO and HMO plans, as announced by the Tampa-based facility. This follows Moffitt's exclusion from Aetna's Medicare Advantage PPO and HMO plans on December 1, showcasing a trend among insurers and healthcare providers to renegotiate terms amid changing regulatory compliance requirements and cost management pressures.

Moffitt's Network Departure: Implications for Providers and Insurers

Moffitt attributes these terminations to "business reasons that are unrelated to the quality of care provided," suggesting challenges in reaching contract renewal agreements. This reflects a broader industry trend where insurers, acting as payers, prioritize underwriting and claims strategies to mitigate escalating healthcare costs. Such negotiations are increasingly influenced by the complex landscape of regulatory and compliance considerations.

As the only National Cancer Institute-designated comprehensive cancer center in the Tampa Bay area, Moffitt boasts a substantial research portfolio and access to advanced clinical trials. These attributes typically justify higher reimbursements compared to community hospitals, a factor that often complicates risk management during contract discussions with carriers like Humana and Aetna.

Impacts on Medicare Advantage Enrollees and Coverage Options

Humana and Aetna have not publicly addressed the termination of these agreements. However, Humana Medicare Advantage members may face increased out-of-pocket expenses, potential AI-driven prior authorization delays, or limitations on coverage for certain treatments, contingent on individual plan benefits. Additionally, Humana may extend continuity-of-care options for patients in active treatment phases until late December, decided case-by-case.

Despite these network changes, Moffitt remains in-network for a variety of other Medicare Advantage plans in Florida. Some plans offer out-of-network benefits, allowing patient access to Moffitt's services, albeit with additional costs. The center continues collaboration with several insurers providing Medicare Advantage PPO plans, ensuring diverse coverage options remain accessible.

During the Medicare Advantage Open Enrollment Period, which concludes on March 31, enrollees can switch plans effective April 1. Information is available on Medicare.gov or by calling 1-800-MEDICARE (633-4227). Moffitt stays recognized by Aetna as an “Institute of Excellence,” underscoring its commitment to delivering exceptional care. For more details, visit the insurance page on Moffitt's website.