Cigna Medicare Advantage members in Delaware are eligible for a special enrollment period after a contract split between the insurer and Dover-based Bayhealth.
On Jan. 1, Bayhealth went out of network with Humana and Cigna Medicare Advantage plans, the system's CFO confirmed to Becker's.
"This decision was not made lightly but is a necessary step to ensure the financial sustainability of our health system and our ability to continue providing high-quality care to the communities we serve," Michael Tretina, Bayhealth's senior vice president and CFO, said.
Because the "termination significantly changes the Cigna provider network," the Delaware Department of Insurance and its Medicare Assistance Bureau said Jan. 9 that Cigna members are eligible for a special election period to choose a new plan beginning the month they are notified and ending two months after the month notices are received.
"Individuals who use this special election period to elect original Medicare will have Medigap Guaranteed Issue rights – they cannot be denied enrollment regardless of health status," the state wrote.
"Cigna Healthcare is committed to keeping health care affordable for our Medicare customers in Delaware," a company spokesperson told Becker's. "We have negotiated in good faith with Bayhealth, but unfortunately Bayhealth is choosing to leave our network. We will continue to offer access to quality care for our customers in the region and will work closely with them on care transition plans where needed."
Bayhealth's full statement:
As of January 1, 2025, Bayhealth will no longer participate in the networks of Humana Medicare Advantage and Cigna Healthspring plans. This decision was not made lightly but is a necessary step to ensure the financial sustainability of our health system and our ability to continue providing high-quality care to the communities we serve.
Over the past several years, Bayhealth, like many health systems nationwide, has experienced a significant increase in patients transitioning from traditional Medicare to Medicare Advantage plans. While Bayhealth has led the Delaware market in payment rates with these plans, we have faced overwhelming challenges related to denied claims, downgraded reimbursement codes, and audits. Despite extensive efforts to renegotiate terms and address these issues collaboratively with Medicare Advantage plans, net payments remain far below those of traditional Medicare.
These practices hinder our ability to provide the level of care our patients deserve, as they result in significant financial strain and administrative burdens. After thorough evaluation, we made the difficult decision to terminate these contracts. We continue to participate in Medicare Advantage plans with other providers, including WellCare, Highmark, Aetna, AmeriHealth Caritas VIP Care, and United Healthcare, while closely monitoring their performance.
To assist affected patients, Bayhealth sent letters to Humana and Cigna Healthspring members who have received care at Bayhealth since 2022. These letters provided detailed information about the decision and guidance for selecting alternative plans during the 2025 open enrollment period. We remain committed to helping patients navigate this transition and ensuring access to care through other participating plans.
Bayhealth understands the challenges this decision may pose for some members of our community. We encourage patients with questions or concerns to contact our billing office or Medicare Assistance Bureau for support.