Mainers Brace for Higher Out-of-Pocket Costs as Northern Light Health Ends Medicare Advantage Contract with Humana

Northern Light Health — one of the largest medical service providers in the state — has decided to end its Medicare Advantage contract with Humana as of September 30, 2024, which will likely result in many older Mainers being forced to pay more out-of-pocket.

A press release published by Northern Light Wednesday said that this was “a difficult decision” and came after “considerable time and effort” was spent “try[ing] to resolve numerous ongoing administrative issues.”

Humana Military patients will not be affected by this change, only those who use Humana’s Medicare Advantage plan.

Northern Light went on to explain that while it will continue to service those using this insurance as an out-of-network provider, this will likely result in higher out-of-pocket costs for such patients.

Medicare Advantage plans that will continue to be in-network for Northern Light include: Aetna Medicare Advantage, Anthem Medicare Advantage, Martins Point Generations Advantage, United Healthcare Medicare Advantage, and WellCare Medicare Advantage.

Click Here to Read Northern Light Health’s Full Press Release

In a statement to WABI, Humana said that they “remain open to further good faith discussions with Northern Light Health regarding continued participation in [their] network so that” disruption can be avoided.

“At the same time,” they said, “we must ensure our contracted hospitals and physicians provide both quality and cost-effective care to keep health coverage costs as affordable as possible for our members.”

By the end of 2023, Northern Light reportedly had an operating deficit of $36 million, a promising upturn from the 2022 deficit of $132 million. So far in 2024, however, they appear to have already incurred a $60 million deficit.

An email sent by Gregory LaFrancois — president of Northern Light Eastern Maine Medical Center — and shared with the Bangor Daily News revealed a sense of instability within the organization.

“Government programs have been cut, expansion of Medicare Advantage reduced reimbursement, our costs increased, and many other headwinds have kicked up,” LaFrancois reportedly wrote.

As a result of this, LaFrancois said the hospital was examining how it spends its money in order to continue providing services “at a cost we can afford.”

Northern Light Health has reportedly responded to financial and operational difficulties in a number of ways, including reducing hours for their Bangor walk-in clinic, closing its audiology center, altering the provision of ambulance services in seven Penobscot County towns, and closing its Internal Medical facility in Dexter.

Not long ago, Northern Light also announced the closure of a clinic in Southwest Harbor, as well as a primary care practice in Orono.

According to the Bangor newspaper, Northern Light’s workforce decreased by about 1,500 employees between 2021 and 2023.

Changes in federal funding have also reportedly had an impact on Northern Light’s ability to effectively provide services, as much of the pandemic-era funding has since dried up.

Suzanne Spruce, a spokesperson for Northern Light Health, has previously told the said that 66 percent of the organization’s services are provided to Medicare and Medicaid patients.

Northern Light Health, like most of Maine’s hospital providers, operates as a 501(c)3 nonprofit, an arrangement that allows the system to pay less in taxes than it would if it were a private hospital.

This arrangement was originally reached on the premise that, in exchange for the significant tax benefits, the system would accept Medicare and Medicaid patients even though those patients are not as profitable to care for as privately insured patients.