Everett, WA. Starting January 1, certain UnitedHealthcare Medicare Advantage plans will no longer be considered in-network at Providence facilities across Washington and Oregon.
The adjustment applies to Medicare Advantage Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, including both individual and Group Retiree plans. Non-hospital services, such as those offered through PacMed clinics, will also shift out of network. In Snohomish County, Providence Regional Medical Center Everett and Swedish Edmonds are among the facilities affected.
Earlier reporting indicated negotiations were ongoing for Group Retiree plans, but as of this week, those plans have been confirmed to be included in the change. A UnitedHealthcare representative initially suggested those discussions were still in progress, while Providence confirmed the plans would transition to out-of-network status effective the first of the year.
Dual Eligible Special Needs Plans (D-SNPs), designed for individuals enrolled in both Medicare and Medicaid, remain under negotiation. Should no agreement be reached, D-SNPs will also move out of network on Jan. 1.
The update does not extend to commercial plans sponsored by employers or those enrolled in traditional Medicare. Members impacted by the change have already received notifications via mail or email outlining the adjustments.
UnitedHealthcare cited rising medical spending, increased service utilization, and tightening federal program funding as central reasons behind the decision. “As health care costs continue to rise, we must make decisions that help maintain the long-term viability of benefits and access,” the insurer noted on its website.
To support continuity of care, patients with active treatment for serious or complex conditions, including those undergoing cancer therapy or organ transplant follow-up, may continue receiving services at in-network rates through a continuity-of-care provision.
Emergency department visits remain fully covered at in-network rates for all Medicare Advantage members, and UnitedHealthcare advises patients to seek care at the nearest hospital during emergencies, regardless of network status.
“Our top priority is providing the people we serve continued access to the care they need,” a UnitedHealthcare spokesperson said. “That is why we are notifying our members of this change in advance of the Medicare Annual Enrollment Period so they can make an informed decision regarding their health care needs.”
The Medicare Annual Enrollment Period runs from Oct. 15 to Dec. 7, giving members time to evaluate options before the January transition.
Providence is advising UnitedHealthcare Medicare Advantage members who wish to maintain care within its system to consult with their insurance advisor or American Senior Resources. Additional resources are available at swedish.org/lp/medicare and providence.org/lp/wamt-medicare.
Members seeking in-network hospital locations can use the contact information on their plan ID card or visit their plan’s online portal.