KIMBALL -- Kimball Health Services announced that effective January 1, 2025, the hospital and its clinics in Kimball and Pine Bluffs will no longer participate in any Medicare Advantage plans. 

KHS based their decision on their commitment to providing safe and timely care to their patients. 

“We have observed that patients with Medicare Advantage plans often experience delays, longer hospital stays and denials of care due to pre-authorization requirements,” said KHS CEO/CFO Cassie Gasseling. 

KHS is one of many hospitals in Nebraska and nationally who are choosing to no longer participate with Medicare Advantage plans. According to the Nebraska Hospital Association, in October 2023, 90% of Nebraska hospitals reported that Medicare Advantage plans negatively impacted the care their hospitals can provide to patients. Additionally, over 92% reported that prior authorization requirements by Medicare Advantage plans delay necessary care. 

“We don’t want to see out patients get into a Medicare Advantage plan and not get the care they deserve from us,” Gasseling said. 

Traditional Medicare and Medicare Advantage plans are not the same, Gasseling said. Both are funded by the federal government, but Medicare Advantage plans are operated by private insurance companies, meaning that their coverages and premiums are different than traditional Medicare are. 

Revenue Cycle Manager Jessica Miller said the crucial difference between the two is the pre-authorization for procedures and the out-of-pocket costs. 

Traditional Medicare only requires prior authorization on certain procedures, but Medicare Advantage plans require it for almost every procedure. 

“It can delay care for up to 30 days, so if you need a procedure right away, we can’t do it until we get authorization from insurance.” 

The Medicare Advantage plans also have a much higher out-of-pocket cost. Based on the local advantage plan, your out-of-pocket cost is 50% of your total cost; however, with traditional Medicare, your out-of-pocket cost is 20%. You can also apply for a supplement plan with Traditional Medicare, which normally picks up the other 20%. 

Due to the change, KHS will be considered out-of-network for patients with a Medicare Advantage plan. Patients who choose to remain covered by a Medicare Advantage plan after December 31, 2024, will still be able to receive care from Kimball Health Services but will be subject to their plan’s out-of-network guidelines. 

KHS Director of Public Relations Kerri Ferguson said: “I think it’s going to continue to help us provide the very best care possible to our patients. When you take into account the delay often counted in there, we're just going to be able to do a better job.” 

Patients are encouraged to contact their insurance provider to discuss the best options and to consider switching to Traditional Medicare during the open enrollment period from October 15 to December 7 each year. Additional resources available to patients include: 

- H.E. Ferguson Agency, Inc. – Scottsbluff, Nebraska – 308-632-6915 

- Nebraska State Health Insurance Assistance Program (SHIP) – 800-234-7119 

- Carin Long, Local SHIP Representative – 308-765-5546

- Medicare – 1-800-MEDICARE

More information including a list of FAQs and additional resources can be found at https://kimballhealth.org/patient-resources.