Gifford CEO Michael Costa authored this Q&A about Medicare and how it interacts with Gifford services.
Why is Gifford talking about Medicare Advantage?
Community members, especially seniors, have asked us to explain how Medicare Advantage plans affect their care at Gifford. Our goal is to provide clear information so you can make the best choice for yourself and your family.
Does Gifford accept Humana Medicare Advantage?
No. Gifford does not have a contract with Humana Medicare Advantage. If you have Humana Medicare Advantage, you may face higher out-of-pocket costs or be considered “out of network” for many Gifford services.
If I have Humana Advantage, can I still get care at Gifford?
Yes, but coverage and cost may differ. Services may be considered “out of network,” meaning you could pay more out-of-pocket. We encourage you to call your plan’s member services to understand how your specific plan covers your care.
Why doesn’t Gifford have a contract with Humana?
Unfortunately, Humana pays less than traditional Medicare, and they have not taken any steps to create a relationship with Gifford that would work for both parties. Overall, accepting payment rates that do not adequately cover the cost of care, or at least pay comparably to traditional Medicare, would harm Gifford over the long term.
What about other Medicare Advantage plans?
At this time, Gifford believes that Humana is the only Medicare Advantage plan still offered in Orange County.
What’s the difference between Medicare Advantage and traditional Medicare?
Traditional (or “Original”) Medicare is run by the federal government. You can see any doctor or hospital in the U.S. that accepts Medicare. It typically covers 80% of approved medical costs, and patients are responsible for the remaining 20%. Many people choose to purchase a Medigap (supplemental) plan to help cover that portion, along with other out-of-pocket expenses.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans often include prescription drug coverage and may offer extra benefits like dental or vision. However, they usually have provider networks, prior authorization requirements, and cost-sharing structures (such as deductibles, copays, and coinsurance) that vary by plan.
If I want to switch back to traditional Medicare, how do I do that?
You can change your coverage during the Medicare Open Enrollment Period (October 15 –December 7) each year. Switching from Medicare Advantage to traditional Medicare with a Medigap plan can be confusing, so we recommend contacting a local, certified counselor for free help (see below).
Who can help me understand my options?
• Vermont State Health Insurance Assistance Program (SHIP): 802-479-0531
• Gifford Patient Financial Assistance Services Health Connections Office: 802-728-2323
These programs can help you review your current plan, compare options, and understand costs and coverage before you make changes.
Will Gifford continue to care for me?
Absolutely. Regardless of insurance type, Gifford is committed to caring for every patient with compassion and respect. We will continue to advocate for fair reimbursement and for policies that sustain local access to care for our region.
Where can I learn more?
Visit https://giffordhealthcare.org/patients/financial-assistance/ or call 802-728-2323
Michael Costa is the CEO of Gifford Health Care. He lives in Norwich.
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