Ohio State’s Wexner Medical Center, The James Cancer Center and its affiliated physicians will remain in-network for Humana’s group Medicare Advantage and Medicaid plans through 2027, Humana confirmed this month, correcting reports that suggested the health system was leaving the insurer’s network altogether. The carve-out is narrower than it sounds: individual Medicare Advantage members, the plans people buy on their own rather than through a former employer, lose in-network access to the Columbus health system starting October 1. The split leaves thousands of central Ohio retirees sorting out which version of Humana coverage they actually hold before the deadline arrives.
The Difference Between Group and Individual Medicare Advantage at Ohio State
In a notice updated September 4, Humana said it reached an agreement with Ohio State that “preserves in-network access for Humana Medicaid and Group Medicare members in 2026 and 2027.” Group Medicare Advantage plans are the ones an employer or union sponsors for its retirees, distinct from the individual policies a person buys directly from an insurer during Medicare’s enrollment windows. That distinction is the entire story here: the same insurer and the same hospital system land on opposite sides of the network line on the same date, depending only on which type of plan a member holds. Humana’s own statement lays out the split in a frequently-asked-questions format aimed at members trying to figure out which category they fall into.
For individual Medicare Advantage members, the language is unambiguous: Wexner Medical Center, The James and Ohio State-affiliated physicians “will be considered out-of-network” starting October 1. Group Medicare Advantage and Humana Healthy Horizons Medicaid members keep the access they have now, with no action required on their part. A retiree covered through a former employer’s Humana retiree plan and a retiree who bought an individual Humana Medicare Advantage policy on the open market can therefore end up with completely different answers to the same question about whether their hospital still takes their insurance.
The financial stakes of that distinction are real. Under Medicare Advantage rules, cost-sharing for care received outside a plan’s network is generally higher than for in-network care, and some plan types do not cover routine out-of-network care at all outside of a true emergency, according to KFF’s annual review of Medicare Advantage plan terms. A Humana individual Medicare Advantage member who keeps seeing an Ohio State cardiologist or oncologist after October 1 without qualifying for a continuity-of-care exception could face a meaningfully higher bill for the same treatment a Group Medicare Advantage member receives at the standard in-network rate.
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Why Humana and Ohio State Split the Difference Instead of a Clean Deal
Ohio State’s original Medicare Advantage relationship with Humana dates to a 2020 network agreement that gave Humana members access to Wexner Medical Center’s outpatient locations and thousands of OSU-affiliated physicians. According to Becker’s Hospital Review’s running tally of health systems narrowing Medicare Advantage ties in 2026, Humana notified Ohio State that it was terminating that broader contract, while the health system said it remained interested in reaching new terms. Humana has said it “remains dedicated to maintaining a robust, high-quality provider network” and is open to further conversations, language that leaves the door open to a renewed deal even as the October 1 date for individual members holds.
The partial resolution reflects a pattern playing out at hospital systems across the country, where insurers and providers increasingly negotiate coverage by plan type rather than accepting an all-or-nothing outcome. Group Medicare Advantage contracts, negotiated directly with employers and unions that represent large blocks of retirees, often carry different reimbursement terms than the individual plans Humana sells on the open market, giving each side more room to preserve part of a relationship while letting another part lapse.
What Individual Medicare Advantage Members Can Do Before October 1
Humana said individual Medicare members losing access to Ohio State facilities are eligible for continuity-of-care support, including personalized help identifying an in-network replacement provider. Members with certain ongoing medical conditions, such as an active course of cancer treatment at The James, may qualify to keep seeing their current doctor at the in-network benefit level for a defined transition period rather than facing an abrupt switch. That protection is not automatic; it depends on the specific condition and treatment plan, which means members need to contact Humana directly rather than assume the exception applies to them.
Emergency care is unaffected regardless of network status. Humana said members experiencing a medical emergency should go to the nearest hospital, and those services will be covered at the in-network benefit level whether or not that hospital participates in Humana’s network. Members with billing questions or looking to confirm which category of coverage they hold can call the number on the back of their Humana member ID card.
The Ohio State situation is a reminder that a Medicare Advantage plan’s network can shrink even when a member has taken no action and received no plan change notice for the coming year, because the change originates in a contract dispute between the insurer and a hospital system rather than in the plan’s own benefit design. With Becker’s tracker now listing 29 health systems that have narrowed or ended Medicare Advantage ties in 2026, Ohio State is one entry in a list that keeps growing rather than an isolated case.
Whether the October 1 date holds as written depends on whether Humana and Ohio State reach the broader agreement both sides say they are still discussing, and neither party has offered a timeline for when, or whether, that conversation might restore individual-member access to the network it is set to leave.
This article was drafted with AI assistance and edited for accuracy.
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