St. Vincent Health, the hospital district in Leadville, Colorado, says it will be out of network for Humana Medicare Advantage plans starting Jan. 1, 2027. Patients on those plans can still be seen at the hospital after that date, but as an out-of-network provider, which can change what a visit costs. Chief Executive Officer Bubba Bartlett signed a notice that points to administrative requirements, coverage approvals, denials, delays and reimbursement practices. The announcement arrives just as Medicare’s yearly enrollment season opens, which means Humana members who use the hospital can still choose a different plan for 2027.
What St. Vincent Health told patients
In its notice to patients, the hospital said it has “experienced ongoing challenges with the Humana Medicare Advantage plan that have created barriers to patient care.” Bartlett’s letter goes on to say that “administrative requirements, coverage approvals, denials, delays, and reimbursement practices all require resources and can affect how efficiently healthcare can be delivered.” The wording describes a dispute over paperwork and payment, not a change in what the hospital offers, and the letter closes by thanking patients for trusting the hospital’s team with their care.
The change is narrow. It applies only to people whose coverage is a Humana Medicare Advantage plan, the private plans that Medicare lets insurers sell in place of the traditional government program. It does not reach other Medicare beneficiaries or people with commercial insurance. The hospital also spelled out that emergencies are not part of the dispute: “Insurance questions should not prevent someone from seeking emergency medical attention,” and anyone in a medical emergency is told to call 911 or come to the emergency department, which is open around the clock.
The people with the most to weigh are Humana Medicare Advantage members who rely on St. Vincent Health for more than emergencies. The hospital lists inpatient care, imaging, laboratory work, rehabilitation and visiting specialist clinics, and each of those becomes an out-of-network service on Jan. 1. Members have until Dec. 7, 2026, to change plans for coverage that starts at the beginning of the year, so the real decision is whether to keep Humana and accept the new network status or move to a plan that still includes the hospital.
Deciding between those two paths means checking each 2027 plan against the same doctors, services and drugs. The 2027 Medicare Open Enrollment Decision Kit, a paid guide from RetireShield, includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors and a provider call script for asking a plan whether St. Vincent Health is in its network.
Get the plan cost calculator and call script for checking St. Vincent Health →
What out-of-network means on a Medicare Advantage plan
How much the change costs depends on the kind of Humana plan a member holds, and the hospital’s notice does not say which kinds are affected. Medicare’s guide to Medicare Advantage plans explains that under an HMO plan, members generally must get care from the plan’s network of doctors and hospitals, with exceptions for emergency care, urgent care away from home and temporary dialysis away from home. Some HMO plans add a point-of-service option that covers out-of-network care for a higher copayment or coinsurance.
Under a PPO plan the rules are looser. Medicare says members can generally go to out-of-network providers for covered services, but they will usually pay more. For a Humana member in Leadville, that means one Jan. 1 date can produce a different result depending on the plan: a stricter plan may decline to pay for routine care at the hospital, and a looser one may pay but at a higher cost. The notice recommends comparing network participation, specialist coverage, deductibles and prescription drug benefits when choosing a replacement.
Plans are required to announce changes of this kind in advance. Medicare’s booklet says costs and rules can change each year and that a plan must send its Annual Notice of Change before Open Enrollment for the next year begins. A Humana member who has not looked at that mailing can compare it with the hospital’s announcement, since the plan’s own paperwork is where cost and rule changes for 2027 are supposed to appear.
Two windows for changing plans
The main window is the one the hospital points to. Medicare says that between Oct. 15 and Dec. 7 each year, anyone with Medicare can join, switch or drop a Medicare Advantage plan, and coverage begins Jan. 1 of the following year as long as the plan gets the request by Dec. 7. The hospital’s own notice names the same Oct. 15 to Dec. 7, 2026 period.
A second window opens after the cutoff. Medicare’s plan enrollment page says that from Jan. 1 to March 31, people already in a Medicare Advantage plan can switch to a different Medicare Advantage plan or go back to Original Medicare. That period begins on the same day St. Vincent Health leaves Humana’s network, so a member who stays put and then learns the hospital is out can still change course, though only after the hospital is already out of network.
Checking a 2027 plan against St. Vincent Health
Medicare’s free Plan Finder is the official place to compare 2027 plans by county, drugs and doctors. Medicare also says plan questions can be answered at 1-800-MEDICARE, which is 1-800-633-4227, and that members should confirm their doctors are in a plan’s network before enrolling. For any plan that appears to include the hospital, the plan itself is the final word on whether St. Vincent Health is in network, so a call to the plan with the hospital’s name ready settles it in writing before the Dec. 7 deadline.
Free one-on-one help is also available locally. The notice lists the State Health Insurance Assistance Program, known as SHIP, at 719-471-2096 for information or to schedule an appointment and at 1-888-696-7213 to reach a counselor toll-free. SHIP counselors give unbiased Medicare guidance, and the national SHIP site has a tool to find a local program. For questions about expected costs at the hospital itself, the notice lists the St. Vincent Health Patient Financial Counselor at 719-486-0230, ext. 205.
Dec. 7 is the date that decides how Leadville’s Humana members enter 2027. A plan change requested by then starts Jan. 1, the same day the hospital’s network status changes, while a switch made in the January to March window comes after the hospital has already left the network. The hospital has said emergency care stays open to everyone. What it has not said is how many patients hold Humana plans, so the size of the change in Lake County is still unreported.
For members weighing a move away from Humana, The 2027 Medicare Open Enrollment Decision Kit adds a prescription-by-plan comparison to check each candidate plan against a drug list, along with the Open Enrollment calendar of dates for switching. It is paid, optional help alongside Medicare’s free tools.
This article was produced with AI assistance and reviewed by The Money Overview’s editorial team.
