By BEVERLY NEAL-CLINTON
The Retirement Answer Team
Editor’s note: Beverly Neal-Clinton is sharing this information in her role with The Retirement Answer Team and not as a Los Alamos County Councilor.
Los Alamos County is announcing its 2025 health benefit annual enrollment period, set for Oct. 15 to Dec. 7. This year’s enrollment is accompanied by major industry changes, including Humana’s withdrawal from the Los Alamos area, and multiple lawsuits against Humana, UnitedHealthcare, and Aetna involving federal investigations, “steering” practices, Medicare Advantage ratings, and denial of care.
- Humana’s Lawsuits and Market Exit
- Humana Exiting Los Alamos:
Humana has announced it will no longer offer Medicare Advantage and group employer health plans in Los Alamos County for 2025, affecting both county employees and retirees enrolled in their plans. The decision comes amid strategic shifts and increased regulatory burdens (Humana Investor Newsroom; Modern Healthcare). - Medicare Advantage Star Ratings Lawsuit:
Humana has sued the Centers for Medicare & Medicaid Services (CMS), claiming its Medicare Advantage plan star ratings were unfairly downgraded, jeopardizing billions in federal bonus payments (Reuters, 2024). The courts deemed the lawsuit was premature and the case was sent back for appeal within CMS’s guidelines. - Federal “Broker Steering” Lawsuit:
The Department of Justice alleges that Humana (alongside Aetna and Elevance Health) paid hundreds of millions in illegal kickbacks to insurance brokers (eHealth, GoHealth, SelectQuote) from 2016–2021 to steer Medicare beneficiaries into their plans, even when they were not in the consumer’s best interest—particularly prioritizing healthier, lower-cost enrollees (Bloomberg Law; DOJ Press Release, May 2024).
- UnitedHealthcare: Lawsuits and Federal Scrutiny
- United has been forthcoming and cooperating with providing the requested information to the relevant agencies.
- Aetna: DOJ Action and Other Lawsuits
- DOJ Medicare Broker Kickback Lawsuit:
Aetna, like Humana, is named in the DOJ’s federal suit regarding alleged illegal steering of Medicare Advantage participants through broker kickbacks (Bloomberg Law). - Billing Fraud Litigation:
Aetna has filed a lawsuit against Radiology Partners over allegations of coordinated fraudulent billing and overpayments (Modern Healthcare, 2024). - Class Actions and Settlements:
The insurer has agreed to settle class actions, including $3.4 million to cancer patients for denial of proton beam therapy (Courthouse News Service) and $4.8 million over administrative fee disputes (org).
What Should You Do?
- Humana Participants: Must select new coverage for 2025.
- UnitedHealthcare and Aetna Participants: Remain available but are under legal and regulatory scrutiny. Stay informed and consider your options carefully.
- Annual Enrollment: Oct. 15 to Dec. 7, 2025
- Informational Sessions: Oct. 3 (10:00 a.m. to 12:30 p.m.) & Oct. 10 (1-3 p.m.), Los Alamos Public Library.
We are available to explain plan options, market developments, and next steps.
For more information, contact Beverly Neal-Clinton @ 505.412.0995 or beverly@retirement.agency.
About The Retirement Answer Team
Loreen and Lane, the Retirement Answer Team, is a local New Mexico business that provides personalized retirement planning services for individuals and businesses, specializing in Medicare, tax-free retirement strategies, and group health insurance. They focus on empowering clients to make informed decisions about healthcare, life insurance, and financial security by offering tailored consultations and guidance through the complexities of Medicare and related benefits