UPDATE: Anthem and Mercy have come to an agreement and seniors on an Anthem Medicare Advantage plan WILL remain in-network.
Tens of thousands of seniors in Ohio just received some bad news over the last few weeks that could potentially cost them thousands in out-of-pocket costs—furthering tough times as inflation rages on and cripples seniors living on a fixed income.
Are you one of the 33,000 Ohio seniors affected by this change?
Keep reading to find out if you’re in danger of losing your doctors, and learn what you can do to potentially save thousands of dollars in out-of-pocket costs and even unlock better benefits to boot!
What’s happening?
Last month, Mercy Health announced that its hospitals and physicians in Ohio will soon be out-of-network for patients with Anthem Blue Cross Blue Shield Medicare Advantage plans. After months of unsuccessful negotiations with Anthem’s parent company, Elevance Health, Mercy will stop accepting Anthem Medicare Advantage plans on October 1.
Mercy Health, one of the 20 largest health systems in the U.S. and the fifth largest Catholic health system in the country, alleges that Anthem still owes $100 million for services previously rendered. Mercy also claims that Anthem isn’t paying the costs required to keep providing services due to a sudden increase in the cost of labor, drugs, and supplies—which was exacerbated by the pandemic. This is evident in Mercy’s loss of 1.2 billion dollars for the year 2022.
Who’s affected?
This sudden drop of coverage means that the 33,000 Ohio seniors with an Anthem Medicare Advantage plan won’t be able to keep their Mercy Health providers. Those who have both Medicaid and an Anthem Medicare Advantage DSNP plan are also affected by this change.
If you want to keep your doctors and hospitals in the Mercy Health network, you’ll have to change Medicare plans.
What’s the solution?
Most seniors would be correct in assuming that they can only change their Medicare Advantage plan during the Annual Enrollment Period (AEP), which spans October 15 to December 7 this year. However, CMS allows seniors to change ANYTIME throughout the year IF you change to a plan that has been designated by CMS as a Five-Star Plan.
A five-star rating from CMS indicates excellent performance and exemplary service from a plan. The biggest benefit for an insurance company with a Five-Star Plan is the ability to enroll seniors ANYTIME OF THE YEAR! This allows seniors to move to a potentially better plan with lower costs and more benefits than they had before.
Next step
Want to see if you’re eligible for better benefits or lower costs while keeping your Mercy Health medical providers? Call toll free 1(888) 841-8848 or click HERE to schedule a time to go over your plan options. A dedicated Ohio insurance agent will help you compare your options over the phone, so you don’t lose access to your doctors next month.
