Important Update: Anthem Medicare Plans & Mercy Health Patients

This information is a must read for patients in Ohio who have Anthem Medicare Advantage plans and go to Mercy Health doctors or facilities. If this does not apply to you directly, but does to friends or family members, please feel free to direct them to this post.

As you may have heard, there are ongoing network contract negotiations between Mercy Health Bon Secours and Anthem Blue Cross and Blue Shield (now known as Elevance Health). Mercy Health is a large hospital and medical provider system with locations spanning through many parts of Ohio and several other states. Anthem Blue Cross/Blue Shield (Elevance Health) has been in negotiations with Mercy Health for a while now and as of this post, they have not come to an agreement. The termination of the Anthem and Mercy Health agreement is set to occur on 9/30/2023. If an agreement is not achieved, Mercy Health providers and facilities will be considered out-of-network for individuals enrolled in an Anthem Medicare Advantage Plan effective 10/1/2023.

Contract negotiations between hospital/provider systems and insurance companies are normal — they are a standard business practice that happens behind the scenes. These contracts allow you as an insurance policyholder to go to those providers and only pay the amount for services laid out in your policy (your fixed copay or coinsurance). In this negotiation both sides believe they have given as much as they can and they are still at a standstill. When both sides cannot come to an agreement, this causes the contract to expire and these providers become "out of network" with the insurance plan. Some plans allow for out-of-network coverage, such as a PPO plan (but at a higher cost), or Medicare Supplement plans which are NOT affected by this contract negotiation. It is important to understand that HMO plans — which are the most common Medicare Advantage plans in Ohio — do not allow you to go see out-of-network providers without you as the patient paying 100% of the bill (with the exception of emergency coverage). This is the case for many of Anthem's more popular plans, including the Mediblue Preferred.

Resources from Both Sides

Both Mercy and Anthem have provided consumer information web pages for your review. We want to provide you with both perspectives to help you with your decisions.

What Are Your Options?

We are not taking sides as to who is right or wrong in these negotiations — our responsibility is to our clients. If you have an Anthem Medicare Advantage plan, once the contract officially terminates, you must make a decision:

We still hold out hope that a deal will be done. Assuming it is, if you like your plan and your doctors you can keep both. However, we need to prepare for a change.

So, What Do You Do Now?

Once October 1st arrives, if a deal has not been struck and you want to keep your doctors, you will need to change your plan. That's where we come in. In most of the affected areas we have 5-star plan options, which will allow us to make changes before January 1st — so you can continue to see your doctors during the span of time between October 1st and December 31st.

We are also about to enter the beginning of the Annual Enrollment Period, so if you are looking at a January 1st effective date, we can help with a majority of your possible plan options. A full listing of the carriers Medicare Made Simple and our affiliated agents can offer you can be found on our Complete Carrier Listing page. As of October 1st, we can discuss all of the plan changes for 2024 as well. At that time we can do a complete review and come up with a good alternative that will allow you to keep the doctors you wish to see in your network — not just now, but moving into next year as well.

We know it's not just our clients who are being affected by this major change. If you have friends or family members who you know are being affected by the Mercy and Anthem contract, please give them our number or send them to our website and have them reach out to us. Consultations can be completed over the phone, via Zoom, or in person (depending on location). As always, our consultations and all services we provide are 100% free to our clients.