HUNTINGTON — An insurance broker is advising Lawrence County, Ohio, residents who plan to enroll for Affordable Care Act health insurance coverage to look closely at offered plans to determine whether health care providers they use in neighboring West Virginia are included in their networks.
Joel Thompson, an independent life and health insurance broker based in Kenova, West Virginia, but licensed in Ohio and other neighboring states, says many West Virginia providers in Huntington aren’t included in the plans covering Lawrence County offered on the ACA government insurance exchange.
Open enrollment for ACA coverage in 2020 begins Friday, Nov. 1, and ends Dec. 15.
“Currently, there are two carriers offering Affordable Care Act individual coverage in Lawrence County, but neither of them included Cabell Huntington, St. Mary’s or their associated physician networks among their HMO (health maintenance organization) providers,” Thompson told The Herald-Dispatch.
All of those providers are based in West Virginia.
The carriers offering plans for Lawrence County residents are Anthem Blue Cross Blue Shield, which has by far the lowest rates, according to Thompson, but only has providers based in Ohio, and CareSource.
“This will mean the closest network hospital will be Southern Ohio Medical Center in Portsmouth,” Thompson said.
“There will be another carrier available to Lawrence County consumers, Molina Healthcare, but it likewise does not list Cabell Huntington Hospital or St. Mary’s (Medial Center) in its network,” Thompson added. “It does include one West Virginia hospital: Jackson General in Ripley.”
Both Ashland hospitals, King’s Daughters Medical Center and Our Lady of Bellefonte Hospital, are in the CareSource and Molina networks for Ohio.
“Although CareSource does offer network coverage for all local hospitals to West Virginia residents, both of them in Ashland and both of them in Huntington, the Huntington institutions are excluded for marketplace members in Kentucky and Ohio,” he said. “The only major West Virginia provider currently in the Kentucky and Ohio CareSource networks is Valley Health.”
Generally, those covered by insurance will pay more out of their own pockets for services provided by providers who not in the HMO networks.
Thompson said to prevent confusion, individuals should know that CareSource has separate networks for its marketplace, Medicaid and Medicare Advantage clientele. Marketplace members are people who enroll in individual coverage through HealthCare.gov.
“This issue pertains specifically to marketplace coverage,” he said.
Messages left for CareSource, Anthem Blue Cross Blue Shield and Molina Healthcare were not returned.
Mountain Health Network, which owns both Cabell Huntington Hospital and St. Mary’s Medical Center, sent a statement via email when asked by The Herald-Dispatch about coverage for Lawrence County residents through the government insurance exchange health plans.
“Members who select an Anthem plan may have care received at Cabell Huntington Hospital and St. Mary’s Medical Center covered through the Blue Cross Blue Shield Network,” Greg Wageman, director of managed care at Cabell Huntington Hospital, said in the email. “However, the plan may redirect them to an Ohio facility if the care is reasonably available and the plan has a contract with the Ohio facility.”
The Affordable Care Act states that emergency care must be delivered at any facility, whether it is in network or out of network, and paid at in-network rates.
Mountain Health Network did not respond to attempts for an interview for further clarification and follow-up questions.
“I’m hoping attention will cause the network limitations to be eased as I help Lawrence County residents, as well as northeast Kentuckians, enroll in their ACA coverage over the next month and a half,” Thompson said.
In West Virginia, CareSource is offering plans in 44 counties, while Highmark Blue Cross Blue Shield remains the only company serving all 55 counties via the government insurance exchange.
Free assistance in West Virginia with enrollments is available from community assisters, navigators working with First Choice Services and certified agents. A full list of helpers, broken down by county, is posted at wvinsurance.gov or can be accessed by calling toll-free at 888-879-9842.
In Kentucky, two insurers are continuing to offer coverage in the exchange, CareSource and Anthem Blue Cross Blue Shield.
CareSource is expanding its coverage area in Kentucky for 2020, so residents in 56 counties will be able to choose from both Anthem and CareSource. Residents in the other 64 counties will only have one insurer offering plans, although there will still be multiple plan options available, since insurers offer a variety of plans.
For information about Kentucky’s health insurance marketplace, visit online at https://www.healthinsurance.org/kentucky-state-health-insurance-exchange/.
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