Anthem Medicare Advantage patients still without OSU coverage. How they can stay in network

COLUMBUS, Ohio (WCMH) -- The Ohio State University Wexner Medical Center and Anthem Insurance reached an agreement on Dec. 30, guaranteeing that a majority of OSU patients with Anthem have coverage in 2025.  

But the two sides did not find common ground for around 20,000 Anthem Medicare Advantage plan holders, and those people are now out-of-network at Ohio State medical facilities.  

Christina Reeg, the director of the Ohio Senior Health Insurance Information Program, said OSU isn’t alone in this.

“We have seen several health systems changing which Medicare Advantage plans that they take,” Reeg said. “And it’s not just Columbus, it’s not just in Ohio, this is occurring across the country.”  

Reeg said Anthem Medicare Advantage patients will need to change their Medicare plan if they want to continue care at OSU medical facilities. The good news is that open enrollment for Medicare Advantage Plans just started. 

Open enrollment started Jan. 1 and runs through March 31, with the new coverage kicking in quickly. 

“Typically when you choose a new plan during the Medicare Advantage Open Enrollment it would start the first day of the next month, so folks that start shopping in the month of January would have coverage effective on Feb. 1,” Reeg said. “It’s for individuals who are already in a Medicare Advantage plan, giving them some flexibility to join another Medicare Advantage plan or go back to original Medicare.”  

Medicare Advantage plan holders have a few months to switch to a different plan that Ohio State accepts. Reeg said this is the caveat with Medicare Advantage versus original Medicare.  

“One of the considerations to joining a Medicare Advantage plan is knowing that network can change midway throughout the year, and that’s something that a lot of folks don’t take into consideration before they enroll in the plan," she said.

This situation may be confusing for many of the people affected. The Ohio Senior Health Insurance Information Program is operated through the state so Reeg said her team can help people navigate this in an unbiased way.  

“We can tell you the good, the bad and the ugly, you know?” she said. “We’re going to look at you, we’re going to ask you questions like what doctors, what hospitals do you want to utilize, what prescription medications are you currently taking.” 

The best and fastest way to reach the Ohio Senior Health Insurance Information Program is through their hotline at 800-686-1578, with the program’s team being available on weekdays. Users can also visit the program’s website by clicking here.