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Ohio health consumers face hard choices

MARIETTA — With open enrollment just around the corner, those without health insurance may be hard pressed to buy into a plan, with few options now available in Southeast Ohio.

CareSource is the new outlined provider of health insurance for local counties per the Ohio Department of Insurance, after Anthem pulled out earlier this summer. But some may be looking to find new primary care providers and specialists because the company is not contracted with the Memorial Health System.

“After I wasn’t teaching anymore I didn’t have health care anymore,” said Stacey Hall, 51, of Marietta. “Now this is the second time in two years that I’ll have to find a new health insurance plan through the marketplace.”

Hall said because she doesn’t have insurance through an employer and her insurer this year pulled out of the marketplace she once again will have to enroll in a new health plan on the marketplace or face penalties per the Affordable Care Act.

“But some of my friends choose to just pay the penalty because it’s cheaper,” she said. “I’ve had to purchase a plan for the last two years but the premiums have been over $900 per month.”

Open enrollment begins Nov. 1 and runs through Dec. 15, with coverage continuing through the end of 2017. After that, those who have not enrolled will be in a tight spot.

“The (Affordable Care Act) was passed in 2010 with the main purpose of providing coverage for all, regardless of pre-existing condition either through medicaid expansion or private insurance,” explained Mark Schwendeman, owner of the Schwendeman Agency in Marietta. “The promise was you could keep your doctor and premiums would reduce, but neither of those happened.”

Hall said she was covered by MedMutual until they pulled out of Ohio last year and then switched to Anthem.

“But then in July I got another letter again saying I was going to be dropped because Anthem was pulling out this year,” she said. “But the thing is the deductibles are so high already. What’s going to happen next?”

What’s going to happen come Jan. 1 is on the minds of many like Hall who purchase health insurance through the Ohio marketplace.

“What happens to the patient that’s right in the middle of their cancer treatment?” said Schwendeman. “When the only provider that covers Washington County doesn’t cover (the Memorial Health System)… does that mean you’re going to lose access to care or have to travel out of county or state for care?”

He explained how the marketplace exchange for the past two years allowed for cost-sharing subsidies to help insurers off-set the cost of providing insurance to patients who qualified for reduced rates.

“That cost-sharing from the federal government goes away at the end of 2017,” explained Schwendeman. “Without that federal subsidy and with people buying insurance only to get a condition taken care of and then dropping coverage when they got better, many companies left the marketplace because it wasn’t sustainable.”

To fill the void left, Caresource took on Washington, Morgan, Monroe and Noble counties after Anthem announced it would be pulling out of the state earlier this year, leaving 10,500 people in Ohio to find another insurer.

But Memorial Health System Chief Financial Officer Eric Young said CareSource is not a reliable payer of medical bills and so the system does not do business with them.

“We’re partners with Anthem and meet with them all the time so we were saddened when they left the market too,” said Young. “We struggle with CareSource… they haven’t even called us to try and set up a plan with this expansion…We struggle already to get paid for the (Medicaid) services we already provide and struggle to get doctors signed up with them.”

But for those in the midst of long-term care or treatment, Young said not to fret.

“The last thing we want a patient to do is worry about how they’re going to pay for their care,” he said. “We won’t delay or postpone care for anyone in treatment.”

He said the health system already has in place avenues utilized by cancer patients to help with out-of-pocket expenses and that practice is available, though underutilized throughout the remainder of the system.

Jennifer Offenberger, senior director of marketing and service excellence for the Memorial Health System, said the system will be taking the next few months to review policies concerning CareSource’s insurance as of next year and how care could still be provided.

“We do give significant discounts for self-pay,” added Young. “And we have patient financial advocates to help patients navigate the system and work out payments based on income level.”

But Inge Chenowetch, manager of contracting managed care with the system, said the number of patients they currently see that were enrolled in marketplace plans is still small in comparison to the number of individuals the system treats.

“There were just a few hundred enrolled that will need to find an alternative,” she said.

“But we’re still deeply committed to providing care for the whole community,” added Offenberger, explaining that further decisions need to by made by the health system on how individuals insured by CareSource would be charged.

CareSource did not provide answers to questions asked by The Marietta Times this week.

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