Five things to know about Medica
Follow the instructions you heard from your parents in your youth before you sign up for the Affordable Care Act.
Do your homework.
Open enrollment for the Affordable Care Act, commonly called Obamacare, starts Wednesday.
With Blue Cross and Blue Shield of Kansas City no longer an option, the insurance networks offered are narrower than they used to be when it comes to hospital care and one insurer’s network includes only one hospital system.
Going somewhere that’s not in the network could be costly. All of the Obamacare plans left in the Kansas City area are health maintenance organizations (HMO) or exclusive provider organizations (EPO) that offer no reimbursement for out-of-network care except in emergencies.
The enrollment period to log on to healthcare.gov and purchase 2018 health insurance plans ends Dec. 15.
Consumers in Wyandotte County and Johnson County can choose from two insurers: Minnesota-based Medica and Missouri-based Centene, which is selling Kansas plans under the name Ambetter from Sunflower Health Plan.
Medica has signed an exclusive deal with St. Luke’s Health System for its plans, which are called Select by Medica. The only Kansas City hospitals in Select by Medica’s network will be St. Luke’s affiliates.
“Medica and Saint Luke’s Health System are committed to making care more efficient and accessible in Kansas,” Geoff Bartsh, Medica’s vice president for individual and family business, said in a prepared statement. “Select by Medica does that by providing a seamless care experience with one of the nation’s top health care systems.”
The Select by Medica plans’ narrow network means that consumers in Wyandotte County might have to drive past closer hospitals like Providence Medical Center and the University of Kansas Hospital to find covered care.
St. Luke’s has hospitals in Leavenworth, Overland Park, Lee’s Summit, Smithville and Kansas City, Mo., but none in Wyandotte County.
“To me that means most of our people are going to choose Sunflower,” said Molly Moffett, an Obamacare enrollment expert with the Community Health Council of Wyandotte County. “The further west you go, the less that’s going to appeal to anyone.”
Centene, based in the St. Louis area, is selling plans on both sides of the Kansas City metro area. Its Missouri product is called Ambetter from Home State Health.
Both Ambetter plans have hospital networks that include St. Luke’s, the HCA Midwest Health chain, Truman Medical Center, Providence and others in the metro area.
But they also come with a disclaimer that just because a hospital is in the network, that doesn’t mean the anesthesiologists, radiologists and other professionals who work there are, too.
“We encourage you to ask providers if they participate with Ambetter before they treat you, so you know whether or not you may receive an additional bill for their services,” the disclaimer reads.
The Ambetter plans are available in Johnson County and Wyandotte counties in Kansas; and in Platte, Clay, Jackson and Cass counties in Missouri.
Another insurer, Connecticut-based Cigna, is also selling plans in those four Missouri counties, plus Ray County.
The plans, called Cigna Connect, have networks that include Children’s Mercy Hospital, North Kansas City Hospital, Kindred Hospital, Select Specialty Hospital of Western Missouri and the HCA Midwest hospitals.
As of Wednesday, none of the Obamacare plans available in the Kansas City metro included the University of Kansas Health System, which has the area’s largest hospital, or other large providers like Shawnee Mission Health and Olathe Health.
Those providers were in-network for Blue KC, but Blue KC decided to exit the Obamacare marketplace this year, citing financial losses.
Chris Garmon, an assistant professor of health administration at the University of Missouri-Kansas City, said insurers have been narrowing their networks on Obamacare plans nationwide to try to hold down premium increases.
“By excluding certain hospitals, the insurers can negotiate lower prices with the other hospitals in the market and those hospitals are willing to accept the lower prices because they know the insurer will send more patients to them,” Garmon said.
Jessica Droste, who oversees Obamacare enrollment navigators for the Kansas City Care Clinic, said more hospitals could still be added to the Centene and Cigna networks. Droste said that at a meeting Wednesday representatives from those companies said they were in negotiations.
Droste said consumers should get accustomed to checking their insurer’s networks regularly, both to see if new providers have been added and to see if some have dropped out.
“Unfortunately provider networks do change regularly,” Droste said.