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Medical Mutual OSU Network Changes

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Medical Mutual and OSU NetworksEvery year there are changes to provider networks for many Medicare insurance plans. The biggest change for 2021 is Ohio State University will no longer be in network for Medical Mutual Medicare Advantage plans. This does not affect all of their insurance plans, however.

It’s not uncommon to see large providers move in and out of network with Medicare Advantage plans. This might happen due to high costs or low utilization by the insured population. But for 2021, OSU hospitals and affiliates won’t be in network for Medical Mutual Advantage plans. This includes both their HMO and PPO plans.

This means that beginning Jan. 1, 2021, all PCPs, specialists and facilities associated with the Ohio State University Wexner Medical Center (including Ohio State University Hospital, Ohio State East Hospital, The James Cancer Hospital and The Ohio State University Physicians) will no longer participate in Medical Mutual’s Medicare Advantage network.

What If I Want To Change Plans?

The good news is that Medicare Open Enrollment is right around the corner. It runs from October 15th thru December 7th. If you’re enrolled in a Medical Mutual Advantage plan and wish to continue to see doctors in the OSU network, then switching plans is advisable. Any change you make will be effective January 1, 2021.

In Central Ohio, there’s a lot of competition for Medicare Advantage plan enrollees. Aetna, United Healthcare, Humana, Anthem BCBS, and a few others all offer comprehensive coverage. And many of these include Ohio State hospitals and doctors in their networks. And many also offer $0 HMO and PPO plans that include prescription drug coverage just like Medical Mutual.

In other words, it should not be hard to find a new Advantage plan with your same doctors and hospitals in network while also including OSU. And the benefits should also be similar. Many Advantage plans are structured in similar ways in terms of out of pocket costs and the ancillary benefits offered.

Copays, coinsurance, out of pocket maximums may not differ much. And these plans typically include the dental, vision and hearing coverage (among other perks) you’re used to.

Does This Affect Their Medicare Supplements?

The answer is, no. Almost all Medicare Supplement plans do not have networks to worry about. They are simply a secondary payor after Medicare. This means you can go see any doctor or hospital you choose so long as they accept Medicare.

If you own a Medical Mutual Medicare Supplement plan, you can still go to Ohio State University. This change only affects their network-driven Medicare Advantage plans. This is one of the pros of having a Supplement (also referred to as Medigap coverage). You don’t have to worry about being bounced in and out of networks like you would with an Advantage plan.

You do not need to worry about changing insurance if you own a Medicare Supplement with Medical Mutual of Ohio. You can still go see every provider you’re used to seeing – same as before.

What About Individual & Group Health Insurance?

OSU has not been in network for Med Mutual’s individual and family insurance plans for some time. In Central Ohio, all plans sold today only offer Ohio Health as a network of choice. This gives you access to Riverside, Dublin Methodist, Grant and several other facilities, but not Ohio State.

So there are not changes there. Those on individual and family MMO plans sold on the exchange will continue to have access to Ohio Health facilities in and around Central Ohio for 2021.

And group health plans sold off the exchange will continue to have OSU in their network. There should be no disruptions there either. Again, this change only affects Medicare Advantage enrollees.

Contact Us to Discuss Your 2021 Medicare Insurance Options

Network changes are inevitable in today’s insurance environment. In many cases, the two parties later reach an agreement and things return to normal. However, if you’re utilizing OSU and own a MMO Advantage plan, you may want to shop for new coverage. We can help. Contact us today to learn more about your 2021 options.

Category: Medicare Advantage