Genesis Healthcare System, headquartered in Zanesville, Ohio, will no longer participate in Anthem and Humana Medicare Advantage plans in 2024, citing unspecified reasons. However, they will maintain contracts with Aetna, Medical Mutual of Ohio, UnitedHealthcare, and Medigold from Trinity Health. This decision follows a national trend of hospitals and health systems discontinuing agreements with Medicare Advantage plans due to issues such as high prior authorization denial rates and slow payments. Some systems also express concerns about Medicare Advantage carriers facing allegations of billing fraud and legislative investigations. Conversely, other health systems are partnering to launch or expand their Medicare Advantage plans for 2024.
Genesis Healthcare System, based in Zanesville, Ohio, has announced its decision to discontinue its contracts with Anthem and Humana Medicare Advantage plans starting in 2024.
This healthcare system, which operates a single hospital and serves a six-county region in southeastern Ohio, revealed its intent on October 18th. While it did not provide a specific reason for this move, Genesis Healthcare System will continue to maintain contracts with Medicare Advantage plans offered by Aetna, Medical Mutual of Ohio, UnitedHealthcare, and Medigold, which is the Medicare Advantage plan associated with Livonia, Michigan-based Trinity Health.
This development reflects a broader trend observed across the nation, as hospitals and health systems increasingly terminate agreements with Medicare Advantage plans, either with specific carriers or altogether. Commonly cited factors for these decisions include high rates of prior authorization denials and delayed payments from insurers. Additionally, some health systems have raised concerns about Medicare Advantage carriers facing federal allegations of billing fraud and ongoing investigations by lawmakers into their elevated denial rates.
While some healthcare systems are distancing themselves from Medicare Advantage, others are opting to collaborate with payers, grocery chains, or other health systems to either establish their own Medicare Advantage plans or expand their existing offerings for the upcoming year 2024.
