PCHS Change in Medicare Advantage Plan Participation

Phillips County Health Systems (PCHS) recently made the decision to discontinue contracted agreements with Medicare Advantage plans. This change is specific to Medicare Advantage insurance plans only. This change will not affect traditional Medicare or Medicare-covered services. We understand this change may raise questions for our patients, and we want to clearly explain what it means.

PCHS STILL ACCEPTS MEDICARE

Traditional Medicare and Medicare Advantage are NOT the same thing. PCHS continues to accept Traditional Medicare. This change applies specifically to Medicare Advantage plans, which are private insurance plans offered through insurance companies that contract with Medicare.

We understand that changes involving insurance coverage can be confusing, and we want Advantage plan participants to understand what this decision may mean for them.

What is changing?

As a result of PCHS's decision, PCHS will become an out-of-network provider for the affected Medicare Advantage plans.

This does not mean that PCHS can never provide care to someone who has a Medicare Advantage plan.

Medicare Advantage plans are offered by private insurance companies and may have their own provider networks, coverage rules, copayments, coinsurance, deductibles, and prior authorization requirements. What a patient pays for care can depend on the specific Medicare Advantage plan they have.

What does this mean for Medicare Advantage patients?

Beginning with the effective date of this change, PCHS will be out-of-network for the affected Medicare Advantage plans.

This does not mean that patients with Medicare Advantage can never receive care at PCHS. What is covered, and what a patient may have to pay, will depend on the specific Medicare Advantage plan and the type of care needed.

Patients with Medicare Advantage may experience:

• Higher out-of-pocket costs for some services

• Different coverage for out-of-network care

• Prior authorization requirements for certain services

• Different rules depending on the type of Medicare Advantage plan.

Medicare Open Enrollment: October 15 – December 7

Medicare Open Enrollment is October 15 through December 7. This is an important opportunity for patients with Medicare Advantage to review their current coverage and consider how PCHS's change in network status may affect their access to care and potential out-of-pocket costs.

During Open Enrollment, Medicare beneficiaries can review available plans and, depending on their circumstances, make changes to their Medicare coverage. Changes made during this period generally take effect January 1.

If you currently have a Medicare Advantage plan and regularly receive care at PCHS, we encourage you to use this enrollment period to review your plan's network, coverage, and out-of-pocket costs and determine whether your current coverage continues to meet your healthcare needs.

If you receive regular care at PCHS and have a Medicare Advantage plan, we encourage you to:

• Review your current plan's provider network.

• Check whether PCHS will be considered in-network or out-of-network.

• Ask about your potential costs for out-of-network care.

• Compare your available Medicare coverage options.

• Contact your insurance company or 1-800-MEDICARE (1-800-633-4227) with questions about your coverage.

PCHS cannot recommend a specific insurance plan, but we encourage patients to understand how their insurance choice may affect their access to healthcare.

We are here to help

At PCHS, our commitment to Patient-Centered Excellence remains unchanged. We understand that insurance decisions can be confusing, and we want our patients to have the information they need to make informed decisions about their healthcare coverage.

To be clear: PCHS continues to accept Traditional Medicare. The change announced here is specific to PCHS's contracted participation with Medicare Advantage plans.

If you have questions about how this change may affect your care at PCHS, please call 785-543-5226.

For questions about your specific Medicare Advantage coverage, contact your insurance company directly.

Insurance coverage varies by plan. Patients should contact their insurance provider for the most accurate information about network status, coverage, authorization requirements, and potential out-of-pocket costs.