A hospital system in Zanesville, Ohio is giving four Medicare Advantage and Medicaid insurers roughly four months to change how they handle coverage denials or lose in-network status for non-emergency care starting January 1, 2027. Genesis HealthCare System says it is currently contesting about 9,000 active denials of care its own doctors had already ordered, and that the resulting unpaid claims have grown large enough to threaten how many doctors, nurses and local services the hospital can keep staffed. Unless Aetna, UnitedHealthcare, Medical Mutual of Ohio and CareSource agree to new terms, the termination becomes real on the same date millions of Medicare beneficiaries nationally will already be locking in next year’s coverage.
Four Contracts, One January Deadline
According to Genesis’s own press release, the health system separately notified Aetna, UnitedHealthcare and Medical Mutual of Ohio over their Medicare Advantage business, and CareSource over both its Medicare Advantage and Medicaid managed-care plans, that current contracts will lapse unless the insurers negotiate new terms. Commercial, employer-sponsored insurance is not part of the dispute, and neither are traditional Medicare Supplement, or Medigap, policies. That leaves the fight narrowly focused on the government-program side of each insurer’s Ohio business, the part of their operations tied most directly to federal coverage rules Genesis says it is not seeing honored.
Genesis says the notice follows two years of rising denials and payment takebacks for treatment its own doctors determined patients needed and that Genesis already delivered. The system is contesting roughly 9,000 active denials of coverage for care already provided, a dispute it estimates has cost millions of dollars, and it argues many of those denials conflict with federal rules governing how Medicare Advantage plans must cover care. Because Genesis says it will not send patients a surprise bill for amounts it believes an insurer owes, the unpaid claims land on the hospital system itself rather than on patients.
For now, nothing changes for patients: Genesis says coverage remains the same through December 31, 2026, and it is urging patients to keep scheduled appointments, seek non-emergency care as usual, and go to the emergency department without hesitation if they need it, since emergency visits are always covered at the in-network rate regardless of contract status. Genesis HealthCare System President and CEO Matthew Perry called the move “not our first choice but was our last resort,” and said the system would renew the contracts immediately if the four insurers agree to cover the care their own members’ doctors order.
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The Annual Enrollment Window Becomes the Real Deadline
The termination date is not incidental. Medicare’s annual Open Enrollment Period runs October 15 through December 7 this year, the single stretch when Medicare beneficiaries can switch Medicare Advantage plans, and any change made during that window takes effect January 1 — the same day Genesis’s contracts with Aetna, UnitedHealthcare and Medical Mutual of Ohio are set to lapse. That means Genesis Medicare Advantage patients who want uninterrupted, in-network access to the Zanesville-based system have a roughly seven-week window to act, not a full year to wait and see whether new terms get signed.
Genesis says it will not choose or recommend a plan for anyone, but it plans to run free community information sessions, publish what it calls a plain-language guide to the change, and staff a Patient Financial Advocate Hotline through the enrollment period so patients can ask what a switch would mean for their own doctors and hospital access. The hospital system frames this as a deliberate substitute for steering patients toward a specific insurer, arguing its role is limited to explaining the mechanics of a decision the insurers, not Genesis, put on this year’s calendar.
Nothing about the enrollment deadline touches emergency care, which Genesis says is always covered at the in-network rate no matter what happens to these four contracts. The pressure point is specifically non-emergency, doctor-ordered treatment — the same category of care behind the roughly 9,000 denials Genesis is currently contesting — which is what would move out-of-network on January 1 if Aetna, UnitedHealthcare, Medical Mutual of Ohio and CareSource do not reach new agreements before then.
Medicaid Members Get a Narrower, Different Off-Ramp
CareSource carries a second complication because it covers both Medicare Advantage and Medicaid managed-care members through Genesis, and Ohio’s Medicaid rules do not run on the same October-to-December calendar as Medicare. Genesis’s press release tells Medicaid patients they have the right to change managed-care companies if Genesis goes out of network with CareSource on January 1, and points them to the Ohio Medicaid Consumer Hotline’s plan-change process to do so.
That right is narrower than it may sound. Ohio Medicaid managed-care members can typically switch plans only within roughly the first three months of enrollment, during the state’s own annual open-enrollment period each November, or by showing “just cause,” a category that includes losing access to care through a network change like this one. A hospital dropping out of a Medicaid plan’s network is a recognized trigger for that just-cause exception, which is effectively what Genesis is pointing Medicaid patients toward even though its own release does not use that specific term.
What is still unresolved is whether any of the four insurers move before enrollment season ends. Genesis says it will “share what it knows when it knows it” as talks continue, the same transparency standard it is now asking Aetna, UnitedHealthcare, Medical Mutual of Ohio and CareSource to apply to the roughly 9,000 denials sitting on its books — a dispute that, left unresolved, will decide in January whether tens of thousands of Zanesville-area Medicare and Medicaid patients keep their current hospital system in network at all.
This article was drafted with AI assistance and edited for accuracy.
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