Plan holders react to CarolinaEast dropping Medicare Advantage coverage

NEW BERN, N.C. (WITN) — CarolinaEast Medical Center will drop in-network status for two Medicare Advantage plans, the hospital announced Thursday.

Blue Cross Blue Shield Medicare Advantage and UnitedHealthcare Medicare Advantage plans will become out-of-network on July 1.

Rachel Voris with Flatlands Jessup Insurance Group said that plans are mainly used by seniors and that the terminations could mean higher cost shares or no coverage, with the exception of emergencies.

“We want to let people know that they’re not alone in this,” Voris said. “Many seniors and families across Craven County and Eastern North Carolina are being affected by this, and understandably, there’s going to be a lot of confusion.”

Plan holder Andrea Smith said she is concerned about the terminations, especially with her husband needing a knee replacement this year. She said they might now need to travel to Raleigh or Durham for care.

“We’re fairly capable, so we can handle that if we need to, but there are so many seniors that it would be difficult for them,” Smith said. “Maybe they live alone or don’t have transportation, and they are just left, so we have six months where a lot of people are going to be wondering what is going to be happening.”

As of right now, Voris said the two options for those impacted are to either travel for care or make the switch to Medicare. Open enrollment doesn’t start until the fall and wouldn’t be effective until January.

Smith said both options are challenging and that she’s worried about what the future will hold.

“Things have changed so much, and with the rising cost of everything, some people think it’s easy to just change from Medicare Advantage to Medicare, but with that comes increased costs, and we are budgeted so thin right now,” Smith said.

Voris said she understands the frustration many are facing and would like to see the Centers for Medicare and Medicaid Services open up a special enrollment period due to the disruption.

“The way to get that to happen would be to, you know, reach out to your local representatives,” Voris said.

Voris also said she urges those impacted to contact a trusted advisor, like a SHIP counselor or local agent, for a review of their coverage so they know how the terminations will impact them personally.

The hospital said this does not impact patients with CarolinaEast Physicians, as they will remain in-network with both plans.

ECU Health is also in a reimbursement dispute with UnitedHealthcare. Last week, some services at ECU Health facilities became out-of-network for UHC members.