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PETERBOROUGH

MCH joining ACA fray

New Hampshire networks expand

PETERBOROUGH — Area residents who were interested in signing up for coverage under the Affordable Care Act this year had to make a choice. Anthem Blue Cross Blue Shield, the only insurance company offering plans through the Affordable Care Act marketplace, did not include Monadnock Community Hospital in its network of providers. So anyone looking to take advantage of the Affordable Care Act might have had to switch doctors or travel to hospitals in Keene, Manchester or Nashua.

But that will be changing next year. According to the N.H. Insurance Department, four different insurers are expected to offer Affordable Care Act networks that will include Monadnock Community Hospital, and the hospital has already signed a contract with one of those companies — Harvard Pilgrim Health Care.

“In 2015, we anticipate that employers and consumers choosing a plan offered by Harvard Pilgrim through the Exchange will be able to retain their relationship with physicians, other health-care providers, and hospital services at MCH,” said Cynthia McGuire, the hospital’s CEO, in a statement last week to the Ledger-Transcript. The coverage would be effective on Jan. 1, 2015, with an enrollment period expected to start in November. Details on the rates and products being offered are expected to be announced in October.

Hospital officials said Harvard Pilgrim is the only company the hospital has actually signed a contract with, although they anticipate additional options. In addition to Harvard Pilgrim and Anthem, companies that have applied to offer ACA plans on the N.H. Marketplace are Assurant Health, Massachusetts-based Minuteman Health and Maine Community Health.

Anthem will not be adding Monadnock Community Hospital to its list of hospitals participating in its Affordable Care Act network for 2015, which is known as Pathway. According to hospital officials, MCH lost about 100 patients who had to choose doctors affiliated with different hospitals, when they chose to sign up with Anthem’s Pathway network last year in order to get coverage under the Affordable Care Act.

Anthem spokesperson Chris Dugan said Monday that Monadnock Community Hospital is a valuable partner to Anthem, which provides coverage at MCH for customers in group plans, seniors, individuals who have grandfathered plans purchased prior to March 2010, and people who chose to renew their individual plans in 2013.

“Approximately 90 percent of our customers will continue to be served by Anthem’s broad network, which includes all of the state’s hospitals,” Dugan said.

But the Pathway network will still not include Monadnock Community Hospital. Dugan said Anthem has limited the number of hospitals in the Pathway network in order to reduce the cost of the Affordable Care Act plans it offers to consumers.

“When we put this network together, we were looking to be able to provide lower-cost options,” he said. “By delivering the network we have, consumers will be paying less. We didn’t want a really great plan that was unaffordable.”

In a recent press release about Anthem’s Pathway network plan for 2015, Anthem President Lisa Guertin said, “Our goal in building Pathway was to achieve a price position that is attractive to consumers, while meeting network adequacy requirements. We strongly feel we are meeting that objective based on enrollment figures that are well above projections and therefore our goal remains unchanged in 2015.”

According to Dugan, about 38,000 people in New Hampshire have signed up for coverage through Pathway to date.

Another new program will provide health insurance protection to low-income residents. New Hampshire legislators recently approved a Medicaid expansion program, accepting federal funds that are expected to help as many as 50,000 uninsured residents statewide. Run by the N.H. Department of Health and Human Services, the N.H. Health Protection Program will assist in paying health insurance premiums for residents who are eligible for insurance coverage through an employer or enroll low-income adults in a Medicaid health plan.

“If someone has access to employer-based insurance, the funds will pay for the employee share of premiums and for copays,” said Ann Walls of the Concord-based Foundation for Healthy Communities on Friday. “It’s a unique program for the state.”

Walls said those who don’t have employer coverage can be enrolled in a Bridge program, which will sign them up for one of the state’s two Medicaid managed care health plans.

Both of the Health Protection Program offerings use federal funds, which became available after the N.H. Legislature in May approved expanding Medicaid services. Individuals are eligible if their annual household income is less than $16,105 and a family of four will qualify if the family income is less than $32,913.

The enrollment period for the Health Protection Plan started in July and coverage under the premium assistance plan is already in effect. Anyone eligible may enroll online at www.nheasy.nh.gov or www.healthcare.gov or by calling the Medicaid Service Center at 1-888-901-4999.

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