Adena Health will end our agreement between Adena Regional Medical Center and Anthem Medicare Advantage/Anthem Medicaid Advantage on November 2, 2023. Learn More

Medicare & Medicaid Advantage Plans FAQ


To Our Adena Health Medicare and Medicaid Advantage Patients:

How do retailers react when faced with higher costs? They reduce expenses. They innovate. They raise prices.

Like businesses across the country, the health care industry is being impacted by higher costs during these tough economic times. However, unlike your favorite coffee shop or restaurant, health care systems, like Adena Health, can’t raise prices by simply updating our menu board. That’s because the payment rates that Adena Health receives are determined by government agencies, as well as those that are negotiated with insurers. In many cases, and especially now, those rates are fixed and don’t cover the increasing cost of care.

Like other health systems across the country, we have reached out to insurers and asked them to work with us to find a fair rate that appropriately covers the costs of the care provided. Unfortunately, conversations with the Anthem Medicare Advantage Plan and Anthem Medicaid Advantage have not been productive. As a result, we have made the very difficult decision to terminate the agreement between Adena Regional Medical Center and Anthem Medicare Advantage Plan and Anthem Medicaid Advantage, effective November 2, 2023

While the cost to provide care has risen dramatically since the last time Adena Health and Anthem discussed Medicare and Medicaid Advantage plan rates, Anthem’s payments to Adena did not adjust in response to the increased cost of care. It’s important to note that the Federal Government’s traditional Medicare program reimburse hospitals at a rate more in-line with the cost of care than health plans (Anthem, United, Aetna, etc.) that contract with the Federal Government to administer advantage programs. Talks between Adena and Anthem did not resolve the gap, so Adena made the difficult decision to end its agreement.  

Information regarding how the decision affects you, as well as your Medicare Advantage Plan and Medicaid options, are below.  Please know that there are available options to your current Anthem plans.

Thank you for choosing Adena Health as your health care partner. We remain focused on providing you with the quality care that you expect and deserve as we manage the economic realities of maintaining a sustainable health care system that serves our communities.


Why did Adena terminate its affiliation with the Anthem Medicare Advantage Plan and Anthem Medicaid?

As a not-for-profit health care system, Adena provides both quality care and accessible services across the region, and works to assure the financial resources required to provide that care are available for all residents. Adena must always be mindful of the costs to administer care across its nine-county service area. Anthem’s reimbursement rates fall short of the compensation necessary to ensure the cost of care to our patients. In addition, unpaid claims, denials, and delays by Anthem, as well as its administrative burdens and vague reimbursement policies, don’t align with Adena Health’s mission, vision, or values.


Are commercial Anthem insurance beneficiaries and traditional Medicare beneficiaries affected by the change?

No.  Only Anthem Medicare Advantage and Anthem Medicaid plans are impacted.


What should I do if I’m affected by the change? 

Review the information on this page, including the list of common questions below.

Talk to an insurance broker or advisor to see if you qualify for another plan. The Medicare Advantage plans currently accepted by Adena:

  • Aetna
  • Allwell
  • Humana
  • MediGold 
  • Medical Mutual of Ohio (MMO)
  • The Health Plan
  • United Healthcare

Call the number on your insurance card for help with finding in-network providers.

Medicaid plans accepted by Adena Health include:

  • AmeriHealth—Caritas
  • Buckeye Health Plan
  • CareSource
  • Humana
  • Molina
  • United Community Health Plan


Adena is a not-for-profit health care system; why do insurer reimbursement rates matter? 

Adena must always be mindful of the costs to administer care across its nine-county service area. Anthem’s reimbursement rates fall short of the compensation necessary to ensure the quality of care that should be available to our patients.

Can Adena subsidize the cost of Anthem Medicare Advantage and Anthem Medicaid patients from reimbursement received from commercial insurers?

Adena has relied on other business units to subsidize the Anthem Medicare Advantage’s and Anthem Medicaid’s reimbursement shortfalls for several years; however, given excessive inflation, staffing shortages, and supply chain issues, this model is no longer sustainable.

Why can’t Adena simply adjust its costs so that it can continue to provide care to Anthem Medicare Advantage Plan and Anthem Medicaid patients?

Adena regularly reviews its costs to ensure that it can continue to provide quality care across its nine-county footprint.  Adena relies on insurers to improve their reimbursement rates to reflect the rising cost of care. The cost of providing clinical care and supplies to patients has significantly increased over the last two to three years, while payment for services provided has significantly lagged behind inflation.

On average, how much reimbursement does Adena receive for care provided to Medicare Advantage Plan and Anthem Medicaid patients?

Adena is paid based on patient type (inpatient or outpatient), the procedure(s) performed, or services provided and by acuity of the patient.  As a result, the range of payment received varies, but is, at times, considerably less than the traditional Medicare programed administered by the federal government.

Can I still see my Adena physician (provider)?

Adena Medical Group providers are still in-network with Anthem Medicare Advantage and Anthem Medicaid; patients can continue to receive care from other Adena providers if you enroll with another Medicare Advantage plan or traditional Medicare.  Medicare Advantage Plans currently accepted by Adena include:

  • Aetna
  • Allwell
  • Humana
  • MediGold 
  • Medical Mutual of Ohio (MMO)
  • The Health Plan
  • United Healthcare

What should I do about my scheduled procedures at Adena?

You can continue to have procedures performed at Adena facilities and by Adena providers until November 2, 2023, under your current Anthem Medicare Advantage Plan and Anthem Medicaid.

When does the change take affect?

November 2, 2023.

Which hospitals/outpatient care centers are affected by the change?

Adena Regional Medical Center, including the ARMC regional medical centers located in/at:

  • Bridge Street
  • Cancer Center
  • Circleville
  • Jackson
  • Waverly
  • Western Avenue


Are the critical access hospitals and Adena Medical Group impacted by the change?

Only Adena Regional Medical center is affected. Anthem Medicare Advantage and Anthem Medicaid will still be accepted at the critical access hospitals (AFMC, AGMC, and APMC) and by Adena Medical Group.

Are all Medicare Advantage Plans and Medicaid plans affected?

No. Only Anthem.  Refer to the list of plans that are still accepted.

Are all my Adena providers affected by the change?

No. Only services provided by Adena Regional Medical Center are affected. In addition, community health partners who are not employed by Adena, but who perform procedures at the impacted hospitals, may be affected. Talk to your provider about your specific situation. Note: the current termination does not impact the physicians and providers in the Adena Medical Group (AMG).

How do I transfer my records to an in-network provider?

You can transfer your records via your MyChart account; completing our online medical records request form; or by calling 740-779-7640. If you’re a patient at an Adena-affiliated partner, you may request your records by calling them directly.

How can I reschedule an appointment or make a new appointment with my Adena provider so that I can be seen before November 2?

To make an appointment for services provided before November 2, 2023, call your provider’s office or make an appointment online or via your MyChart account.

How will the change affect provider-based billing (PBB) clinic locations?

Charges for Anthem Medicare and Medicaid plans are split between their professional and technical components for billing; the professional component is billed on the 1500, and will still be in-network with AMG physicians, but the technical component billed on the UB will be out-of-network on the hospital side.  As such, those services will be both in and out of network. 

How can I cancel a scheduled appointment? 

Call your provider’s office or cancel your appointment via your MyChart account.

Can I keep my doctor or can he/she recommend a new provider? 

Contact the member services number on the back of your insurance ID card to inquire about in-network providers under your new plan.

How can I continue to get care from Adena Health? Can I change my plan?

Contact your insurance broker or benefits advisor for help with switching plans.

I have a surgery or other procedure scheduled with Adena before November 2, 2023. Can I get my post-procedure care from Adena?

Under the “No Surprises Act” federal law, continuity of care allows for coverage and care for patients who are:

  • undergoing treatment for a serious and complex medical condition
  • undergoing inpatient of institutional treatment
  • scheduled to undergo non-elective surgery, including receipt of postoperative care, with respect to such surgery
  • pregnant and receiving care related to the pregnancy
  • terminally ill per the Social Security Act and receiving care for the terminal illness.


Will the prescriptions written by my Adena providers and filled through Adena pharmacies or may be affected by the change?

We don’t expect that prescriptions written by Adena providers will be affected. Please verify your prescription coverage drug coverage by contacting the Adena pharmacy at 740-779-8761 or contact your pharmacist through your MyChart account.

What if I need emergency care?

Regardless of your insurance coverage, go to the closest urgent care or hospital emergency department for medical emergency care.

What does Adena consider to be acceptable Medicare Advantage Plan reimbursement rates?

Services provided by Adena to Medicare Advantage Plan patients should be paid at 100% of the hospital’s rate received from the Center for Medicare & Medicaid Services (CMS) for Medicare and Medicaid patients not enrolled in a Medicare Advantage or Medicaid plan. 

How much of Adena’s overall revenue is composed of Medicare reimbursement?

Approximately 75% of Adena’s payments come from fixed-payment, government sponsored programs—Medicare and Medicaid. 

How much do Medicare Advantage Plans pay in comparison to the cost of care?

Please visit for a brief, general summary of Medicare Advantage Plan hospital reimbursement rates.


Does Adena Health recommend a specific Medicare plan?

While Adena Health cannot recommend individual Medicare options.

Should I look for a new insurance provider?

Please consider your options and note that Medicare open enrollment is from October 15 through December 7.

Where can I go for help with choosing another Medicare Advantage Plan?

Please visit or call 1-800-MEDICARE (1-800-633-4287) for help with selecting the Medicare Advantage Plan that best suits your health care needs. You may also visit to explore Medicare coverage options in your area.

How can I switch to another Medicaid insurer?

Please visit for help with and information about changing Medicaid plans.