As the end of the year is quickly approaching, beneficiaries should begin to explore their healthcare coverage options for the upcoming year. This can be a daunting task for most individuals, which is why Sampson Regional Medical Center (SampsonRMC) encourages individuals to take time to review each plan carefully. 

"It is important to know your coverage and understand not all health plans are accepted by every hospital or physician," stated Jerry Heinzman, Chief Financial Officer for SampsonRMC. Mid-October through the first of the year is a time when many beneficiaries review their current Medicare, Medicaid, and Marketplace plan coverage to explore options for the upcoming year. "As your community hospital, we understand the options are many, and the answers are few. While we can not endorse any products or plans, we do offer these tips," explained Heinzman. 

1.    Review your plan each year, even if you had coverage in 2025 and want to keep the same plan. Based on your income or household changes, there may be plans that better meet your needs.
2.    Know if your providers are contracted with your insurer. As plans change each year, providers and healthcare facilities may no longer accept next year's plan. 
3.    Know your plan benefits before enrolling, as coverage options can change.

"Plans change from year to year, so it is important to review your options and enroll before the deadline approaches," expressed Heinzman. For example, a benefit such as vision coverage may be included in your plan this year but removed next year. Deductibles and coinsurance are subject to change as well. "We do not believe it's right for an insurance company to sell a product in a county where the hospital is not contracted. It puts the hospital in a position to bill the beneficiary for services provided, or in many cases, not be paid for service at all," emphasized Heinzman. While this is an issue for Sampson Regional Medical Center, it can also be an issue for other community providers who may not be in contract with all plans.

"No one wants to be left with out-of-network premiums, so it's essential to make sure your healthcare plan is in-network with all of your healthcare providers, both locally and any out-of-community specialists that are part of your care team," shared Heinzman. 

Medicare open enrollment began on October 15 and will remain open for review and selection of plans until December 7. Marketplace open enrollment begins November 1 and will remain open until January 15. 

For Medicare, Sampson Regional Medical Center and its practices are now in network for Aetna Medicare Advantage, Blue Cross Medicare Advantage, Liberty Medicare Advantage, Troy Medicare Advantage, United Healthcare Medicare Advantage, and Wellcare Medicare Advantage. However, Sampson Regional Medical is still not in-network with Humana Medicare. 

For Medicaid, Sampson Regional Medical Center and its practices are in network with Carolina Complete, United Healthcare, Wellcare, AmeriHealth Caritas, Healthy Blue, Alliance, Trillium, Vaya, and Partners. 

For the Marketplace, Sampson Regional Medical Center and its practices are in contract with Ambetter, Wellcare, BCBS, and United Healthcare.  

For more information, you may visit: 
•    Medicare – www.Medicare.gov or 1.800.633.4227
•    Health Insurance Marketplace – www.HealthCare.gov or 1.800.318.2596
•    Medicaid – www.NCMedicaidPlans.gov or 1.888.245.0179

For participants of the State Health Plan, the State of North Carolina introduced a new benefit for state employees regarding surgical coverage benefits through Lantern. This is an example of a plan that employees are told they have access to, without being clearly informed of where it is actually accepted. Sampson Regional Medical Center and its physician practices are not contracted with Lantern and therefore cannot accept this new benefit for surgical services. Beneficiaries should be aware that not all medical facilities are in-network with Lantern, making it vital to confirm which hospitals and providers participate before receiving care. It is also important to know where postoperative care will be provided if surgery is performed in another city or state. 

As your community hospital, Sampson Regional Medical Center encourages everyone to take the time to verify their coverage and make selections that best support their health and well-being in the year ahead.