Regrettably, starting January 1, 2024, a popular plan, the Horizon Blue Cross Blue Shield gold coverage plan, which used to give access to hospitals all over the country, won’t be available anymore. This is tough for those needing out-of-state coverage, especially in big hospitals like Columbia and Cleveland Clinic, which can be crucial for people dealing with health issues.

Now that open enrollment is here and we're all choosing health insurance plans, addressing this challenge as a community demands a strategic approach. Many local Medicaid recipients are opting for the same HMO plan, which lacks coverage for out-of-state hospitals, not even granting coverage on a case-by-case basis. Consequently, individuals found themselves needing to purchase the Horizon Gold plan when faced with health complications. This situation potentially created a scenario where a significant proportion of the gold-plan participants were those requiring costly out-of-state hospital care, rendering the Horizon Gold plan unprofitable for Horizon.

It's important to recognize that alternative HMOs, such as United Healthcare, have actively collaborated with the community. They have worked closely to establish pathways, enabling individuals to access these out-of-state hospitals even though they are out of network. If this information had been more widely known, it could have potentially lessened the need for individuals seeking out-of-state, out-of-network hospitals to rely on the gold plan, potentially contributing to the prevention of its discontinuation.

In hindsight, understanding these alternatives are a must. This awareness could possibly have mitigated our reliance on a single plan, contributing to a more balanced and diversified approach to healthcare. As we navigate open enrollment, it's an opportunity to learn from this oversight, encouraging individuals to explore and consider all available HMO options to create a more resilient healthcare plan for the future.

It's noteworthy that local doctors readily accept multiple HMO plans, offering flexibility for our community. Let us unite in making choices that benefit everyone, transforming healthcare planning into a collective effort.