40,000 people in the Triangle will have to switch doctors or health insurers

WakeMed Health & Hospitals and Duke Health were dropped by Blue Cross. They’ve now found a new health insurance partner.
WakeMed Health & Hospitals and Duke Health were dropped by Blue Cross. They’ve now found a new health insurance partner.

About 40,000 people in Wake and Durham counties will not have to scramble to find a new doctor next year on the Affordable Care Act marketplace in the wake of changes by the state’s dominant health insurer, Blue Cross and Blue Shield.

Centene, the nation’s largest ACA insurer, has created a two-county medical network with WakeMed Health & Hospitals and Duke University Health System to fill a gap being created by a Blue Cross decision not to include WakeMed and Duke Health in its ACA network in the Triangle next year.

Raleigh-based WakeMed and Durham-based Duke Health announced the partnership Thursday.

Centene’s Ambetter plans will be offered in Durham and Wake counties starting Nov. 1 and will go into effect Jan. 1. Centene has not previously sold health insurance in North Carolina. Missouri-based Centene currently insures about 1.5 million people on ACA plans in 16 states.

“The main thing is people will have a choice,” WakeMed CEO Donald Gintzig told The News & Observer in a phone interview Thursday afternoon. “So they’re encouraged to look at plans and choose one that allows them to get care where they want to get care.”

Detailed pricing for the ACA health insurance plans is under review by the N.C. Department of Insurance and won’t be public until October. But Duke Health official Thomas Owens, who’s president of Duke University Hospital and senior vice-president of Duke University Health System, said in a phone interview with The N&O that the benefits and pricing on Centene’s Ambetter plans will be competitive and will offer a local provider network containing several thousand doctors.

Plans in the ACA marketplace, also known as Obamacare, are sold directly to individuals and include federal subsidies for households below certain income thresholds. Most Americans, however, buy their health insurance through an employer or through a government program like Medicare, which insures people who are 65 and older, Medicaid, which insures low-income adults, their children and some people with disabilities, or Tricare for military personnel.

The 40,000 people who are affected by Thursday’s decision are now covered by Blue Cross’s Blue Local ACA plan and can use WakeMed and Duke Health doctors and facilities with lower in-network costs through the end of this year. Blue Cross announced last week that it is eliminating Blue Local for 2019 and dropping WakeMed and Duke Health out of its network to keep down costs as of Jan. 1.

People have until Dec. 15 to decide whether to switch to Centene’s Ambetter plan so they can continue to see their current doctors or stay with Blue Cross and find other health care providers.

Centene is the largest ACA insurer in the country and it specializes in insuring lower-income people on government programs like Medicaid. The company also plans to bid to administer North Carolina’s Medicaid program under a $6 billion-a-year program that will be awarded to multiple bidders next year.

Owens at Duke Health said the Ambetter option might not only appeal to people on Blue Local, but also to people currently on Blue Value, which will include UNC Health Alliance as its provider network.

“Our network will be broader and more comprehensive than the network UNC brings,” Owens said. “Our goal for all of those lives on Blue Value in Wake and Durham counties is to stay with us through Ambetter, and we’d be thrilled to have others choose us as well.”

President Donald Trump signed an executive order Thursday to provide what he calls "Obamacare relief" for millions of Americans. He says the action people more competition, more choices and lower premiums. Trump said he still wants Congress repeal

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