Genesis HealthCare System, the main hospital network serving Zanesville and Muskingum County, Ohio, has sent termination notices to four health insurers, telling them their contracts will end on January 1, 2027, unless the companies agree to new terms. The system says the move follows two years of rising claim denials and payment takebacks for care its own doctors had already decided patients needed. For households in the area who carry Medicare Advantage or Medicaid coverage through one of the four affected insurers, the notice is an early warning: without a new deal, in-network access to the region’s dominant hospital system could disappear in less than four months.
Four Contracts, One Notice, and a Deadline That Isn’t Final Yet
The notices went to Aetna, UnitedHealthcare and Medical Mutual of Ohio for their Medicare Advantage plans, and to CareSource for both its Medicare Advantage and Medicaid plans, according to a press release Genesis issued that WHIZ published in full on August 31. Genesis says the contracts will end Jan. 1, 2027, if new terms aren’t reached, language that leaves the door open to a renewed deal with any or all four insurers before the new year arrives. Two coverage types sit outside the fight entirely: commercial, employer-sponsored insurance for working families is untouched, and so is traditional Medicare Supplement (Medigap) coverage. The exposure is narrower and specific: people on a Medicare Advantage plan through Aetna, UnitedHealthcare, Medical Mutual or CareSource, or on CareSource Medicaid, in a service area where Genesis is the closest full-service hospital system. Medicare Advantage plans, unlike Original Medicare, are built around a specific network of contracted hospitals and doctors, so losing that contract typically means higher out-of-pocket costs, or no coverage at all, for non-emergency care.
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Two Years of Contested Claims Sit Behind the Break
Genesis says it is currently contesting 9,000 active denials of coverage for care it had already provided, and that the unpaid claims add up to millions of dollars in losses. Chief Executive Officer Matthew Perry framed the termination notices as a last resort rather than a first move: “This was not our first choice but was our last resort. We had to take this action because we believe the behaviors of these insurance companies are so harmful to patients, doctors and our community’s hospital.” Genesis has said the unpaid amounts affect its ability to keep funding the doctors, nurses and local services the community relies on, since it does not pass those disputed costs on to patients as surprise bills. Genesis also argues that many of the denial and takeback practices it is disputing run against federal rules for how Medicare Advantage plans are required to cover care, rules that already give enrollees a formal right to challenge a coverage denial through the plan and, if needed, an independent reviewer, under the federal Medicare Advantage appeals process that CMS oversees. That existing appeals structure is separate from, and in addition to, the help Genesis says it will now provide directly.
What Stays the Same for Patients Through the End of the Year
Nothing changes today. Genesis says coverage is unaffected through Dec. 31, 2026, and patients should keep scheduled appointments, seek care when they need it, and go to the emergency department in an emergency; emergency care is always covered at the in-network rate regardless of how the contract dispute ends. Genesis has also made a specific promise: it will not send patients a surprise bill for amounts it believes their insurance company is responsible for paying, though it says making that promise work depends on patients responding promptly to insurance paperwork, appeal requests and other information Genesis needs to pursue payment from the insurers directly. Genesis says it will help patients appeal wrongful insurance denials at no charge, on top of the federal appeal rights those patients already have.
A Medicare Enrollment Window That Lands Right on Top of the Deadline
The timing overlaps with a decision every Medicare Advantage enrollee already has to make. Medicare’s Open Enrollment period runs Oct. 15 through Dec. 7, and any plan change made in that window takes effect Jan. 1, the same date Genesis’s contracts are set to lapse if no new terms are reached. For a household on one of the four affected plans, that means the usual annual plan-shopping decision now carries an extra variable: whether Aetna, UnitedHealthcare, Medical Mutual or CareSource will still cover in-network care at the local hospital system next year. Genesis says it will hold free community information sessions, publish a plain-language guide, and staff a Patient Financial Advocate Hotline at 740-454-4335 to answer questions, while stressing that it cannot recommend or choose a plan for anyone.
Medicaid Members on CareSource Have a Separate Path to Switch
Medicaid works differently from Medicare Advantage. Genesis says patients enrolled in CareSource’s Medicaid plan have the right to change insurance companies, and that if Genesis ends up out-of-network with CareSource on Jan. 1, 2027, those patients can move to a different Medicaid managed-care plan. Ohio’s own enrollment system normally limits a plan switch to a person’s first three months after enrolling, a documented problem getting needed care, or the state’s open enrollment period each November, and a network loss at a household’s main hospital is squarely the kind of access problem that path is meant to cover. The Ohio Medicaid Consumer Hotline lists the same toll-free number Genesis is pointing patients to, 800-324-8680 (TTY 711), with counselors available Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m. Eastern time to compare plans and process a change.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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