Meridian health insurance to drop Northwestern Medicine from network in 2025

Meridian, a major health insurance provider, no longer will accept Northwestern Medicine health system in network beginning Jan. 1, a health system spokesman confirmed.

That decision is expected to affect “tens of thousands” of patients, including many who receive their health insurance through Medicaid, a service offered to low-income qualifying patients, said Christopher King, a spokesperson for Northwestern Medicine.

“It’s unfortunate because they’re the ones that dropped Northwestern Medicine,” King said. “That was not an us decision. They alerted us, and we were kind of surprised and shocked they did that. And so those patients that were impacted, and it was significant, we’re reaching out to them to get them transitioned to another plan within the Northwestern Medicine system.”

The health system in total sees about 1.2 million patients across its 11 hospitals and 200 other locations.

“It’s a lot,” King said. “But two patients being impacted by insurance is a lot.”

Medicaid provides health insurance to almost 3.5 million people in Illinois, including low-incoming qualifying adults, children, pregnant people and those with disabilities, according to the Illinois Department of Healthcare and Family Services.

Melissa Kula, a spokesperson for the HFS, told Shaw Local on Friday that the agency is working with patients to ensure they continue to get access to necessary health care.

“The Illinois Department of Healthcare and Family Services will continue working with Northwestern and Meridian to minimize any negative impacts to Illinois Medicaid customers,” Kula said. “HFS will open a special enrollment period for consumers who are assigned to a Northwestern Medicine primary care provider. In addition, HFS will strongly enforce requirements that ensure customers’ continuity of care is maintained and that they maintain access to high-quality health care services. HFS ensures that all of the Illinois Medicaid managed care organizations meet network adequacy requirements and has ensured that Meridian will continue to meet network adequacy requirements when this change takes effect.”

Northwestern Medicine issued an announcement about the Meridian Medicaid termination contract Nov. 25 on its website. The contract ends Dec. 31. Beginning Jan. 1, affected patients will need to choose a new plan if they want to continue getting care at Northwestern Medicine.

King said patients should expect to get notification letters from both Meridian and Northwestern Medicine. He said he recommends that patients visit the health system’s website to learn more about plans it accepts before the end of the year.

Northwestern Medicine accepts two other insurance providers for Medicaid patients: Blue Cross Community Health plans and CountyCare, the latter of which is available for Cook County residents only.

“The biggest thing is [to] reach out to your insurance provider, then see what’s available,” King said. “I know we’re doing everything we can for the continuum of care, because a lot of Meridian users are Medicaid patients as well. We’re trying to make sure their coverage isn’t dropped.”

By the numbers

Meridian Medicaid users per county

Excluding Cook County, Northwestern Medicine is a major health system across northern Illinois. In DeKalb County, the only major hospitals in the health system are Kishwaukee Hospital in DeKalb and Valley West hospital in Sandwich. The health system also has hospitals in Kane, DuPage, Kendall, McHenry and Will counties, among others.

According to the HFS, 7,737 residents of Cook County were enrolled with Meridian health insurance through Medicaid as of September. In DeKalb County, that’s 44 residents; DuPage has 489, Bureau has 35, Grundy has 52, Kane has 534, Kendall has 39, La Salle has 129, Lake has 565, Lee has 48, Ogle has 54, McHenry has 141, and Will has 515.

Medicaid users overall per county

Overall, thousands of residents in northern Illinois were enrolled in health insurance plans through Medicaid as of September, state data shows.

In Cook County, 35,189 residents get their health care through Medicaid: 408 in DeKalb, 4,058 in DuPage, 175 in Grundy, 2,706 in Kane, 298 in Kendall, 868 in La Salle, 3,104 in Lake, 245 in Lee, 857 in McHenry, 293 in Ogle and 2,734 in Will.

Meridian did not respond to a request for comment by press time.

What should I do if I’m a Medicaid Meridian patient?

Although most Meridian-holding Medicaid patients can get care at Northwestern Medicine through Dec. 31 only, some may qualify for exceptions, according to the health system.

Temporary exceptions to qualify for Meridian-insured care past the new year include patients who are undergoing active cancer treatment or being treated for an organ transplant, are in the second or third trimester of pregnancy, already have scheduled surgeries before Dec. 31 to happen between Jan. 1 and March 31, already have scheduled behavioral health services to be provided between Jan. 1 and March 31, or already have scheduled primary care appointments to happen between Jan. 1 and Feb. 28.

Patients with additional questions can visit www.nm.org to learn more about in-network health insurance plans. To transfer medical records, patients can visit www.nm.org/medical-records or call 877-973-2673.

To contact Meridian, patients can call 866-606-3700 or visit www.ilmeridian.com.