Insurance

Thank you for choosing Mercy Health for your care. Our goal is to provide information about the insurance plans accepted by Mercy Health hospitals and Mercy Health Physicians, and help you understand your options when choosing a health benefit plan.

Accepted Insurance Plans

Mercy Health accepts a variety of health insurance types (including commercial, Medicare and Medicaid) from many local and national health insurance carriers to best serve our communities. To check if our hospital is contracted with your insurance, choose the hospital location you plan to visit below. Please know this list is subject to change. 

It is always a good idea to confirm coverage and restrictions with your insurance provider before scheduling visits and procedures. For example, please be aware that your health plan may require you to schedule some services (such as lab work, imaging, etc.) at select locations in their network. If you choose to receive services outside of those locations, your insurance may deny coverage, and you may be responsible for all charges provided outside your network.

Have questions about billing, insurance, or something else? Call (513) 956-3729 or click here.

Ohio

Cincinnati

Lima

Lorain

Springfield

Toledo

Youngstown

Kentucky

Irvine

Paducah

Non-participating Insurance Plans

We recommend you confirm coverage and restrictions with your insurance provider before seeking services.

Some health insurance plans do not use a contracted network of providers or are not contracted with Mercy Health. These plans are considered out of network at Mercy Health. Due to the structure of these benefit plans, Mercy is unable to bill the insurance on the patient’s behalf, and the patient will be responsible for total billed charges.  

Here are some non-participating plans*:

  • Allied Benefits System**
  • Altrua Healthshare
  • Apostrophe Health
  • Benefit Administration Systems
  • Christian Care Medi-Share
  • Cypress Benefit Administrators
  • ELAP
  • Employee Benefit Management
  • Enterprise Group Planning (EGP)
  • Group Pension Administrators (GPA)
  • Group Plan Administrators
  • Health Cost Solutions
  • Healthscope
  • Healthy Ohio Network
  • HS Technology
  • Imagine Health
  • JP Farley
  • Lucent Health
  • Maestro Health
  • MedBen
  • Nova Healthcare Administrators
  • OhioHealthy
  • Sure Solutions
  • TrueCost (Custom Design Benefits)

*Because contracts may change on a regular basis. this list of non-participating plans may not be comprehensive and is subject to change.

**Allied Benefits System is a non-participating plan if no other payer network is referenced on the insurance card. If the insurance card lists another payer that is in network for Mercy Health, the insurance may be in network.

Medicare 

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease. Medicare has four parts: A, B, C and D.

  • Part A: insurance that covers the cost when you are admitted to the hospital
  • Part B: insurance that covers the cost of visiting a physician or other outpatient services
  • Part C: also called Medicare Advantage plans, offers the choice to receive Medicare benefits through local or regional private plans
  • Part D: helps pay prescription drug costs, for which you must enroll in a private drug plan or have it as part of your Medicare Advantage plan

Sometimes Medicare Part B payments are made directly to you, and then you will submit payment to Mercy Health for any portions not covered by Medicare or other insurance. More information can be found at medicare.gov or by calling Customer Service.

Medicaid

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. 

Medicaid managed care provides Medicaid health benefits and additional services through arrangements between state Medicaid agencies and managed care organizations. 

Ohio Medicaid

With a network of more than 83,000 active providers, Ohio Department of Medicaid delivers healthcare coverage to 2.9 million residents of Ohio daily. For more information, please visit medicaid.ohio.gov.

Kentucky Medicaid

If you are a Kentucky resident enrolled in Medicaid, please visit http://www.chfs.ky.gov/default.htm for more information on your benefits and next steps.

Choosing Your Health Insurance

To make sure you’re covered, here are some things to consider when choosing health insurance for you and your family. 

Where to get health insurance

Many people have access to health insurance through their employer. If this is available to you, it is often the most cost-effective. 

For those who don’t have access to health insurance through a job, the government provides plans for purchase on the health insurance marketplace. You can explore your options at healthcare.gov

You also have the option to get health care insurance directly from an insurer or through a private exchange. If you choose one of these options, you won’t be eligible for marketplace premium subsidies, which provide income-based discounts on your monthly premiums. 

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with end-stage renal disease. Learn more at medicare.gov

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Learn more at medicaid.gov.

What to know about your cost for health insurance

When choosing a plan, there are many factors that affect the overall price of a plan and costs you may pay:

  • Premium: This is the monthly amount you pay for your coverage. It doesn’t include payment for any medical services you receive.
  • Deductible: This is the amount you pay for covered services before your insurance plan pays a portion of your bills. This typically resets each year.
  • Co-insurance: This is the percentage of a medical charge you are responsible to pay and usually applies after you’ve met your deductible.
  • Co-pay: This is a set amount you are responsible to pay at the time you receive a certain service or medication.
  • Out-of-pocket maximum: This is the maximum amount you would be responsible to pay in one year for health care before your insurance covers 100% of the bill. Your plan may have an out-of-pocket maximum for in-network services and another out-of-pocket maximum for out-of-network services. 
  • In-network facilities and doctors: If you are choosing a plan, you should verify your preferred providers are in network with the plan. Check with the plan to get a list of doctors and facilities that are in network. 

Types of plans

Health insurance plans have different requirements for you to receive coverage. For some, you must stay in network to get coverage (except for emergencies), while others offer lower costs to encourage you to stay in network. Some plans also require a referral for procedures and specialists.

According to healthcare.gov, these are the most common types of plans and their definitions:

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost.

Point of Service (POS) Plans: A type of plan in which you pay less if you use doctors, hospitals and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor to see a specialist.

Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you go to doctors, specialists or hospitals in the plan’s network (except in an emergency).

Questions to ask yourself

When considering what type of plan may work best for you, consider trends in how you and your family use health care.

  • Does the plan give you access to any current providers you see and would like to continue seeing? If so, check to see if they are in network for a plan you’re considering.
  • Do you need to see specialists often and prefer to access them without a referral? Or would prefer your primary care physician to provide a referral?
  • Because of your location, do you need to see providers that are out of network to get the care you need? If so, make sure you have coverage for out of network providers and services.
  • Do you use health care often? If so, consider plans that will minimize your out-of-pocket costs. 
  • Do you need health care less frequently? If so, consider plans that will minimize your monthly premium.
  • Do you anticipate a large medical expense, such as a surgery or having a baby? If so, consider if your deductible will lessen your out-of-pocket costs.
  • If you take any medications, how will they be covered under the plan?