Kettering Health Terminated Anthem Medicare Contract
The Dayton-based health system will be out-of-network for Anthem Medicare Advantage plans starting in 2027.
Updated on Oct. 6, 2026 in Healthcare
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Kettering Health has terminated its contract with Anthem Medicare Advantage due to disputes over reimbursement levels and administrative burdens. The system will be out-of-network for those members effective January 1, 2027.
Why it matters
The change stems from Kettering Health facing payment shortfalls, citing claim denials and reimbursement rates that lag behind inflation and traditional Medicare benchmarks. The move forces local patients to navigate potential provider changes as the network agreement concludes.
The system reported that Anthem reimbursement rates currently trail both traditional Medicare levels and standard inflation benchmarks. This decision follows operational challenges involving persistent claim denials and administrative burdens.
The players
Kettering Health
A non-profit network of hospitals and outpatient centers headquartered in Dayton, Ohio.
Anthem Medicare Advantage
A private insurer providing Medicare health plans to eligible seniors and individuals.
RetireMed
An organization that provides assistance and guidance to individuals regarding Medicare enrollment.
The details
Kettering Health confirmed that it will contact impacted patients via letter to explain the upcoming network change. Meanwhile, resources like RetireMed are available to assist members during the Medicare Annual Enrollment Period to help them manage their health coverage transitions.
Timeline
October 15, 2026: The Medicare Annual Enrollment Period begins.
December 7, 2026: The Medicare Annual Enrollment Period ends.
December 31, 2026: The current Kettering Health contract with Anthem expires.
January 1, 2027: Kettering Health officially leaves the Anthem network.
Market Landscape
Kettering Health's decision follows a broader industry pattern of healthcare providers distancing themselves from private Medicare plans due to reimbursement and administrative friction. This shift reflects growing tensions between major hospital networks and insurers over the profitability of Medicare Advantage contracts.
Anthem Medicare Advantage members in the Dayton area will need to evaluate their coverage options before the annual enrollment window closes in December to ensure continued access to Kettering Health facilities. Patients should watch for official notifications from the health system regarding specific transition steps.
The takeaway
Patients currently utilizing these plans should proactively review their provider networks and enrollment choices during the upcoming winter window. Staying informed about insurance contracts is a critical step in maintaining continuity of care for specialized medical needs.
Further reading
For more on the changing landscape of local medical coverage, visit Healthcare.
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Do you believe private insurers should be required to match traditional Medicare reimbursement rates?
