New Individual health insurance Marketplace (Exchange) plans starting January 1, 2024

Members are signing up* for new Affordable Care Act (ACA)-compliant Individual health plans that will be effective January 1, 2024:

• Blue Value Individual Network HMO
• Pathway PCP Copay Choice

Blue Value Individual Network HMO

In the October 2023 edition of Provider News, we introduced Blue Value Individual Network HMO, a new network and set of six silver and gold plans being sold in 61 counties in mid-southern Georgia. Members who no longer qualify for Medicaid coverage or are not enrolled in any health benefit plan may find these products an affordable coverage option with Silver plans starting at $0 per month for fully subsidized individuals in 31 counties.

Pathway PCP Copay Choice

Pathway PCP Copay Choice plans are also new in 2024 and are being sold to members in nine counties and 101 ZIP codes in the Atlanta area with three plan designs. The PCP Copay Choice plans use the same provider network as the other Pathway Guided Access plans. As some PCPs will accept a lower copay ($5 vs. $30), it is important to verify each member’s benefits on Availity Essentials.

Provider demographic updates

During Individual Open Enrollment (November 1, 2023, to January 15, 2024), it’s important for you to take time to review your data and submit any demographic changes through Availity Essentials and GAMMIS. Updating your data will ensure our files are up to date and our directories stay current, which is critical for Anthem Blue Cross and Blue Shield to accurately assign PCPs in gatekeeper plans.

Quick reference guide

We’ve put together everything you need to know about these plans in a useful Quick Reference Guide, including samples of member ID cards so you can easily identify members on these new plans. This guide is available on the Provider News section of our website.

Thank you for the quality care you continue to provide your patients, our members. We look forward to working together to achieve improved outcomes.