By Mark Miller
Many seniors in San Diego, California are facing a confusing scramble to find new insurance or healthcare providers as Medicare enrollment rolls around this year. Scripps Health, a major healthcare provider, announced that it will no longer accept patients enrolled in Medicare Advantage starting next year. This has left 32,000 San Diego seniors rushing to find new options for 2024.
Disabled individuals who qualify for Medicare before turning 65 are also affected by this change. Scripps Health is not alone in terminating Advantage contracts, as several other health systems around the U.S. are doing the same.
Medicare’s annual enrollment period is currently underway and will end on December 7. If you are enrolled in traditional Medicare (Parts A and B) with a Medigap, there is no need to review that coverage. However, it is important to review Part D prescription drug or Medicare Advantage coverage during this time. This is also the opportunity to switch between Advantage and traditional Medicare.
Over the past decade, Medicare Advantage enrollment has grown rapidly due to its all-in-one features and lower upfront costs. Most Advantage plans include prescription drug benefits and do not require supplemental Medigap policies, which can be expensive. However, the recent decision by Scripps Health highlights a downside to Medicare Advantage plans – the lack of guarantee to continue seeing preferred doctors and hospitals. Advantage plans can drop providers from their networks if agreements cannot be reached.
This new development of healthcare systems dropping out of Medicare Advantage adds another layer of complexity for individuals deciding between traditional Medicare and Advantage. The choice is not just a financial consideration but also one that affects health and quality of life.
Scripps Health CEO and President, Chris Van Gorder, explained that the decision to stop working with Advantage plans was driven by insurance companies’ low rates of payment and the tendency of sicker patients to seek treatment at top-tier medical centers like Scripps. The administrative burden of dealing with Medicare Advantage’s prior authorization procedures also played a role in the decision.
The Scripps move has left thousands of seniors scrambling for alternatives. Sophie Exdell, program manager of the San Diego area HICAP, said they have been receiving numerous calls from people trying to figure out what to do. The most common concern is individuals in the middle of treatment who want to continue seeing their doctors.
Affected Scripps patients have two options: switch healthcare providers or insurance coverage. During the annual enrollment period, it is possible to drop Medicare Advantage and opt for traditional, fee-for-service Medicare. However, traditional Medicare does not have an annual out-of-pocket limit, exposing patients to potentially high co-pays and deductibles. Many individuals address these coverage gaps by purchasing a Medigap supplemental policy. However, transitioning from an Advantage plan to traditional Medicare can be complicated.
The best time to buy a Medigap policy is when first signing up for Medicare Part B. During this “guaranteed issue” window, Medigap plans cannot reject individuals due to pre-existing conditions. Some states, such as Connecticut, Maine, Massachusetts, and New York, provide additional enrollment protections for individuals with pre-existing conditions.
In California, one insurer is offering two plans to all applicants, declaring a limited “underwriting holiday” that does not consider health conditions.
Switching to Medigap will result in higher upfront premium costs. Medigap policies are priced based on age, and the annual cost for a Medigap G plan in San Diego ranges from approximately $2,500 at age 70 to $4,200 at age 80, according to the SHIP.
Some patients are open to switching healthcare providers, but they face the challenge of navigating a crowded Advantage market with over 90 plan offerings next year.
The author, a columnist for Reuters, explains that this decision by Scripps Health highlights the complexities and considerations involved in choosing between traditional Medicare and Medicare Advantage.
Note: This news article has been rewritten to meet the specified word count.
