Medicare Dis-Advantage: Scripps Ends Medicare Advantage Coverage
- Don Mosier | Rimini Road
In late September, Scripps Clinic and Coastal Group informed seniors with Medicare Advantage insurance that their coverage would stop at the end of the year. This change leaves about 32,000 seniors in San Diego with only a few, more costly options. I’m not an insurance expert, and anyone forced to change insurance plans should consult someone qualified to give advice. Let me just list the most obvious options to maintain full coverage.
Basic Medicare Plans A (hospitalization), B (physician services, outpatient visits) and D (prescriptions) cover major medical expenses with a deductible ($1600/year for Plan B) and some limits on coverage. These Medicare Plans are not affected by the Scripps action. Medicare is not free. You pay monthly fees based on income; the fees are usually deducted from your Social Security payment. Medicare Part B premiums for higher income families are over $500/month.
Many insurance companies offer Medigap policies to fund services not covered by standard Medicare policies The Medigap plans are offered at three levels: Advantage HMO (Health Maintenance Organization) plans that have no or very low monthly fees, but restrict services to in network providers; Advantage PPO (Preferred Provider Organization) that have moderate (usually less than $100) monthly fees, and cover visits to providers not in the plan network; and Medicare Supplemental Plans that may cover most or all fees not covered by Medicare basic plans, but they are more expensive ($150-1,000/month for Plans F or G, depending on your age).
FACTOID:
Health spending per person in the U.S. was $12,914 in 2021, which was over $5,000 more than any other high-income nation. The average amount spent on health per person in comparable countries ($6,125) is less than half of what the U.S. spends per person. The high cost of medical care is a national problem with unfortunate local consequences.
Because Scripps is ending coverage for Advantage HMO and PPO plans, individuals enrolled in those plans have until the end of February 2024 to choose a new insurance plan. However, delaying the decision beyond December 2023 may result in a gap in coverage.
If you want to stay with your current Scripps doctor, it appears that the first option is to enroll in a Supplemental Plan and pay more per month for the coverage. More information about these plans is available at: https://bit.ly/options-scripps
A less expensive but more risky option is to depend on Basic Medicare Plan B and accept the deductible and 80% coverage of expenses.
Other health care providers in San Diego are still accepting Advantage HMO or PPO plans. The downside of this option is that you are likely to have a new doctor and new location to deal with. In addition, other providers may face the same financial headwinds as Scripps and decide to end Advantage plans at some point in the future.