SAN DIEGO — Scripps Health is cutting coverage for thousands of seniors in San Diego County at the end of this year when it stops its participation in the Medicare Advantage program.
On Monday, Lisa Bock and her wife Lori received what they call a shocking letter from their Medicare Advantage Plan, SCAN.
It read in part, “as you may have heard, Scripps Clinic and Scripps Coastal primary care doctors will not be contracting with Medicare Advantage HMO plans by January 1, 2024 … Because your SCAN plan is an HMO, this means you may not be able to see your current primary care doctor after December 31, 2023.”
“When Lori read that, she just went through the roof because she loves her primary care doctor,” Bock recalled. “I’m freaking out … she started hyperventilating. I had to calm her down.”
Lori and Lisa are just two out of the more than 30,000 elderly San Diegans under one of several health plans like SCAN that will no longer be able to use Scripps Health services without a significant financial burden.
It’s a move gravely impacting the Bocks, who have been users of Scripps Health for the past 20 years.
“She’s had heart issues, she’s had breathing issues, she has early-stage dementia … these things require a lot of treatments, and they require a lot of checkups,” Bock said, referencing her wife, Lori. “She has access to a pain management clinic and she most likely will lose that, which is crucial to her wellbeing.”
FOX 5 reached out to Scripps Health regarding the matter to which they responded with the following statement:
Scripps has long served seniors and others in our community who are enrolled in Medicare and Medicare Advantage plans. Scripps and health systems across the country are facing unprecedented financial pressures. We are looking at all we do and, when necessary, making difficult decisions to ensure that we can continue to meet the needs of the community we serve. The revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide.
As a result, Scripps Clinic and Scripps Coastal medical group doctors will not be in-network with individual Medicare Advantage plans in 2024. However, doctors from both Scripps Clinic and Scripps Coastal will continue to accept original Medicare (Part A and Part B). Medicare Advantage plans may continue to be accepted by doctors in other medical groups affiliated with Scripps, allowing patients to continue to receive care at Scripps hospitals.
We are committed to working closely with both our patients and medical groups to ensure as smooth a transition as possible.Scripps Health
Now, the thousands impacted — including Lisa and Lori — are left scrambling to figure out what is next.
“Most seniors don’t like change, and they’ve grown use to their doctors and their networks over the years,” explained Pat Salas who is the President and CEO of SBHIS Insurance Services, the county’s largest and oldest Medicare Advantage Agency.
Salas says patients who would like to stay with Scripps Health have options, but it comes with a price. “They can consider a Medicare supplement, which will probably have a cost somewhere between $300 to $400, including prescriptions per month. Right now, they’ve been paying zero.”
Another option to keep one’s current primary care doctor includes disenrolling with your current Medicare Advantage plan and choose different health care coverage for the new year.
“We can’t afford that at all,” Bock said. “We’re both on fixed incomes. We’re both on disability.”
In response to the news, SBHIS Insurance services is hosting a conference with Salas to address any concerns users may have on Monday, October 2nd. Patients can connect with them here.
The meeting will be held at 740 Bay Blvd. Chula Vista, CA 91910.