SAN DIEGO — Thousands of Scripps patients are scrambling to figure out where they'll receive medical care next year after Scripps announced two of its health groups will no longer accept Medicare Advantage HMO Plans. This change will impact the roughly 32,000 people who have Medicare Advantage HMO Plans at Scripps Clinic and Scripps Coastal.
The change goes into effect Jan. 1, 2024.
Patients like David Lombardi said this change is a hard pill to swallow. He has a chronic condition and replies heavily on the care he receives.
"It's just a burden,” Lombardi said. “It took a lot of work to find what I consider to be the right specialist getting the care that I think I need."
Medicare Advantage HMO Plans are privately run versions of the federal government's Medicare program mainly for people 65 and older. That means Lombardi will either have to enroll in a new plan to stay at Scripps, which could cost upwards of 350 dollars more per month, or find a different doctor.
“One, they don't know my history even if they get it in a chart, they're not gonna know really my reactions that the specialists I'm dealing with now know,” said Lombardi.
In a statement, Scripps tells CBS 8:
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.
Medicare Advantage plans are insurance products sold to the public by private insurance companies and funded by the Centers for Medicare and Medicaid Services. Scripps tried to negotiate with private insurers for reimbursements that would cover our costs but was unsuccessful.
As a result, no individual Medicare Advantage plans are open for enrollment by patients where Scripps Clinic and Scripps Coastal medical group doctors are in-network.
Doctors from both Scripps Clinic and Scripps Coastal will continue to accept original Medicare (Part A and Part B) and Medicare Supplemental products (Medigap). Scripps independent physicians, through their medical groups, will still be accepting Medicare Advantage and using Scripps hospitals.
If patients have specific insurance-related questions, they should first contact their insurance plan or broker. Scripps is better able to help patients with questions about their care and access to medical records.
Additionally, patients should be receiving emails and/or letters from their insurance plans which should answer some of their insurance coverage questions and provide additional resources.
We are committed to working closely with both our patients and medical groups to ensure as smooth a transition as possible.
CBS 8 spoke with Pat Salas, President and CEO of SBHIS insurance services, the county's largest and oldest Medicare Advantage agency.
According to her, while hospitals drop plans all the time, this is the largest disruption in San Diego history.
"Imagine if you're that person," Salas said. "You're going to have to decide, 'Do I pay for this expense or not?' It's a tough one."
She said if patients can't pay more to stay, she advises patients to make sure to voice which medical provider you would like to change to and to see if they have space as soon as possible. Many establishments may now get inundated with new requests, she said.
"It's not like you'll be left in the cold January 1. You're gonna still have that plan and they'll switch you to another provider. This is where members need to take a role and say 'let me choose where I wanna go,'" Salas said.
At this point, Lombardi isn't sure what he's going to do, but says neither option is ideal.
“It's just gonna be starting from ground zero again,” said Lombardi.