Learn what this means for you, what your options are, and the pros and cons

You’ve probably heard the news. Scripps has stated that the Scripps Clinic and Scripps Coastal Medical groups will no longer accept Medicare Advantage plans starting on January 1st, 2024. This change affects about 30,000 San Diego patients receiving medical care within the Scripps Medical System.

During the Annual Election Period that starts on October 15th and ends on December 7th, you must decide if you are going to stay with your Scripps doctors or join another medical group. There are several options available to you if you decide to stay with Scripps, and a couple more options if you decide to leave. I’ll describe all 5 below.

If you want to keep your Scripps Doctors

It is possible to continue seeing your Scripps Doctors but you will have to make changes and accept higher costs. The 3 options are listed below.

  1. Disenroll from your current Medicare Advantage plan and use only your Medicare Part A Hospital coverage and Part B Outpatient coverage, plus enroll in a Part D prescription drug plan.

    This option will add $5-$123 in monthly premiums for the Part D drug plan, depending on your medications. You will be responsible for a $1635 Part A deductible if you are admitted to a hospital, and potentially daily copays if you remain in the hospital longer than 60 days, along with a $240 Part B deductible and 20% of the costs for any doctor visits, lab tests, or other outpatient services you receive.
  2. Disenroll from your Medicare Advantage plan and enroll in a Medicare Supplemental plan (also known as a Medigap plan) along with a Part D prescription drug plan.

    This option will add monthly premiums for the Supplemental plan and the prescription drug plan. Depending on your age the range of these costs is:

       
    Age    
       
    Medigap Plan N & G   Cost   
       
    Prescription Drug Plan Cost   
       
    Total Cost   
       
    65   
       
    $106 to $230   
       
    $8 to $123   
       
    $114 to $353   
       
    80   
       
    $186 to $388   
       
    $8 to $123   
       
    $194 to $411   

    The decision about which Supplemental plan to use is best discussed with each person as it depends on several personal factors. The purpose of this table is to help you decide if keeping your Scripps doctors is affordable for you.

  3. Switch to a PPO Medicare Advantage plan and continue to use Scripps doctors as out-of-network providers.

    This option might increase your monthly premiums (some PPO plans have $0 premium) by up to $87. This option may work, but you will be paying out of pocket for many of your Scripps medical services. Therefore, unless you are healthy this might not be a good choice for you.
  4. For those few Scripps members currently receiving high-level treatment within Scripps, there will be provisions in place to allow you to continue. Please contact your broker or your insurance company to let them know.

    If you would like help in making this decision and selecting the right Medicare Supplemental plan for your needs, contact our office, and a broker will help you and answer any questions you may have.

    Leave the Scripps System and select New Physicians

    If you are not closely tied to your Scripps Physicians, then you have a couple of options.

  5. Stay with your current HMO Medicare Advantage plan and switch doctors. This will entail learning about the other Medical Groups that are in your plan network. Once you have selected a Primary Care Physician PCP) that is accepting new patients, you will notify your Medicare Advantage plan that you want to use the new PCP. That change will take effect at the beginning of the month.
  6. Switch to a new Medicare Advantage plan and use a doctor from another medical group as your PCP. You will again need to find a new PCP that accepts new patients. This option may be attractive because there are Medicare Advantage plans with richer benefits than the plans with the Scripps Network. Ask us about those Medicare Advantage plans.

These options will likely not change your monthly premiums because most San Diego County Medicare Advantage plans have a $0 monthly premium.

What are the Pros and Cons of the options?

  • Option 1Pros: You get to keep all your doctors and continue going to the same Scripps Locations, and this option is relatively low-cost.
    Cons: You may not be able to afford this option because you could be exposed to higher out-of-pocket costs for your medical services via deductibles and coinsurance.
  • Option 2Pros: You get to keep all your doctors and continue going to the same Scripps Locations. You have additional coverage to protect you against high out-of-pocket medical costs.
    Cons: Price. You may not be able to afford the cost of a supplemental plan and a drug plan.
  • Option 3Pros: This is another relatively lower-cost option that allows you to continue seeing your Scripps doctors at Scripps locations.
    Cons: You must be careful which PPO Medicare Advantage plan you select and investigate the out-of-network benefits offered in each plan. These plans will typically have a much higher maximum out-of-pocket risk than the Medicare Advantage plan you currently have, so in the event of a major medical event, your costs could be high by going out-of-network.
  • Option 4Pros: This is the easiest transition during this Annual Election Period. All you must do is select a new PCP. It does not add any cost.
    Cons: Your Medicare Advantage plan probably has other medical groups you can choose a PCP from. You need to make sure the PCP you select is “accepting new patients.” One issue to be aware of is that a doctor may be accepting new patients when you tell your insurance company that you are changing to that doctor. However, until you visit that doctor your spot in the doctor’s panel of patients is not finalized. Therefore, quickly schedule an appointment after you change doctors.
  • Option 5Pros: Most likely, this does not add any costs. You may be able to get a Medicare Advantage plan with better benefits than the plan you use for the Scripps Medical System.
    Cons: You must find a new PCP and submit a new Medicare Advantage application. The new plan will start on January 1st, 2024. There is a possibility that the new PCP you put on your application will not be available when you try to visit their office.
  • Summary

    The Annual Election Period (AEP) begins on October 15th and ends on December 7th. It is impossible to make any changes to Medicare Advantage plans or Part D Prescription Drug plans until the AEP begins. Furthermore, pricing and the benefits of plans for January 1st will not become available in quote engines until 10/15/23.

    There are more details that I would like to share with you but can’t because of Medicare restrictions.

    For more additional details, please contact one of our offices and we will make sure you get answers to your questions.


2 Comments

  1. Which Medicare PPO plans (and Insurers) Scripps will accept starting January 1, 2024? Will my current PCP, Dr. Isabel Cheon accept these plans?
    Thanks for all your help.

    1. Author

      Vijay,

      Scripps will not take any Medicare Advantage PPO or HMO plans. To continue to use Scripps Clinic and Scripps Coastal doctors you must enroll in a Medicare Supplemental plan and a Part D drug plan.

      Tim

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.