Starting Jan. 1., two Scripps Health groups will no longer accept Medicare Advantage plans — a decision that will affect thousands of patients.
Scripps Clinic and Scripps Coastal have more than 32,000 Medicare Advantage HMO patients, according to Pat Salas, the CEO of SBHIS Insurance Services.
Scripps Health released a statement outlining the reason for their decision.
“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.
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"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’ most recent financial report details the financial pressure.
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Roc Rogers, a Medicare Advantage enrollee, says he recently received an email notifying him about the plan being pulled.
“I have a couple of specialists with Scripps, so I won’t be able to see them as far as I know," Rogers said. "I’m going to have to change my healthcare, and I don’t know what I’m going to do yet because you can’t change until October 15th."
But Medicare Advantage users have some options, according to Salas.
“Choice one is to stay at Scripps Clinic or Scripps Coastal because maybe you're on treatment, maybe you love your doctor, you've been there for years, and you don't want to leave,” Salas said.
Another option Salas provided is for Medicare Advantage users to leave Scripps Clinic or Scripps Coastal.
“Keep an HMO, which is inexpensive, but move your healthcare elsewhere," Salas said. "That's where I really think at least a third or not two-thirds of the people are going to end up."
Scripps Health's clinic and coastal medical groups will continue to accept original Medicare (Part A and Part B).
