There’s no getting around the reality that medical plan disruptions are difficult to navigate. And unfortunately, right now more than 31,000 San Diegans who receive care from Scripps Clinic and Scripps Coastal Medical Groups through Medicare Advantage (MA) HMO and PPO plans are experiencing this. Because, starting in 2024, these plans will no longer be accepted by Scripps.
At the same time, UC San Diego Health will no longer accept plans from Blue Shield of CA or Brand New Day in 2024. Each one of the seniors affected by these changes will need to understand their situation, be presented with their choices and make an informed decision about their Medicare benefits. And they’ll be looking to their Medicare insurance agent for help.
For your Medicare clients who are experiencing a medical plan disruption, fully explaining what’s happening and assuring them they have options are the two most important actions you can take right now. But first, you need to understand the disruptions and what their options are.
Causes of a medical coverage disruption
Medical coverage can be disrupted for a variety of reasons. And, the decision to stop accepting Medicare Advantage isn’t unprecedented. When an insurance company is difficult to deal with or no longer makes financial sense, doctors can decide to stop accepting a specific insurance plan.
In the case of Scripps, they have publicly shared a few of the reasons behind their decision to discontinue accepting MA plans. According to news reports, low reimbursements and high administrative costs for handling out-of-network care are the primary reasons.
So, if a provider in your area makes a decision affecting your clients’ coverage, what should you do?
Options for when medical coverage is disrupted
A disruption in medical coverage means making new, and not always easy, choices. The best path forward won’t be the same for every client, depending on their personal and financial situations. Here are the two main options for your clients when a disruption occurs.
Option #1: Find a new doctor
For many seniors, switching medical care professionals can be difficult. Seniors want to work with the doctor they know and are comfortable with. But, if a client is experiencing medical coverage disruption, finding a new doctor may be the most cost-effective solution.
Remind your clients that just because they’re experiencing a disruption doesn’t mean their plan is ending! Only their doctor is changing, not their Medicare insurance coverage. To best support your senior clients, make sure they know how to explore their healthcare options. There are likely many highly-regarded physicians and groups in their area that will continue to accept their insurance.
Option #2: Add a Medicare Supplement Plan
If your client’s priority is staying with a doctor that no longer accepts their plan, they’ll need to purchase a Medicare Supplement Plan. Of course, these plans come with an additional cost per month. Supplemental plans can cost between $150 and $250 per month, plus the cost of a prescription drug plan.
Medical plan disruptions are just what they sound: disruptive. So, while providing these options to your affected clients is important, don’t forget the human touch. In-person information sessions go a long way towards making your clients feel heard and supported, and they give you the opportunity to act as a steady and supportive force. If you have questions about these changes or would like more information on our weekly in-person events, contact us today.
image credit: shutterstock/izzuanroslan