Popular Scripps Health groups leave Medicare Advantage, impacting 32,000 patients.

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Scripps Health has announced that its popular clinic and coastal medical groups will no longer be participating in Medicare Advantage plans starting from January 1, 2024. This decision is estimated to impact approximately 32,000 San Diego County seniors who are enrolled in various plans from organizations such as SCAN, Anthem, Alignment, and Blue Shield, among others. The move was confirmed by Scripps’ CEO, Chris Van Gorder, who stated that it is not a negotiation tactic. Traditionally, Scripps Coastal and Scripps Clinic have been the most sought-after provider networks within the organization.

Many patients are already beginning to explore alternative options in response to the announcement. Roc Rogers, who has been a SCAN plan holder with a Scripps doctor since 2018, is considering switching to original Medicare with the help of supplemental health insurance. However, this would likely come at an additional cost of nearly $300 per month. Despite the potential financial burden, Rogers values the high-quality care received at Scripps and wishes to stay with the provider. On the other hand, some patients, like Dave Averett, are less concerned about remaining with Scripps due to their dissatisfaction with the provider’s services.

Scripps’ decision to withdraw from Medicare Advantage plans is a result of financial challenges. The organization has been operating at negative margins, experiencing increased labor and supply costs, which have impacted medical providers nationwide. Pulling out of Medicare Advantage will save Scripps from sustaining a projected operating loss but might potentially affect its bond rating. The organization needs to maintain its cash reserves for future borrowing to fund crucial projects, such as repairing and replacing medical campuses and making seismic improvements mandated by state law. As patients now face the task of finding new doctors during the upcoming Medicare open enrollment period, Scripps has established a hotline to assist them in exploring alternative options.

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