SCRIPPS CLINIC and SCRIPPS COASTAL
Scripps Clinic and Scripps Coastal are NOT accepting ANY Medicare Advantage
HMO plans. However, they will accept Medicare Advantage PPO plans or Medicare
Supplement plans
It is IMPORTANT to understand that with a PPO plan you will have IN-Network
doctors and services with lower copays and a lower Maximum Out of Pocket. The
OUT-of-Network doctors and services will have higher copays and a considerably
higher Maximum Out of Pocket.
The copays MAY be a fixed dollar amount, so you will know what you owe. But
for many of the Out-of-Network services, your portion will be a PERCENTAGE of
the cost of the service. For example, if you see your Scripps doctor (which will be
OUT-of- Network on ALL PPO plans in 2025), and he/she refers you to get an MRI or
have an Outpatient Surgery, your copay is 40%. But the question is ... 40% of what??
The doctor is not going to be able to tell you what the full cost of the MRI or
Outpatient Surgery is, and most likely will not refer you to an IN-Network medical
group to have it done at the lower copay. Also, your OUT-of-Network Maximum Out
of-Pocket is probably going to be in the $8,900 - $10,000 range. If you have to have
access to Scripps Clinic or Coastal doctors and have a Medicare Advantage PPO, you
are going to need keep track of IN and OUTof-Network doctors, facilities, services
and copayments.
SHARP COMMUNITY, SHARP REES STEALY and PALOMAR
HEALTH
If you are seeing Sharp Rees Stealy, Sharp Community or Palomar Health doctors, and
currently have the UnitedHealthcare Sharp Walgreens plan, which is changing its name
to the UnitedHealthcare Sharp Value RX plan, this plan will remain relatively
the same for most copays. What will be changing are some of the additional benefits:
- The vision allowance for frames is being reduced to $300 every TWO years.
- The $1,500 comprehensive dental coverage is going away. Instead, you will have
preventative dental coverage (2 exams, x-rays and cleanings per year at $0
copay). You have the option to add an additional HMO dental rider to this plan
for $54/month.
- There will be a $175 Part D deductible, where there was no deductible before.
- The transportation benefit is going away.
The only reason I would suggest you make a move from this plan is if you really
relied on the transportation benefit.
UCSD MEDICAL GROUP
If you currently are using UCSD doctors, you probably have either the SCAN Alta plan
or the Humana UCSD plan. Both are great plans, however, if you are new to Medicare
or trying to switch from another medical group to UCSD Medical Group, we cannot
enroll you in the SCAN Alta plan, as UCSD has put a hold on taking any new patients
with the SCAN plan.
However, we can enroll you in the Humana UCSD plan, and that will get you to see UCSD
doctors and use UCSD facilities/hospitals. If you already have the Humana UCSD plan
or SCAN Alta plan, you do not need to do anything.
|
