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Some San Diego Medicare Advantage customers face a tough choice

Open enrollment for Medicare began on Sunday. But more than 30,000 Scripps Health clients who have Medicare Advantage plans are now facing a difficult choice: either get new doctors or different coverage.

Scripps Health says its Scripps Coastal and Scripps Clinic Medical Groups will stop accepting Medicare Advantage plans in 2024.

Scripps Health President and CEO Chris Van Gorder said there was one big thing to understand about Medicare Advantage programs.


“It’s important for people to understand that Medicare Advantage is not Medicare," Van Gorder said on Monday.

He said Medicare Advantage plans were just private insurance companies that manage health coverage for Medicare. There are nonprofit companies and there are for-profit companies in the business.

Van Gorder said the companies did a good job of selling people on plans that they say are low-cost, with great benefits.

“Usually no copays, no deductibles, takes their profit out and pays the remaining part to the health care providers, the doctors and the hospitals," he said.

Van Gorder said business was great for a lot of the companies offering Medicare Advantage plans. For example, he said, “United Healthcare just announced a $5.8 billion third-quarter profit.”


At Scripps and other providers who accept, or have been accepting, Medicare Advantage plans, the dollars are flowing in the opposite direction.

“In fact, we’re losing more than $75 million a year, and that’s just not sustainable," Van Gorder said.

Some congressional Democrats say the Advantage plans are scams and are co-sponsoring the Save Medicare Act.

Representatives Ro Khanna of California, Jan Schakowsky of Illinois and Mark Pocan of Wisconsin have put out a video asserting that "only Medicare is Medicare," and saying: “We want to stop private plans from calling themselves Medicare, and protect actual Medicare, making sure seniors’ care is covered for the rest of their lives by a program with the power of real Medicare."

But what can patients do in the meantime? It's a question KPBS put to Chris Van Gorder.

“You need to call your insurance brokers or you need to call your insurance company to make any adjustments that you want to make," he said.

Other than that, Van Gorder said, Scripps Health is limited by federal law in what it can tell patients, who have until Dec. 7 to make their choices.