Since January 2024, Scripps Health has no longer accepted Medicare Advantage plans and isn’t in-network with all Medicare Advantage plans as it used to be. There is one exception to this. The existing members from the Alignment PPO plan who were enrolled before January 2024 were grandfathered for another year, meaning they can still access their Scripps doctors in 2024 as in-network providers.
As anticipated from the last 2023 Medicare Open Enrollment (AEP), this will only last until the end of this year. Those PPO members recently received a notification letter this month from the Alignment Health Plan indicating that SCRIPPS Costal and Clinic physicians will no longer be in-network for the PPO plan and will terminate their contract on 1/1/25. However, Scripps hospitals are still in-network with this plan.
This may significantly impact members who are enrolled in the plan. Here are some ideas to consider:
- Keep the same Alignment PPO plan and Scripps doctors. However, they will be considered as Out of Network (OON) providers, which translates to higher copays and coinsurance for the members. Check the plan benefit summary to see how much you would pay using Scripps as an OON provider.
- Explore other Medicare Advantage PPO plans and stay with Scripps doctors. This is also a good option since OON costs for the Alignment PPO plan may be high for you. Consider switching to a PPO plan that has lower OON costs. Keep in mind that at this time of writing, Scripps Clinic and Coastal doctors are out of network for all PPO plans in San Diego.
- Change your doctors to doctors in groups who are still accepting Medicare Advantage plans. It also means you can switch to a different and better Medicare plan.
If you have any questions, don’t hesitate to contact me at 858-432-2322 or schedule an appointment with me. I can provide professional guidance tailored to your situation and help you navigate the transition.
