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Following Anthem Blue Cross Medicare Advantage’s withdrawal of local services in 2023, United Healthcare has announced it will no longer offer Medicare Advantage plans to its members in San Benito County. United’s coverage will end on Dec. 31, 2024, and members have until Dec. 7 to find a new plan.
“It’s called a Service Area Reduction,” said Andrew Shelton of Hollister’s Shelton Insurance. “Nobody really knows why, but you can always blame the money. They’re finding that it’s not viable for them to operate here in the county anymore.”
Shelton said that there are three options for Medicare-eligible coverage. The first is regular Medicare, Plan A, available to individuals who have paid into the program for at least 40 quarters. It helps pay for hospital stays, skilled nursing facilities, behavioral and mental health services, and hospice care.
Additional coverage can be added through Part B, which helps pay for things like doctor visits, outpatient care, preventative services, and durable medical equipment. Shelton said this option usually covers about 80% of an individual’s medical expenses.
“Only that 20% factor would be left open,” he said. “It’s good if you don’t go to the doctor too often or are willing to take that 20% hit down the road if surgery occurs.”
The second option is adding a Medigap plan, which Shelton said has the benefit of allowing a patient to access the majority of available doctors.
“Medicare is the primary,” Shelton said, “and Medicare does what Medicare needs to do. The remaining 20% of the claim is adjudicated through the carrier.”
The third option is a Medicare Advantage plan, usually offered with an additional premium.
“Medicare Advantage plans typically have co-pays and maximum out-of-pocket expenses,” Shelton said. “So if you utilize the benefit and have surgery or visit an emergency room, something along those lines, there’s going to be a cost associated with that.”
Shelton said that the positive of a Medigap policy is that it allows access to a doctor and services no matter where you are rather than being limited to doctors who accept Medicare Advantage plans.
Shelton said the choice between an Advantage Plan and a Medigap Plan depends on what an individual is used to.
“If they have a specific doctor or hospital they prefer,” he said, “then a Medicare Medigap policy would be more ideal. Others might not care about the level of care they get and want the cheapest way. And that’s where the Medicare Advantage plan would suffice.”
Shelton said that around 30-40% of his clientele has reached out for assistance with the changes in coverage and recommends people do not wait until the last minute to decide, no matter which insurance agent they consult.
“We’ve got another 30 days,” he said. “When people come to us, we ask for things up front like medication lists and their doctors of choice, because time is very valuable right now.”
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