There were two plans that left Santa Clara and one that left San Benito at the end of 2023.

 

Cheri Brown

Dear Medicare Cheri,

We have had our health insurance for several years, and it has always continued from one year to the next. In January, we got a huge surprise when we went to the doctor — we had no health insurance coverage! Can you please sign us up for a new plan?

Worried and Can’t Get Sick

 

Dear Worried,

You are not the only person who has contacted me with this situation. There were significant changes in the Medicare Advantage Market between 2023 and 2024.  When a Medicare Advantage plan leaves a county, they are required to notify their clients. Unfortunately, many people either did not receive their notification or didn’t read the notification. Fortunately, when this happens, the Medicare beneficiary has a Special Election period until the end of February. This election period allows people to join either another Medicare Advantage plan or a Part D plan and a Medicare Supplement (without going through Underwriting).

There were two plans that left Santa Clara and one that left San Benito at the end of 2023. This applies to Medicare Advantage plans only, not to Medicare Supplements. This does not apply to the “N Plan,” “G Plan” or “F Plan.”

Essence Health Plan exited Santa Clara County. This company was contracted with Stanford Health, they left the market entirely. People who want to continue seeing their Stanford physicians can either choose original Medicare, with a MediGap (aka Supplement plan) and a stand-alone Part D prescription drug plan. As of this writing, Stanford is only contracted with one Medicare Advantage plan through United Healthcare.

Anthem Blue Cross made significant changes with their Advantage plans between 2023 and 2024 in Santa Clara County. For 2024 they remain in the market with three plans; in 2023 they had 12 different plans. Of those 12 plans, five were automatically moved to a new plan but people on seven of the plans must choose a new plan or they won’t have a plan for 2024.  The plans included their special needs plans for people with chronic conditions such as diabetes, heart disease and lung disease.

In San Benito County, Anthem Blue Cross left the county. Anyone in San Benito with an Anthem Blue Cross Medicare Advantage plan (managed by CareMore Health) who did not choose a new plan for 2024 has reverted to original Medicare.

In addition to the plans that have left the county, there have been contracting changes; Medicare beneficiaries may find their physicians no longer accept their plan.

El Camino Health Medical Group (the physicians, not the hospital) is contracted with Alignment Health Plan and United Health Care for 2024 (as of this writing). People who discover they can no longer access their El Camino Health doctors can use the Medicare Open Enrollment Special Election Period to change to a plan that will allow them to continue seeing those physicians until the end of March.

People concerned about not having Medicare Advantage coverage for 2024 may call 1-800-MEDICARE (open 24/7) or call our local Sourcewise office at  (408) 350-3200, provide them your Medicare number and ask which plan you have for 2024.

Cheri Brown can be reached at [email protected].