About 2,000 Medicare patients in Stanislaus County face change in network for 2020

Close-up shot of stethoscope on table. Getty Images | Royalty Free
Close-up shot of stethoscope on table. Getty Images | Royalty Free Getty Images/iStockphoto

Medicare recipients in the CareMore health plan will make appointments with physicians in Central Valley Medical Group starting next year.

AllCare Independent Physician Association has broken away from the CareMore Medicare Advantage plan. About 2,000 CareMore members are faced with finding another Medicare-approved insurance plan aligned with AllCare, so they can keep their doctor, or finding a new physician with Central Valley Medical Group.

Seniors in the CareMore plan have been notified in letters. Staff members at the Health Insurance Counseling and Advocacy Program office in Modesto are assisting people who have questions.

An enrollment period for Medicare signups or making changes to coverage options runs through Dec. 7.

Newcomers to Medicare soon find out the basic federal program for people 65 and older covers 80 percent of medical costs such as physician visits or emergency room services. Many retirees choose to add supplemental insurance or receive their benefits through a Medicare Advantage plan that provides more coverage.

Starting Jan. 1, the Medigap C and F supplemental insurance covering out-of-pocket expenses will be discontinued.

In Stanislaus County, 10 different insurers are offering HMO-style Medicare Advantage plans in 2020 to cover deductibles and prescription drugs and reduce hospital expenses. The premiums range from zero to $124 per month.

The nonprofit SCAN Health Care is the newest plan in this county. It has coverage options for people with diabetes, heart failure and end-stage renal disease and a provider network including Doctors and Emanuel medical centers and Central Valley Medical Group. The SCAN Classic plan is being introduced with a zero monthly premium.

PACE is a program with all-inclusive care and wrap around services to help the elderly to keep living independently at home. Some services are provided at home, while other services are available in the community or at a day center. According to its website, Sutter Health and a partner created Stockton Pace in 2016, with a center in Stockton, and plan to open a Stanislaus County center.

The services include primary and specialty care, prescription drugs, home support and dental. Those eligible for Medicare are responsible for paying Medi-Cal and prescription drug premiums. Patients with Medicare and Medi-Cal may receive free services if they’re not responsible for a share of cost.

For almost all Medicare Advantage plans in Stanislaus County, the monthly premiums in 2020 are less than $100. AARP Secure Horizons is $99 per month for Plan 1 and $9 for Plan 2, with the provider network including Memorial and Doctors medical centers, Sutter Gould physicians groups and AllCare.

Secure Horizons has a new Focus plan, exclusive to AllCare and Doctors Medical Center, for $19 monthly.

Five other insurers offer coverage at zero monthly cost: Alignment Health AllCare Preferred and My Choice; CareMore StartSmart through Anthem Blue Cross; Blue Shield Promise; Golden State Connected Care; and HealthNet basic Healthy Heart plan. The health plans with zero premiums generally have higher out-of-pocket expenses.

Kaiser Permanente Senior Advantage is priced at $79 per month for Enhanced and $20 for Basic. CareMore’s Value Plus is $49 per month, Humana Gold Plus is $19 per month, and Health Net’s premium Healthy Heart is $124 per month.

Free assistance with navigating Medicare is available to Stanislaus County residents weekdays at the Modesto HICAP office, 3500 Coffee Road. Call 209-558-4540.

Ken Carlson covers county government and health care for The Modesto Bee. His coverage of public health, medicine, consumer health issues and the business of health care has appeared in The Bee for 15 years.