Expert says being able to buy a guaranteed supplemental plan only possible if plans proactively drop Scripps doctor groups
Scripps Health insisted last week that it remained open to keeping its most sought-after medical groups working with Medicare Advantage plans, and one key health insurance executive says he is feeling more hopeful than was previously the case.
What’s more, a quirk in federal and state law makes it difficult for those looking to purchase supplemental Medicare plans — often called “Medigap” coverage — if they have pre-existing conditions. Last week, Scripps’ public relations director cited rising health care costs and “reimbursements not keeping up” as a reason why the Medicare Advantage situation has reached its current state.
Original Medicare allows beneficiaries to select any provider enrolled in the program and is accepting new patients. There is also no requirement to see a primary care doctor before seeing a specialist. Medical underwriting, the practice of basing coverage and premium decisions on a person’s health history, is not allowed for new Medicare enrollees. But, once a person has been in a plan for a year, health insurance companies are allowed to take pre-existing conditions into account. This can put survivors of serious medical problems such as cancer and heart disease at a severe disadvantage.
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