Medicare health insurance plan canceled in Stanislaus County

An image of the latest Medicare card, still in paper form.

An image of the latest Medicare card, still in paper form.

Courtesy of AARP

Many Stanislaus County seniors are facing loss of insurance coverage on August 1 due to financial problems with a Medicare health plan.

The Golden State Medicare Health Plan sent letters toward the end of June informing members that its contract with Medicare was mutually terminated effective August 1. People enrolled in Golden State will lose their insurance on August 1. Seniors covered by other insurance plans are not affected. .

The state Department of Managed Health Care took action last year to revoke Golden State’s health plan license due to the insurance plan‘s deteriorating financial condition.

According to a settlement agreement with the state agency, which governs managed care coverage in California, Golden State reported a $27 million shortfall in an April 2021 financial statement and a $35 million shortfall. in December. A Department of Managed Health Care order in April 2021 barred Golden State from accepting new enrollment applications.

Golden State provided insurance to Medicare beneficiaries in Stanislaus, San Luis Obispo, San Francisco counties and five Southern California counties.

“We get a lot of calls from these people,” said Maria Profeta, health insurance counseling and advocacy program manager in Stanislaus County.

Profeta said the HICAP office, which helps people navigate the Medicare system, takes 10 or more appointments a week to help them get other insurance coverage. Ten other insurance companies offer federally funded “Medicare Advantage” health plans in Stanislaus County.

A representative for Golden State in Newport Beach could not be reached on Wednesday. A phone recording said the health plan will cease to exist as of August 1 and advised members to call the Medicare program or visit the Medicare.gov website to obtain alternate coverage.

The Modesto HICAP office did not count Golden State’s membership in Stanislaus County.

Profeta said Golden State customers who don’t make changes could lose prescription drug coverage and will revert in August to the original Medicare benefits, which don’t cover the full cost of the drug. hospitalization, Profeta said.

“It can be difficult to see a doctor because many doctors don’t work with the original health insurance,” she added.

In addition to the Modesto HICAP office, the program providing unbiased help to Medicare beneficiaries has satellite locations in Turlock, Ceres, Oakdale and Patterson. Residents of outlying communities can call HICAP to make appointments for assistance at satellite locations. HICAP also offers counseling appointments by telephone or videoconference.

The HICAP program will host a registration event on August 18 from 8 a.m. to 11 a.m. at the Stanislaus County Library, 1500 I St., Modesto. The Modesto Farmers Market will also take place during this time. Representatives from various insurance plans will answer questions about their approved health insurance plans.

Golden State began serving its members in Stanislaus County in 2015. It offered zero-premium, no-copay coverage for hospitalizations and doctor visits.

The Health Insurance Counseling and Advocacy Program in Stanislaus County can be reached at 209-558-4540. The toll-free number for Medicare is 800-633-4227 or visit Medicare.gov.

This story was originally published July 21, 2022 06:00.

Modesto Bee Related Stories

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

Comments are closed.