Medi-Cal vs SCAN (medical, plan, doctor, benefits)

[happyexpat]

This post is for Orange County, CA residents. I have Medicare and Medical. I am trying to determine whether or not I would also benefit from the SCAN program, which is a HMO Medicare Advantage Plan. I am 70, with diabetes and am very low income, so I won't pay for doctor visits or prescriptions. There are no premiums or co-pays with SCAN but they mandate that you use a doctor on their list rather than a doctor who accepts Medicare/Medical. I tend to think I don't need SCAN, but has anyone else considered this issue and I familiar with SCAN? Thanks!

[Ariadne22]

Do you have expenses not currently covered? Are your copays too high? Medi-Cal should cover what Medicare doesn't. Drug copays should be small. Imo, you don't want the private oversight of an Advantage plan, not to mention provider restrictions. Just muddies the waters.

https://www.nlacrc.org/home/showdocument?id=682

[happyexpat]

I tend to agree with you. The SCAN program has been inundating me with mail and told me I had to use a doctor off their lists and to use them first for medical treatment. I already had a doctor's visit, a mammogram, and got three medications filled all for free with Medi-Cal before SCAN becomes effective on July 1. So I don't think I need their program. Thanks for responding, you've been a big help on this forum in the past and I appreciate it so much.

[happyexpat]

Sorry, forgot to answer the rest of your post. No, I don't have any medical issues not covered nor do I have any co-payments. Medi-Cal is the CA version of Medicaid and as you said, will pick up what Medicare doesn't cover. For me, Medicare doesn't become effective until July 1, which is why I used Medi-Cal instead.

[Ariadne22]

Originally Posted by happyexpat

For me, Medicare doesn't become effective until July 1, which is why I used Medi-Cal instead.

In that case, in July you should become a dual-eligible - Medicare will be primary, you will remain on Medi-Cal which will function as a Medigap and pay what Medicare doesn't, possibly even paying the $135 Part B premium if your income is low enough. Nothing should change for you in July. You can continue with all the providers you are using now.

If you are happy with your providers and your expenses are covered, you don't need SCAN ever. SCAN is doing what all private Advantage plans do when they see the possibility of enrolling another member - inundating you with info on insurance you don't need in order to increase their revenues from the government - on average $800/mo. per enrollee. SCAN will dole out your benefits and make final decisions on medically necessary treatment - not Medicare. Enrollment in Advantage divorces you from Medicare.

Ignore SCAN now - and in July. SCAN is just another form of Advantage - which puts THEM in control instead of Medicare and Medi-Cal. You do not need the aggravation of an Advantage plan.

And, fwiw, you can always enroll in SCAN during fall Annual Open Enrollment should change your mind at a later date. There is no lockout if you don't make a decision now. Also, fwiw, I have a friend who has been on Medicare and Medicaid in WI - she sees all the best doctors, can go to the best facilities. Frankly, her access to doctors is better than mine because she established relationships with some of the top providers in my area long ago who are no longer accepting new patients of any kind. And, again, she is a dual-eligible on Medicare/Medicaid.

In short, if it ain't broke, don't fix it.