SCAN Health Plan and Scripps Health
Updated: 11/15/2023
Scripps Clinic and Scripps Coastal medical groups will not be contracting with Medicare Advantage plans starting January 1, 2024.
If you currently see a primary care doctor through Scripps Clinic or Scripps Coastal, this change will impact you. If you see a doctor through a different medical group, this change does not affect you.
Not sure? Look at your SCAN member ID card. Your medical group will be listed on the front.
Is Scripps Clinic or Scripps Coastal listed? Please know that nothing is changing for 2023. Your current doctors and plan benefits remain in place through December 31.
And, you can still stay with SCAN in 2024 and continue to receive great clinical care—including from Scripps specialists and Scripps Hospitals. However, you will need a new primary care doctor. You can choose one yourself or we will choose one for you. So if you do nothing, rest assured you will have a doctor and medical group for 2024.
If you want to choose your own doctor, here are some things to consider:
1. To continue to have access to Scripps hospitals, these medical groups have quality primary care doctors and specialists that admit to Scripps hospitals. Some specialists from Scripps Clinic and Scripps Coastal also work with these medical groups:
- Mercy Physicians Medical Group
- Scripps Physicians Medical Group
- Health Excel IPA
- Optum Care Network North County (PCAMG)
- Prospect Medical Group SD, including:
• Prospect – Graybill Medical Group, serving Vista and Oceanside
• Prospect – Palomar Health Medical Group, with locations throughout North County Inland area including Escondido, Poway, Fallbrook, San Diego, San Marcos and more
2. To continue to receive care through an “all-in-one” system, you can choose a primary care physician and see specialists with the award-winning UC San Diego Health. This health system provides convenient, one-stop primary and specialty care, and hospital services at the prestigious UCSD hospitals.
3. More options! We’re pleased to offer members a choice of physicians through these medical groups:
- Greater Tri Cities IPA, with locations throughout the San Diego North County
• Hospitals: Tri-City Medical Center, Palomar Medical Center - Heritage Provider Network Regal Medical Group, with locations throughout San Diego County
• Hospitals: UC San Diego Medical Center, Alvarado Hospital Medical Center, Paradise Valley Hospital, Tri-City Medical Center
Remember, you don’t have to do anything to stay with your current SCAN plan in 2024. If we don’t hear from you, we’ll choose a new primary care doctor and medical group for you. You’ll receive a letter from SCAN by mid-November with your new doctor’s name and information. You can always change your doctor at any time and for any reason. Read more in the FAQs below.
Please refer to these frequently asked questions.
Q: I like SCAN but don’t want to pay a monthly premium. What are my options?
Q: I want to change to a different SCAN plan. What do I need to do?
We’re glad you’ve found a SCAN plan that is a better fit for you. If you have a SCAN online member account, you can change your plan there. If not, please call SCAN Member Services. Remember, you’ll also need to have the name of your new primary care doctor. Again, SCAN Member Services can help you choose a doctor and change your plan.
Q: I want to keep my same SCAN plan. What do I need to do?
That’s great! There’s nothing you need to do to stay with your current SCAN plan. SCAN can choose a new primary care doctor for you, if you like. In fact, if we don’t hear from you by November 1, we will do that.
If you want to choose your own doctor, let us know. To find the doctors available to you, click here. You can also call SCAN Member Services for help choosing or changing your primary care doctor at any time.
Q: How do I choose and change my primary care doctor?
To choose a new doctor, you can start by talking to friends and family and seeing if they have any recommendations. Find out if these doctors are in the SCAN network by entering their name(s) in our online provider search tool. You can also use the search tool to look up doctors by zip code, language, gender and more.
Ready to make the change? Log into your SCAN online member account. From there:
- Go to the “My Plan & Care” tab near the top of your screen.
- Click on “View Care” listed on My PCP under your primary care doctor’s name.
- Click on “Request PCP Change” underneath your current doctor’s details.
From there, follow the simple steps that will lead you through the process. You’ll receive a confirmation that will also let you know when you can start seeing your new doctor.
Or, call SCAN Member Services at (800) 559-3500 TTY: 711 if you need help choosing or changing your primary care doctor and medical group.
Q: How does SCAN choose a new doctor for me?
We first look at your current doctor: their location, gender and the language(s) they speak. Then we find a doctor who matches as many of these traits as possible. For most of our members in San Diego, we’re able to find new doctors very near their current doctors’ locations and who provide the same services.
We will send you a letter in November with that doctor’s name and contact information. Then, you will receive your 2024 SCAN Member ID card in December with this new information.
Q: Should I change my doctor before the end of the year?
You should consider doing so. Remember, this change doesn’t just affect SCAN members—it applies to all Scripps Clinic and Scripps Coastal Medicare Advantage HMO members in San Diego. That’s close to 30,000 patients, many of whom will be looking to change to a new primary care doctor and medical group by December 31.
Making the change to a new doctor and group now will help ensure you get the doctor you want. Keep in mind that not all medical groups work with Scripps hospitals. If it’s important to you to be able to use Scripps hospitals, we encourage you to make this change sooner rather than later.
Q: What do I do if I am in the middle of treatment or have a surgery planned?
If you have appointments or care scheduled, we will help make sure your care goes smoothly during this transition. This includes such things as specialist care, a scheduled surgery or skilled nursing facility stay, and rental of medical equipment (like oxygen, wheelchair, hospital bed, etc.). If you call SCAN Member Services to change your doctor, let us know then. If we choose a new doctor for you, we will send you a letter in November with that doctor’s name. Give us a call when you receive that letter.
Q: What happens if I change to a new doctor but I don’t like them?
We understand that the doctor-patient relationship is very personal and what works well for one person may not work well for another.
That’s why you can change primary care doctors at any time and for any reason. It’s important that you find a doctor you trust and who has an office staff that is helpful.
Q: I don’t want to change my doctor and healthcare team. What can I do?
To keep your current primary care doctor, you will need to disenroll from SCAN and choose different healthcare coverage for 2024. You can do this during the Annual Enrollment Period (AEP), which is from October 15 to December 7. You have a few options, including going with Original Medicare or purchasing a Medicare Supplement plan. You can ask your doctor what insurance they will accept next year. A health insurance broker can help you understand what’s available to you.
You can also contact your local HICAP office at 1-858-565-8772 (TTY: 711) Monday through Friday from 8 a.m. to 5 p.m.
Another resource is 1-800-MEDICARE (1-800-633-4227). This toll-free help line is available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Q: What is the value of staying with a Medicare Advantage HMO plan?
An HMO (Health Maintenance Organization) is designed around your primary care doctor. Your primary care doctor is your first stop for care, the one who knows your challenges, your priorities and your health goals. This is the doctor who oversees and coordinates your care—including your medications and specialty care.
Medicare Advantage HMO plans are also more affordable options for many people. There are set copay amounts so you know how much an office visit, procedure or medication will cost. And a maximum out of pocket amount that puts a cap on what you’ll spend each year on covered medical services.
Q: I have questions about this change—is there someone I can talk to?
SCAN Member Services can answer questions about your SCAN plan and options for doctors and medical groups.
For information on all your options:
- Talk with a health insurance broker in your area.
- Contact your local HICAP office at 1-858-565-8772 (TTY: 711) Monday through Friday from 8 a.m. to 5 p.m.
- Call 1-800-MEDICARE (1-800-633-4227). This toll-free help line is available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
