Medicare medical health insurance plan canceled in Stanislaus County

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An image of the latest Medicare card, which is still made out of paper.

A picture of the newest Medicare card, which continues to be made out of paper.

Courtesy of AARP

Many seniors in Stanislaus County are faced with losing their insurance coverage Aug. 1 due to financial troubles of a Medicare health plan.

The Golden State Medicare Health Plan sent letters near the tip of June notifying members its contract with Medicare was being mutually terminated effective Aug. 1. People enrolled with Golden State will lose their insurance Aug. 1. Seniors covered by other insurance coverage aren’t affected.

The state Department of Managed Health Care took motion last 12 months to revoke Golden State’s health plan license based on the insurance plan’s deteriorated financial condition.

Based on a settlement agreement with the state agency, which governs managed-care coverage in California, Golden State reported a $27 million deficit in an April 2021 financial plan and a $35 million deficiency in December. A Department of Managed Health Care order in April 2021 prohibited Golden State from accepting recent applications for enrollment.

Golden State has provided insurance for Medicare recipients in Stanislaus, San Luis Obispo, San Francisco counties and five counties in Southern California.

“We’re getting quite a lot of calls from those people,” said Maria Profeta, program manager for the Health Insurance Counseling and Advocacy Program in Stanislaus County.

Profeta said the HICAP office, which helps people navigate the Medicare system, is making 10 or more appointments every week to assist them join for other insurance coverage. Ten other insurance carriers offer federally subsidized “Medicare Advantage” health plans in Stanislaus County.

A representative for Golden State of Newport Beach couldn’t be reached Wednesday. A phone recording said the health plan will stop to exist effective Aug. 1 and advised members to call the Medicare program or visit the Medicare.gov website to acquire other insurance.

The Modesto HICAP office didn’t have a count on Golden State’s membership in Stanislaus County.

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

“It might be difficult to see a physician, because many doctors don’t work with original Medicare,” she added.

Along with the Modesto HICAP office, this system giving unbiased help to Medicare recipients has satellite locations in Turlock, Ceres, Oakdale and Patterson. People in outlying communities may call HICAP to make appointments for assistance at satellite locations. HICAP also has counseling appointments by phone or video conferencing.

The HICAP program will hold an enrollment event on Aug. 18 from 8 a.m. to 11 a.m. on the Stanislaus County library, 1500 I St., in Modesto. The Modesto Farmers Market also will happen during that point. Representatives of assorted insurance coverage will answer questions on their approved Medicare plans.

Golden State began serving members in Stanislaus County in 2015. It offered coverage at zero premiums and no copayments for inpatient hospital and doctor visits.

The Health Insurance Counseling and Advocacy Program in Stanislaus County may 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 6:00 AM.

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Ken Carlson covers county government and health look after 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.

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