Keeping Your UCSD Doctors When Medicare Coverage Changes in 2027

What is changing between SCAN and UC San Diego Health?

UC San Diego Health states that SCAN is ending its SCAN Medicare Advantage HMO contract with the health system effective January 1, 2027. UC San Diego Health remains in network through December 31, 2026, then becomes a non-contracted provider for this SCAN HMO relationship.

If you keep a SCAN HMO plan after the contract ends, routine UC San Diego Health care may no longer be covered as in-network care. Medicare Advantage HMOs generally require non-emergency care to come from the plan network unless the plan authorizes an exception. I can review your notice and help you understand the options for your doctors, services and ongoing care.

Is UC San Diego Health also ending its Regal Medical Group contract?

UC San Diego Health lists its contract with Regal Medical Group as currently scheduled to terminate January 1, 2027. This is a separate change from the SCAN HMO contract. The impact depends on your plan, assigned medical group, doctor, referrals and the services you receive.

If you are unsure which change applies to you, have your member card and any notice available during your phone appointment with me. I can help sort out the plan and provider relationships and compare what you can do next.

What happens if you keep your current plan?

If your plan continues for 2027, you may be able to remain enrolled, but you could need a different in-network medical group, primary doctor, specialist or hospital for routine care. I can help you review whether the change affects referrals, authorizations, scheduled procedures or ongoing treatment.

Keeping the plan can be reasonable if you are comfortable changing providers and the rest of the coverage still fits. Before deciding, compare the new care team, prescriptions, pharmacy, medical costs and benefits you actually use.

Option 1: Original Medicare with a Medicare Supplement and Part D plan

UC San Diego Health lists Original Medicare and Medicare Supplement plans as accepted. Original Medicare generally lets you use doctors and hospitals that accept Medicare. A Medicare Supplement policy can help pay some of the Medicare-approved costs left to you, depending on the policy.

Medicare Supplement policies sold today do not include outpatient prescription drug coverage. Most people choosing this route also compare a separate Part D plan using their exact prescriptions and preferred pharmacy. Include the Medicare Supplement and drug-plan premiums when comparing total cost.

Eligibility is important. Outside a protected enrollment right, a Medicare Supplement company may use medical underwriting. A significant Medicare Advantage network change or certain provider-contract terminations may create a limited guaranteed-issue right in some circumstances, but the notice, current treatment relationship, timing and applicable law must be reviewed before assuming that right applies.

• I will help check your doctors and facilities and review Medicare Supplement eligibility.
• We will compare a separate Part D plan using your prescriptions and pharmacy.
• I will help coordinate the applications and effective dates before you make a change.

Option 2: A Medicare Advantage PPO with out-of-network benefits

A Medicare Advantage PPO with prescription coverage, often called an MAPD PPO, may provide another path. PPOs generally let members receive covered services from out-of-network providers, usually at a higher cost. The provider must still be willing to treat the member, and the plan's coverage, medical-necessity and authorization rules still apply.

UC San Diego Health identifies examples of Medicare Advantage PPO arrangements where members may be able to receive care using out-of-network benefits. This means being out of network does not automatically prevent access, but the letters PPO do not guarantee that every doctor, facility or service will be available.

UC San Diego Health lists certain MAPD PPO arrangements where patients may access care through out-of-network benefits, even though UC San Diego Health is not in the plan's network. These benefits can make continued access possible, but out-of-network care may cost more and can have different authorization rules. I will help verify the exact plan, doctors, facilities, services and costs with you before you enroll.

• I will check whether the PPO is available where you live.
• We will review whether your UC San Diego Health doctors and facilities accept out-of-network members.
• I will explain the plan's cost sharing, authorization rules and out-of-pocket limits.
• We will compare the plan's prescription coverage with your medications and pharmacy.

How should you compare the two coverage paths?

Start with access to care, then compare cost and plan rules. Original Medicare with a Medicare Supplement may provide broad access to Medicare-participating providers, with separate premiums and a separate Part D plan. An MAPD PPO combines medical and prescription coverage and has a yearly medical out-of-pocket limit, but out-of-network care can cost more and may involve plan authorization rules.

Neither option is automatically better. The answer depends on your Medicare Supplement eligibility, budget, doctors, expected services, prescriptions, pharmacy and comfort with provider-network rules. I will help compare expected yearly costs and coverage, not just the monthly premium or one additional benefit.

What should you do before December 7?

The Medicare Annual Enrollment Period runs from October 15 through December 7 for changes generally effective January 1. If you want different coverage to begin January 1, 2027, schedule your review early enough to compare your doctors, prescriptions, costs and enrollment steps before December 7.

People already enrolled in Medicare Advantage also have the Medicare Advantage Open Enrollment Period from January 1 through March 31, when they can make one change. That later period should not be treated as a reason to delay. Provider access, Medicare Supplement eligibility and application timing may be harder to coordinate after January 1.

• Have your SCAN, Regal or provider notice and Annual Notice of Change available during the call.
• Have the names of every UC San Diego Health provider and facility you want to keep available.
• Have your prescriptions, doses and preferred pharmacy information available.
• I will help compare the coverage and enrollment timing with you before you decide.