SLO County seniors left without health insurance after plan loses Medicare contract
Morro Bay resident George Garrigues received unexpected news when a letter arrived in the mail, informing him that he has until Aug. 1 to find a new Medicare insurance provider.
“It was a surprise,” the retired journalism professor said. “And August is not too far away.”
Garrigues, who is 90 years old, enrolled in the Golden State Medicare Health Plan when he moved to San Luis Obispo County after years using the Kaiser Permanente system.
The California Department of Managed Health Care, the state agency governing managed health care plans, ordered Golden State Medicare Health Plan to end all existing contracts with current clients on or before June 1, with Medicare coverage ending on August 1, according to a settlement agreement dated February 2022.
The key reason Golden State Medicare Health Plan lost its Medicare license was its failure to maintain good financial standing. The health plan was operating at a deficit of roughly $35 million as of December 2021, according to the settlement agreement.
“Given (Golden State Medicare Health Plan)‘s dire financial condition and its clear inability to operate its business in a manner to allow it to comply with even the minimum financial requirements of all (state) licensees, revocation of (its) health plan license is appropriate and urgent,” according to a July 2021 court filing outlining the accusations against Golden State.
The Golden State Medicare Health Plan serviced roughly 4,966 clients as of April 2021, according to the July 2021 court filing.
Clients of Golden State were spread throughout eight California counties, including San Luis Obispo, according to a 2022 summary of benefits.
Seniors with Golden State Medicare Health Plan search for new insurance
Garrigues told The Tribune that when he chose the Golden State Medicare Health Plan, he didn’t meet with a Health Insurance Counseling & Advocacy Program (HICAP) provider first.
HICAP is a statewide network of nonprofit organizations that are certified to provide unbiased information about Medicare options to seniors.
But now that his Medicare coverage is being discontinued, Garrigues said he wanted to know his health plan options.
Garrigues said he called various HICAP agencies but it was hard to get an appointment.
He drove from Morro Bay to the Central Coast Commission for Senior Citizens office in Santa Maria, which serves San Luis Obispo and Santa Barbara counties, to talk about health plans on Wednesday.
During his appointment, the HICAP advisor reviewed various health plan options with Garrigues and helped him make a decision about the plan that best suits his needs, he said.
By the time his appointment was over, Garrigues decided on a new Medicare health plan.
SLO County residents with questions about the suspension of the Golden State Medicare Health Plan, or other health insurance questions, can make an appointment with a SLO County HICAP provider by calling 805-928-5663 or visiting centralcoastseniors.org/hicap.
This story was originally published June 22, 2022 at 2:13 PM.
