SLO County seniors lose Medicare health plan coverage

Courtesy of AARP

Morro Bay resident George Garrigues received unexpected news when a letter arrived in the post, telling him he had until August 1 to find a new health insurance provider.

“It was a surprise,” said the retired journalism professor. “And August isn’t too far away.”

Garrigues, aged 90, registered with Golden State Medicare Health Plan when he moved to San Luis Obispo County after years of using the Kaiser Permanente system.

The California Department of Managed Health Care, the state agency governing managed health care plans, has ordered the Golden State Medicare Health Plan to end all existing contracts with current customers by June 1, Medicare coverage ending August 1, according to a settlement agreement dated February 2022.

The main reason the Golden State Medicare Health Plan lost its Medicare license was its inability to maintain good financial standing. The health plan was operating with a deficit of about $35 million as of December 2021, according to the settlement agreement.

“Given the dire financial situation of (Golden State Medicare Health Plan) and its apparent inability to operate its business in such a way as to enable it to meet even the minimum financial requirements of all (state) licensees, the revocation of (his) health plan license is appropriate and urgent,” according to a Court filing from July 2021 outlining the charges against Golden State.

The Golden State Medicare Health Plan was serving about 4,966 customers as of April 2021, according to the July 2021 court filing.

Golden State customers were spread across eight California counties, including San Luis Obispo, according to a 2022 benefits report.

Seniors with Golden State Medicare Health Plan seek new insurance

Garrigues told The Tribune that when he chose the Golden State Medicare health plan, he didn’t first meet with a Health Insurance Counseling & Advocacy Program (HICAP) provider.

HICAP is a national network of nonprofit organizations that are certified to provide unbiased information about health insurance options to seniors.

But now that his Medicare coverage is off, Garrigues said he wants to know about his health plan options.

Garrigues said he called various HICAP agencies but found it difficult to get an appointment.

He drove from Morro Bay to the Central Coast Commission for the Elderly Santa Maria office, which serves San Luis Obispo and Santa Barbara counties, to speak about health plans on Wednesday.

During his appointment, the HICAP counselor reviewed various health plan options with Garrigues and helped him make a decision on which plan best meets his needs, he said.

At the end of his appointment, Garrigues decided on a new Medicare health plan.

SLO County residents with questions about Golden State Medicare health plan suspension or other health insurance issues can schedule 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 2:13 p.m.

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