Carson City resident Charles Damon, 67, said he’s had two heart attacks and now has a pacemaker. The retired nurse and state worker – a Medicaid program specialist – was disheartened to leave the Carson Tahoe Health network because of changes to Medicare Advantage coverage.
“I’ve been forced to fire all of my doctors in Carson City. I have had to cancel all appointments,” he said. “Because they’re out of network.”
Damon wasn’t the first person to reach out to the newspaper regarding CTH’s recent changes in coverage. While CTH planned to terminate its contract with United Healthcare at the end of May, it also ended contracts for several Medicare Advantage plans.
The termination dates are listed at carsontahoe.com/ctmg-insurance.html. They include Medicare Advantage plans with Aetna (terminated April 1), Anthem Blue Cross Blue Shield of Nevada (terminated April 1), Humana (terminates May 1) and others.
FAQs are online as well carsontahoe.com/MAFAQs.html.
“Carson Tahoe Health diligently monitors its contracts and relationships with health insurance companies to ensure patients’ claims are addressed thoroughly, properly, and timely,” CTH said. “Through this review, we have determined that processing of requests and claims jeopardizes Carson Tahoe Health’s ability to provide appropriate care to these Medicare Advantage members and customers while continuing as a local not-for-profit, independent hospital whose mission is to enhance the health and well-being of the communities we serve.”
Prominence and Senior Care Plus are “the only Medicare Advantage plans that will be accepted through benefit year 2025.”
“These are local carriers which allow for strong communication and relationships between CTH, the patient, and the policy,” CTH said. “Senior Care Plus is available to residents of Washoe, Carson, and Storey counties. Prominence is available to residents of Carson, Douglas, Lyon, Storey, and Washoe counties.”
Damon, however, said HMOs wouldn’t work for him as he resides in Southern California in the cold months and doesn’t want to pay out of pocket there.
“I don’t have portability,” he said.
Damon said CTH notified him of the changes with a letter last fall during open enrollment. He said traditional Medicare with a supplemental plan was recommended, but that would have cost him and his spouse nearly $500 more each month.
Damon chose to stay with his Aetna Medicare Advantage plan with doctors in Southern California. While in Carson, he said, he will have to use the Barton Health system in Gardnerville or Lake Tahoe. He worried about other seniors in the community and maintained Medicare Advantage is cost effective for seniors.
“That’s maybe something I should be doing… go to the senior center and help people,” he said.
In contrast, CTH said that from a hospital standpoint, “traditional Medicare is the most comprehensive medical coverage.”
“Unlike MA plans, traditional Medicare does not have network limitations, patients can visit any doctor or hospital that takes Medicare in the U.S., and in many cases, referrals are not required like they are with MA plans,” says the CTH website.
CTH also reminded patients of the No Surprises Act and that “emergency services must be provided as in network for those covered by health insurance through an employer (including a federal employees health benefits plan), the federal health insurance marketplace, a state-based marketplace or other individual market coverage.”
For information about traditional Medicare versus Medicare Advantage, go to medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage.