Losing Access To Stanford and Sutter- Medicare

Medicare.gov has made public its 2024 Medicare Advantage and Prescription Drug Plans, which become effective January 1, 2024. A review of this public website indicates many patients may lose access to Stanford and Sutter in 2024. Medicare.gov is a federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services.

Access To Stanford and Sutter

A quick survey of this public-facing website implies big changes are coming to Northern California and the south bay area and peninsula region (and more in 2025). The only individual Medicare Advantage HMO contracted with Stanford Healthcare and Stanford Hospital will withdraw its plans on January 1, 2024. These plan withdrawals also impact patients using the Sutter Health system e.g. Palo Alto Medical Foundation (PAMF) and other regional medical affiliations. For Sutter patients, the news gets worse.

For Sutter It Gets Worse

Overall, Santa Clara County is losing 4 Advantage plans and San Mateo is losing 3. Yet the impact is far greater than it appears, as these include the only individual plans with HMO access to Stanford. In Santa Clara County, the reduced access for Sutter patients is significant, as 2 of the 4 plans leaving the county are very popular with patients accessing the Sutter Health system. The total number of Medicare beneficiaries impacted is likely to be in the thousands. See what one local expert says may happen in 2025.

Breaking Sutter News April 2024

Unfortunately, the medicare advantage open enrollment period has closed just as a new Sutter option becomes available: Effective April 2024 an established medicare advantage PPO insurer has signed on with Sutter.

Northern California Sutter providers e.g. Palo Alto Medical Foundation or “PAMF” have agreed with United Healthcare to in-network PPO status, effective immediately. This information can be accessed at medicare.gov or by phoning 1(800) MEDICARE. If you prefer local assistance, you can search for local United Healthcare agents by zip code at https://www.myuhcagent.com.

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