Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Healthcare Access topic
No spam. Unsubscribe anytime.
Retirees raise concerns over out-of-state coverage and providers not accepting Medicare primary-care patients
Summary
Multiple retirees told CalPERS representatives they face limited plan choice outside California, difficulties getting providers to accept Medicare primary-care patients, and administrative problems when plans send payments to patients rather than providers.
Stakeholders at a CalPERS webinar raised a string of access problems for retirees who live outside California or rely on Medicare. Dana, an out-of-state retiree, asked whether she should worry about losing access to health insurance; Walker said out-of-state members typically have only one option because CalPERS lacks critical purchasing power outside California. "There is only 1 option... we don't have the same purchasing power, outside of California as we do inside," Walker said.
Laura Rosenthal, a former CalPERS legal lead on health contracting, said major provider systems such as Sutter and UC Davis would not accept new Medicare primary-care patients in some areas, raising equity concerns for beneficiaries who carry comprehensive coverage. "Major providers... do not, at any given time, take new Medicare primary care patients," Rosenthal said, and asked how CalPERS could use contractual leverage and the 'bully pulpit' to address the problem. Walker invited Rosenthal to send her details and pledged to pass them to the appropriate office.
Another participant described a small-business provider that refuses network participation because plan payments do not cover costs and said plans often send checks to patients instead of providers, creating administrative friction. Walker acknowledged the frustration and said staff would follow up on complex, case-specific issues via FAQs and stakeholder channels.
