San Diego County seniors who lost in-network access to Scripps Health under several Medicare Advantage plans in 2024 are now hearing system leaders describe the move as a key financial inflection point—while local reporting and credit analysts document the scope of the change.

Scripps “walked away from nearly all of its commercial Medicare Advantage contracts Jan. 1, 2024,” a decision President and CEO Chris Van Gorder told Becker’s Hospital Review affected “about 32,000 Medicare Advantage beneficiaries.” 

“It was a tough decision to make because it involved five health plans,” Van Gorder said. “But we were losing about $75 million a year on those contracts…[and] the payers weren’t willing to negotiate the changes we needed — not just higher reimbursement, but also addressing prior authorization issues and simply paying us what they were contractually obligated to pay.”

Ahead of the change, NBC 7 San Diego reported that Scripps Clinic and Scripps Coastal had “more than 32,000 Medicare Advantage HMO patients,” according to Pat Salas, the CEO of SBHIS Insurance Services, and quoted a Scripps statement saying “the revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide.” The statement added that Clinic and Coastal physicians would “continue to accept original Medicare (Part A and Part B).”

Credit analysts cited similar figures. Fitch Ratings, in a ratings report on Scripps, referenced the planned termination of Scripps Clinic and Scripps Coastal participation in Medicare Advantage plans effective Jan. 1, 2024, saying it would affect “32,000 full risk members.”

Scripps leaders told Becker’s that many patients changed coverage to keep their doctors. Van Gorder said “a lot of those patients ultimately switched back to traditional Medicare with a supplemental plan,” adding, “We didn’t see a huge dip in census or volume… but we muddled through it, and it went really well for us in the end.”

CFO Brett Tande pointed to credit performance: “If you look at our credit ratings, you can see the change,” he told Becker’s, which reported Scripps has not posted a quarterly loss since the exit, according to Tande.

For seniors weighing options, Van Gorder framed traditional Medicare differently than private-plan networks: “Traditional Medicare is not an issue,” he said. “With these other models, seniors need to be wary and savvy buyers.”