Change in Medicare PPO Plan Based on the Results of the Competitive Bid

Frequently Asked Questions

• 1. Why did HSS do a competitive bid for the Medicare PPO plan?

  SFHSS has seen rising costs for our Medicare plans. Just as anyone facing rising costs for their car insurance or home insurance will shop around to make sure they are getting the best price and value; the Health Service System issues Request for Proposals (RFPs) from time to time to secure competitive bids for our benefits. This is one of the most powerful tools we have available to help us achieve our mission of providing affordable and sustainable health benefits for our Members. This process allows us to leverage our group purchasing power to get the best deal for our members while maintaining the same plan design.
• 2. What is the recommendation SFHSS is making as a result of the RFP?

  The San Francisco Health Service System (SFHSS) staff is recommending to the Health Service Board that we change the Medicare Advantage Prescription Drug (MAPD) PPO plan from UnitedHealthcare to Blue Shield of California.
• 3. How will the recommendation maintain high-quality, affordable and sustainable coverage for our Members?

  The staff’s recommendation will reduce the cost for participating employers and Members by up to $67 million over the next three years while maintaining the current plan design and high-quality care for our Members.
• 4. I currently have the Kaiser Permanente Senior Advantage plan; will I be affected by this recommendation?

  No, Kaiser Permanente Senior Advantage Members will not be affected by this recommendation.
• 5. I currently have UnitedHealthcare Medicare Advantage PPO, how will I be affected by this recommendation?

  SFHSS made sure the recommended Medicare Advantage PPO plan would have the same coverage, the same deductibles, and the same co-pays. However, as with any change with health insurers, there will still be some changes you may experience such as:

  • You will get a new health plan I.D. card.
  • You will need to let all your doctors know that you have a new Medicare plan.
• 6. Will I be able to see my existing doctors, and how can I verify that my doctor will accept the new Blue Shield MAPD PPO?

  Yes, there is a significant overlap in providers who accept both the current UnitedHealthcare MAPD and the recommended Blue Shield of CA MAPD plan.

  You can verify if your doctor will accept your new insurance by asking if they participate in Medicare. Our Medicare PPO plan design allows access to both in-network and out-of-network doctors for the same co-pay.
• 7. What if I’m in the middle of treatment?

  Members who are in the middle of treatment will be connected directly with Blue Shield of CA for assistance to ensure a smooth transition. After the recommendation has been approved, implementation will begin immediately.
• 8. What if I received prior authorization for treatment, but I haven’t started treatment yet?

  Blue Shield has agreed to pre-load all authorizations received through UnitedHealthcare as approved authorizations, honoring the procedures codes and providers. In addition, to ensure continuity of medication treatment, Blue Shield has agreed to pre-load prior authorization approvals for any members currently taking prescription drugs that require such prior authorization.
• 9. Will I be able to go to a pharmacy near me?

  Yes, both Blue Shield of CA and UnitedHealthcare are contracted with all major pharmacy chains, including Rite Aid, CVS, Kroger, Lucky, Safeway, Walmart, Walgreens, and Costco.
• 10. Will my current prescription drugs be covered under the new plan?

  The approved prescription drug list for UnitedHealthcare Medicare Advantage and Blue Shield of CA Medicare Advantage are closely aligned. As part of the implementation process, SFHSS and Blue Shield of CA will review all past and current prescriptions to work towards a smooth transition for all members.
• 11. Is the RFP still going on?

  The RFP is now complete and has concluded since the Health Service Board voted to approve the staff recommendation on June 18, 2024. For more information on the RFP, please visit https://sfhss.org/RFPs.
• 12. I don’t live in California. How can I see my doctors outside of California?

  Blue Shield of California Medicare Advantage PPO Plan members will have access to the national provider network of the Blue Cross/Blue Shield Association.