Retire WellSan Diego

Medicare in San Diego: A Plain-English Guide

the path that keeps your hospitals open

San Diego Bay and the downtown skyline from Coronado

The Short Answer

In San Diego, the Medicare decision carries a consequence it doesn't in most cities: two of the region's biggest medical names pulled back from Medicare Advantage. Scripps' two large physician groups stopped taking Advantage plans on January 1, 2024, and UC San Diego Health dropped or narrowed several Advantage contracts for 2026. Both still take Original Medicare and every Medigap (Supplement) plan. So the path that keeps the most San Diego doctors and hospitals open to you is Original Medicare (Part A + Part B) plus a Medigap supplement and a standalone Part D drug plan. It costs more per month than a $0-premium Advantage plan, but it has no network, so Scripps and UCSD stay in reach. Medicare Advantage can still be the right call — Sharp runs its own Advantage plans and stays network-friendly — but know the constraint first: outside your initial window, California insurers can underwrite a later Medigap application and decline it.

Key Takeaways

  • The local hook: Scripps Clinic and Scripps Coastal Medical Group stopped accepting Medicare Advantage on January 1, 2024, affecting more than 32,000 patients — but their doctors still take Original Medicare (Part A and Part B).
  • UC San Diego Health narrowed its Medicare Advantage acceptance for 2026 (its Humana contract ends Jan 1, 2026; several PPOs left San Diego County), while continuing to accept Original Medicare and all Medigap plans.
  • The San Diego verdict, scoped to access: Original Medicare + a Medigap supplement has no network, so it keeps Scripps and UCSD open to you. A $0-premium Advantage plan can quietly cut you off from them.
  • Not all systems left Advantage — Sharp operates its own Sharp Direct Advantage plans through Sharp Health Plan, and Kaiser is its own closed Advantage-only system. If your care lives inside Sharp or Kaiser, Advantage can work.
  • The switch-back constraint: your one guaranteed shot at Medigap without medical underwriting is a 6-month window when you first get Part B at 65. Outside it, California insurers can decline or surcharge a Medigap application based on your health history.
  • 2026 costs: most people pay $0 for Part A; the standard Part B premium is $202.90/month with a $283 annual deductible — the baseline both paths share, before the Medigap and Part D premiums that buy Scripps and UCSD access on the Original Medicare path.

The parts, and what they decide in San Diego

Every Medicare decision in San Diego reduces to one assembly question: which combination of the program's four parts keeps Scripps and UC San Diego Health open to you. Two assemblies exist, and in this county only one still reliably includes both systems.

The four parts, compactly:

  • Part A — hospital insurance. Inpatient stays, skilled nursing after an admission, hospice. Premium-free for most people (10+ years of Medicare-taxed work); up to $565 a month in 2026 with fewer than 30 quarters, per the CMS 2026 rate sheet.
  • Part B — medical insurance. Doctor visits, outpatient care, labs, preventive services. $202.90/month for most people in 2026, with a $283 annual deductible.
  • Part C — Medicare Advantage. A private plan that replaces A and B with its own network and rules. This is the piece Scripps and UCSD have been walking away from.
  • Part D — prescription drugs. A standalone drug plan added to Original Medicare; Advantage plans usually build it in.

From those parts you build one of two paths. Original Medicare (Part A + Part B), almost always paired with a Medigap (Supplement) policy and a Part D drug plan, has no network: any provider in the country who accepts Medicare will see you, and in San Diego that still includes Scripps Clinic, Scripps Coastal Medical Group, and UC San Diego Health. Medicare Advantage replaces the stack with one private plan and buys you exactly that plan's network — and both Scripps groups and UCSD have spent the past two years leaving or narrowing those networks. That contrast is the whole local decision. Here is what each system did.

What Scripps, UCSD, Sharp, and Kaiser each did

Scripps left Advantage first. In October 2023, Scripps Health announced that Scripps Clinic and Scripps Coastal Medical Group would stop accepting Medicare Advantage plans effective January 1, 2024. NBC 7 and KPBS reported the change hit more than 32,000 Advantage HMO patients; CEO Chris Van Gorder told KPBS the system was losing more than $75 million a year on Advantage contracts. The detail that matters for your decision, in NBC 7's words: doctors from both groups "will continue to accept original Medicare (Part A and Part B)." Scripps didn't leave Medicare. It left Advantage.

UC San Diego Health tightened for 2026. UCSD's own accepted-plans page lists Original Medicare and all Medicare Supplement (Medigap) plans as accepted — and a shrinking list of Advantage plans. Its Humana Advantage contract terminates January 1, 2026; the UnitedHealthcare AARP PPO and Blue Shield PPO are no longer offered in San Diego County for 2026; and SCAN primary-care access narrows starting March 1, 2026. Several of the Advantage plans UCSD still takes require a primary-care doctor inside a UCSD-affiliated group. The Original Medicare column on that page, by contrast, hasn't shrunk at all — and UCSD is where the county's academic medicine concentrates, Jacobs Medical Center and Moores Cancer Center included, which is exactly the care people most want available after a serious diagnosis.

Sharp went the other direction. Sharp HealthCare operates its own Sharp Direct Advantage plans through Sharp Health Plan and also accepts UnitedHealthcare Advantage plans, per Sharp's Medicare pages. Sharp also anchors the parts of the county Scripps and UCSD don't — Sharp Grossmont in La Mesa, Sharp Chula Vista in the South Bay — so for East County and South Bay retirees whose care already lives inside Sharp's medical groups, the Advantage question is far less loaded than it is on the coast.

Kaiser is its own world. Kaiser's Advantage plan works only at Kaiser facilities (including the newer San Marcos hospital), and non-Kaiser San Diego doctors don't take it. It fits people already settled in Kaiser; it cannot get you to Scripps or UCSD.

The trade, priced in San Diego access

Original Medicare + Medigap stacks three monthly premiums — Part B ($202.90 standard in 2026), the Medigap policy, and a Part D plan. What that money buys in this county is specific: no network, no referrals, continued access to Scripps Clinic, Scripps Coastal, and UCSD, and a Medigap policy that caps your share of costs. Medicare Advantage inverts the trade: often no premium beyond Part B, frequently with dental, vision, and hearing extras built in, in exchange for one network's doctors, referral and prior-authorization rules, and cost-sharing as you use care, up to the plan's annual cap. One exception applies everywhere: emergency care is covered at any hospital regardless of network, per Medicare's emergency coverage rules — so a Scripps ER would still treat you on an Advantage plan. It's the follow-up and ongoing care that routes back to your plan's network, and that is where the Scripps and UCSD exits bite.

One structural fact sits under all of it: Original Medicare by itself has no annual out-of-pocket maximum. The Medigap policy is the ceiling, which is why the two are quoted together, and why "Original Medicare with no supplement" is not really a third path. The measurable difference between the two real paths is access: in San Diego, the higher-premium assembly is the only one that keeps every non-Kaiser system in the county open.

The enrollment windows — and the one that never repeats

  • Initial Enrollment Period: the 7 months around your 65th birthday — the 3 months before your birthday month, the month itself, and the 3 after.
  • Fall Open Enrollment (Oct 15–Dec 7): anyone on Medicare can switch — Advantage to Original, Part D changes, plan to plan — effective January 1. This is the window in which the 32,000 affected Scripps patients had to act in late 2023, and the one to use if your plan's Scripps or UCSD status changes again.
  • Medicare Advantage Open Enrollment (Jan 1–Mar 31): current Advantage members can switch Advantage plans or drop back to Original Medicare.

The window that matters most here is the one that never repeats. When you first enroll in Part B at 65, you get a 6-month Medigap open enrollment period in which insurers cannot deny you or surcharge you for your health — guaranteed issue, per Medicare.gov. Outside it, and outside a few protected situations, California insurers can medically underwrite a Medigap application: review your history, then decline or reprice it. Mapped onto this county's networks, the sequence to avoid is concrete: choose an Advantage plan at 65, want Scripps or UCSD back later, and find that the Medigap policy that makes Original Medicare affordable is no longer guaranteed to you.

California adds one rule most national guides skip: the Medigap "Birthday Rule" (expanded by SB 407 from 30 to 60 days) gives anyone who already holds a Medigap policy a 60-day window each year, starting on their birthday, to switch to another Medigap plan of equal or lesser benefits with no underwriting, per California Health Advocates. Note its boundary: it moves you between Medigap plans. It does not move you from Advantage into Medigap. The one-time window at 65 is still the decision that matters most.

The 2026 numbers to budget

Budget from the CMS 2026 figures, not a guess. Part A: $0 premium for most people, a $1,736 inpatient deductible per benefit period, and $434/day coinsurance for days 61–90. Part B: $202.90/month standard with the $283 annual deductible, and income surcharges (IRMAA) run the premium up to $689.90/month at the top brackets, worth checking if a pension plus large IRA withdrawals push your income up, a common San Diego retiree profile. On the Original Medicare path, a Medigap premium and a Part D premium stack on top. Neither has one "San Diego price" — Medigap is quoted by plan letter, age, and carrier — so get real quotes for your ZIP and age from the Medicare Plan Finder or a licensed broker before comparing paths, rather than leaning on a published average. To put these lines next to housing and taxes, see our cost of living guide for retirees and the affordability calculator.

How to choose

The deciding input isn't the premium; it's the systems. If your care — or the care you'd want after a serious diagnosis — includes Scripps or UCSD, Original Medicare plus Medigap plus Part D is the assembly that keeps both open, and the 6-month guarantee at 65 is the cheapest moment to lock it in. If your care already lives inside Sharp or Kaiser, an Advantage plan built on that system trades access you weren't using for premiums you don't pay. That's a reasonable exchange, made knowingly. If you're relocating from out of state, treat this as a fresh decision the month you land; the plan that fit in Ohio may not include the San Diego system you're counting on.

That is an access verdict, not a personal recommendation. This article is educational, not licensed advice, and plan details change every year. For a personal decision, talk to a licensed Medicare broker who works San Diego networks, or get free, unbiased help from California's HICAP counselors (the state's Health Insurance Counseling and Advocacy Program). Still weighing whether San Diego pencils out at all? Start with how much you need to retire here.

See which Medicare plans keep your San Diego hospitals open

A licensed Medicare broker who works San Diego networks can check, for your ZIP and your doctors, which Original Medicare + Medigap and Advantage plans actually include Scripps, UCSD, Sharp, or Kaiser — before you commit. Prefer free, unbiased help? California's HICAP counselors offer it at no cost.

Compare plans for your ZIP

Educational only — not licensed insurance, medical, or financial advice; plan details change yearly, so verify with the plan or a licensed broker. We may earn a referral fee from partners; it never affects our guidance.

Frequently Asked Questions

Does Scripps take Medicare Advantage?

Mostly no. Scripps' two large physician groups — Scripps Clinic and Scripps Coastal Medical Group — stopped accepting Medicare Advantage plans on January 1, 2024, a change that affected more than 32,000 patients. Scripps doctors do still accept Original Medicare (Part A and Part B), so pairing Original Medicare with a Medigap supplement is the reliable way to keep Scripps physicians open to you.

Does UC San Diego Health accept Medicare Advantage in 2026?

Only a narrowing list of plans. UC San Diego Health's own accepted-plans page shows it takes Original Medicare and all Medicare Supplement (Medigap) plans, but its Medicare Advantage acceptance shrank for 2026 — its Humana contract ends January 1, 2026, the UnitedHealthcare AARP PPO and Blue Shield PPO left San Diego County, and SCAN primary-care access narrows March 1, 2026. Some remaining Advantage plans require a UCSD-affiliated primary-care doctor. Original Medicare plus Medigap is the reliable way to keep UCSD open.

What happens if I have Medicare Advantage and get seriously sick?

Two things to know. First, your care is limited to your plan's network and its prior-authorization rules — a problem in San Diego if your plan doesn't include Scripps or UCSD. Second, if you then want to switch to Original Medicare plus Medigap to regain access, California insurers can medically underwrite your Medigap application outside your one-time 6-month window at 65 — meaning they can decline you or charge more based on your health. That's why the initial choice matters so much here.

Is Original Medicare or Medicare Advantage better in San Diego?

Scoped to hospital access, Original Medicare plus a Medigap supplement is the broader path in San Diego: it has no network, and Scripps and UCSD both accept it. It costs more monthly than a $0-premium Advantage plan. Medicare Advantage can still be the better value if your doctors are inside a network that stays Advantage-friendly, like Sharp (which runs its own Sharp Direct Advantage plans) or Kaiser. That's an access comparison, not a personal recommendation — the deciding input is where you want your care, not the premium alone.

How much does Medicare cost in San Diego in 2026?

The premiums are federal. Most people pay $0 for Part A; the 2026 inpatient hospital deductible is $1,736. Part B is $202.90 a month for most people with a $283 annual deductible, and higher earners pay an income surcharge up to $689.90. On top of that, Original Medicare users add a Medigap premium and a Part D premium — the cost of keeping Scripps and UCSD in reach — while many San Diego Advantage plans charge no premium beyond Part B but carry network limits and a plan-specific annual out-of-pocket maximum listed in each plan's summary of benefits.

When can I enroll in or change my Medicare plan?

Your Initial Enrollment Period is the 7 months around your 65th birthday. After that, Fall Open Enrollment (October 15–December 7) lets anyone change plans for the next year — in San Diego, it's also the window to act if your plan's Scripps or UCSD status changes — and the Medicare Advantage Open Enrollment Period (January 1–March 31) lets Advantage members switch or drop back to Original Medicare. The one you can't miss is your one-time 6-month Medigap open enrollment when you first get Part B at 65, the only window when insurers can't deny or surcharge you for your health. California's Medigap Birthday Rule later gives a 60-day annual window to switch between Medigap plans without underwriting.

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