UC Health, Blue Shield of California reach new contract, avoiding disruptions to care
The deal means patients who get medical care at UCSF and five other UC Health academic medical centers statewide through Blue Shield can continue accessing services at in-network rates. This had been up in the air, with the previous contract slated to expire Aug. 9. If the two sides had not reached an agreement, patients would potentially have had to find a new doctor, new insurer, or pay out-of-network rates.
The contract applies to people on CalPERS plans, employer plans, Covered California plans and Medicare plans (including Medicare Advantage) offered or administered by Blue Shield.
In the Bay Area, this includes residents insured by Blue Shield who get care at UCSF Medical Center, UCSF Benioff Children's Hospitals, UCSF Medical Group, UCSF Benioff Children's Physicians and the primary care provider One Medical, a UCSF affiliate.
UC Health and Blue Shield had been renegotiating contracts to establish how much Blue Shield will reimburse services provided by UC Health hospitals, clinics and other facilities. Such negotiations between providers and insurers are routine, though they have grown more public and contentious in recent years, often with both sides accusing the other of harming patients through higher prices or less accessible care.
'We are dedicated to ensuring members have access to affordable care and are pleased to be able to continue our partnership with UC Health,' Blue Shield of California said in a statement.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Health Line
2 hours ago
- Health Line
Medicare Coverage of Xiidra
Medicare may cover Xiidra (lifitegrast ophthalmic solution) if you have a plan with prescription drug coverage, such as a Part D plan or a Medicare Advantage (Part C) plan. Xiidra is a brand-name drug that doctors may prescribe to treat the symptoms of dry eye disease. Medicare and Xiidra Xiidra belongs to a group of drugs called a lymphocyte function-associated antigen-1 (LFA-1) antagonist. The drug is approved by the Food and Drug Administration (FDA) to treat the signs and symptoms of dry eye disease. To receive coverage for Xiidra, you need to have a Medicare prescription drug plan. If you have Original Medicare (parts A and B), you can enroll in a stand-alone Part D plan to cover your medications. If you have a Medicare Advantage plan, you likely have prescription drug coverage as part of your plan. However, not all Medicare Advantage plans include drug benefits. Private insurance companies offer Medicare drug plans, and their lists of covered drugs differ. Your plan will cover Xiidra if it's included in the plan's formulary. More than half of Medicare drug plans cover Xiidra. Review your plan's documentation or contact a representative to learn whether it covers Xiidra. If it does not, it may cover an alternative medication for dry eye disease. The Centers for Medicare & Medicaid Services (CMS) offers a coverage finder tool to allow users to find plans in their area that include coverage for Xiidra. Xiidra cost with Medicare The amount you pay for Xiidra will depend on a few factors. These include your location, your plan, and the drug's tier. Medicare prescription drug plans group covered drugs into cost tiers. Xiidra is typically a higher tier drug, with no generic version. The amount you pay for Xiidra will also depend on what stage of coverage you are in. In 2025, most Part D plans have three stages of coverage. Beneficiaries will have different out-of-pocket expenses depending on the stage: Deductible stage: If your plan has a deductible, you'll pay the full cost of the medication until you reach your deductible amount. In 2025, the maximum deductible amount for a Part D plan is $590. Initial coverage stage: After meeting your deductible, you'll pay a 25% coinsurance on the cost of covered medications until your out-of-pocket costs reach $2,000. Catastrophic stage: Once you've spent $2,000 in a calendar year, you'll pay no more for covered medications. If you qualify for cost assistance through the Extra Help program, your costs will be lower.
Health Line
2 hours ago
- Health Line
Medicare Coverage of Revlimid
Medicare may cover Revlimid (lenalidomide) if you have a plan with prescription drug coverage, such as a Part D plan or a Medicare Advantage (Part C) plan. Revlimid is a brand-name drug that doctors may prescribe to treat conditions including multiple myeloma and mantle cell lymphoma in certain adults. Medicare and Revlimid Revlimid is a type of drug called a thalidomide analogue. The drug is approved by the Food and Drug Administration (FDA) to treat the following conditions: myelodysplastic syndromes multiple myeloma marginal zone lymphoma follicular lymphoma mantle cell lymphoma To receive coverage for Revlimid, you must have a Medicare prescription drug plan. If you have Original Medicare (parts A and B), you can enroll in a stand-alone Part D plan to cover your medications. If you have a Medicare Advantage plan, it might cover prescription drugs. Not all Medicare Advantage plans include drug benefits. Private insurance companies offer Medicare drug plans, and their lists of covered drugs differ. Your plan will cover Revlimid if it's listed in their formulary. Most Medicare drug plans cover Revlimid. Review your plan's documentation or contact a representative to learn whether it covers Revlimid. If it does not, it may cover an alternative medication. The Centers for Medicare & Medicaid Services (CMS) offers a coverage finder tool to allow users to find plans in their area that include coverage for Revlimid. Revlimid cost with Medicare The amount you pay for Revlimid will depend on a few factors, including your location, your plan, and the drug's tier. Medicare prescription drug plans group covered drugs into cost tiers. Revlimid is typically a higher-tier drug, although it has generic version. According to Revlimid's manufacturer, the list price for the drug is $18,723 per 28-day cycle. The amount you pay for Revlimid will also depend on what stage of coverage you are in. In 2025, most Part D plans have three stages of coverage. Beneficiaries will have different out-of-pocket expenses depending on the stage: Deductible stage: If your plan has a deductible, you'll pay the full cost of the medication until you reach your deductible amount. In 2025, the maximum deductible amount for a Part D plan is $590. Initial coverage stage: After meeting your deductible, you'll pay a 25% coinsurance on the cost of covered medications until your out-of-pocket costs reach $2,000. Catastrophic stage: Once you've spent $2,000 in a calendar year, you'll pay no more for covered medications.
Health Line
2 hours ago
- Health Line
Can You Lose Medicare Coverage?
Medicare coverage is a lifelong benefit for individuals who meet eligibility criteria. However, there are certain situations where a person may have their coverage canceled. To be eligible for Medicare, the federal health insurance program for older adults in the United States, you need to be 65 years of age or older. If you're younger than 65 years old, you may qualify for Medicare if you: have disability and collect Social Security Disability Insurance have end stage renal disease (ESRD) have amyotrophic lateral sclerosis (ALS) If you meet the eligibility requirements for Medicare, you have a right to coverage for the rest of your life. However, it's possible for your coverage to be canceled or discontinued. In this article, we discuss when this might occur and how to reenroll. Why might you lose Medicare coverage? A person may lose their Medicare coverage if they: stop paying their plan's premiums move out of their plan's service area no longer meet the eligibility criteria for the plan Nonpayment of Medicare premiums If you stop paying your monthly premiums, Medicare may terminate your coverage. Individuals enrolled in Original Medicare may have premium payments for Part A and Part B. Generally, there is a grace period of a couple of months after a person stops paying their premium. During this time, you can get caught up on your payments. However, if you don't resume them, Medicare will disenroll you from your coverage. If you're enrolled in a Medicare Advantage (Part C) or Part D plan, you'll also need to continue paying your monthly premiums or risk termination of your coverage. Moving out of a plan's service area If you move your permanent residence outside of your plan's service area, it may affect your coverage. Original Medicare coverage works anywhere in the United States. If you move abroad, you can stay enrolled in Medicare, but it won't cover any healthcare services you receive. Likewise, if you're incarcerated, you can keep your Original Medicare coverage, but it won't be applied toward any of your healthcare costs, which will be covered by the penal institution. Medicare Advantage plans work a bit differently. These plans have regional service areas, and your home address determines which plans you're eligible for. If you move out of your county or state, it's possible that you'll no longer be in your plan's service area. If you have a Medicare Advantage plan and become incarcerated, the plan will consider you outside its service area and disenroll you. If this happens, you may be disenrolled from the plan. No longer meeting eligibility criteria If you're eligible for Social Security Disability Insurance (SSDI), you're also eligible for Medicare. Eligibility involves having a condition that: prevents you from working at the substantial gainful activity (SGA) level prevents you from working at the same level you once did is expected to last for at least a year or be fatal If you no longer meet the eligibility requirements for disability with the Social Security Administration, and you're younger than 65 years old, your Medicare coverage may be discontinued. However, if you have a qualifying disability but end up returning to work, you won't automatically lose your Medicare coverage, provided your disability persists. If you qualify for Medicare due to ESRD, your Medicare coverage will end 12 months after you stop receiving dialysis and 36 months after a successful kidney transplant. Depending on why you lost Medicare coverage, you can likely reinstate it. If you are disenrolled from Original Medicare, a Medicare Advantage plan, or a Part D plan due to nonpayment of the plan's premium, you'll have to wait until the Medicare open enrollment period to sign back up. However, if you go without Medicare coverage for an extended time, you may be responsible for paying late enrollment penalties after you do enroll. People who lost coverage due to leaving their plan's service area may be able to avoid late enrollment penalties by qualifying for a special enrollment period (SEP). SEPs allow people to enroll in coverage outside of traditional enrollment periods. If you have questions about reenrolling in Medicare after losing coverage, consider speaking with a Medicare representative about your situation or contacting your local State Health Insurance Assistance Program (SHIP). The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
