TRUCKEE, Calif. – At a recent Golden Seniors meeting held on Thursday, June 20, at the Truckee Donner Recreation and Park District, the significant challenges faced by local seniors in accessing affordable healthcare were brought to light. Louise Geist, a Truckee resident since 2014, shared her personal struggles along with those of her peers regarding the limited healthcare options in the area.

Geist conducted an informal poll at the meeting, revealing that out of 25 seniors present, 10 had supplemental Medicare insurance. Others were fortunate to have military or employer insurance benefits, and some were covered by Medi/Media (state Medical and Medicare). 

“CMS.gov, our Medicare agency, reports that enrollment to a Medicare senior HMO is available to us from Imperial Health Plan, United Healthcare, and AARP’s Secure Horizons,” Geist explained. “The problem for our residents is that if we purchase any of these plans, we have no local contracted  providers or hospitals for our care, and must drive 30 miles or more to our contracted provider, unless it is an urgent/emergency situation.”

---

---

This gap in having local contracted providers and hospitals forces residents to pay more for Medicare Secondary insurance. For example, Geist’s monthly healthcare costs amount to $454.00, which includes her Medicare supplement, pharmacy, dental, and vision premiums. This constitutes 18% of her income and does not cover over-the-counter necessities like vitamins.

The current healthcare system in Truckee leaves seniors with no option but to use traditional Medicare and a Medicare Supplement Plan, along with a mandatory drug/pharmacy plan to avoid financial penalties from Medicare. This situation is not only inconvenient but also costly for those on fixed incomes. Seniors also forfeit the additional benefits that can be provided by an HMO. 

---

---

“It’s a matter of geography and administration. We need a contracted provider group and hospitals for local, economic access to care,” Geist said.

The lack of managed care plans has also created a healthcare gap for the working population. Employees lack access to cost-effective HMO options through their workspaces. 

“Consider our teachers as an example, who are expected to pay for their family’s health coverage. The cost is very high. Our teachers already pay out of pocket for many necessary items for their classrooms,” Geist pointed out. “They deserve to pay less for their insurance, as do other employees receiving healthcare insurance from their employers. Employers also benefit from the lower cost of providing healthcare to their employees.”

Currently, many Truckee residents can only choose from PPOs or private insurance, which do not provide cost-effective care. They face monthly premiums, co-pays, and other out-of-pocket expenses, making healthcare unaffordable for many.

“It’s important for people of all ages to have access to HMOs because they’re cost-effective compared to independent insurance plans,” Geist said. “The issue of access to care and cost of care are inseparable here.”

Despite the popularity and cost-effectiveness of HMOs in other parts of California, Truckee residents face unique challenges. The nearest towns with broader healthcare options are Reno, Grass Valley, or South Lake Tahoe. According to Geist, during conversations with Harry Weis, CEO of Tahoe Forest Hospital, he has consistently refused to contract with HMO insurance carriers, without providing any reasonable cause for his decision.

“Because Tahoe Forest Hospital won’t establish a provider group that contracts with available HMOs, we lack the coverage we need,” Geist said. “People with HMOs seek care promptly; they don’t wait.”

In response, the Tahoe Forest Health System issued the following statement: “Tahoe Forest Health System recognizes that access to health care is critical to our community and is committed to improvement as a priority of the administration and the board of directors. The Hospital District is open to talking to any health plan regarding a contract. When the District considers a contract with a health insurance plan, it assesses certain key criteria to ascertain if the contract makes fiscal and practical sense. For example, some of the criteria examined include how many insured individuals live within the District, the administrative policies and processes required for referrals and authorizations, and how willing the plan is to negotiate appropriate, reasonable reimbursement rates. Many aspects must be considered before a contract can be deemed appropriate by the District.” 

Additionally, the Tahoe Forest Health System announced that 11 new providers are scheduled to start by the end of the year, aiming to enhance access and options for patients.

Residents like Geist, who have worked in managed medical groups and understand the benefits of HMOs, feel frustrated and underserved. The isolation of Truckee and the dominance of the Tahoe Truckee Health System present an opportunity to implement contracts with managed care plans, yet this opportunity remains unseized.

“Nobody should go bankrupt from medical care,” Geist concluded.

Zoe Meyer is a reporter for the Sierra Sun, a sister publication for Tahoe Daily Tribune. She can be reached at zmeyer@sierrasun.com.