United Healthcare

[JimG454455]

Just curious when you guys are going to address and speak to this issue. My guess is many of your members are negatively affected by Advantage plans and more specifically the ones AARP endorses - United healthcare. I am currently living the nightmare of dealing with UHC. Their denial, delay and defend strategies have all been applied to my care which has had a significant negative impact to my care and recovery.  I joined AARP because of your advocacies for seniors. What is currently in the news about the horrors of our healthcare system that are affecting seniors most needs to be talked about.

The fact that AARP has been mostly silent on these matters AND endorses the worst offender is a disservice to your members. You lend your respected name, which I know your are paid handsomely for,  at the peril of your members.

The exposure and pressure to reform their cruel practices needs more coverage, not just a silent endorsement.

Please step up and help us on this issue.

Regards

Jim Groll

[LisaS961881]

  Gail,

     I did take the time to read the two links that you provided.  Thank you.

     I feel a bit better that you are asking the same question that I’ve been asking myself for the past eight months.  (And, from what you’ve written, you’ve been “at this” a lot longer than I have, and have a depth of knowledge, whereas naive me was just shaking my head and wondering why they weren’t fixing what they knew needed to be fixed all those years ago.)

I do see that they aren’t just talking the talk, but are allocating resources - tech, workforce, auditing -  but again, like you wrote, they could have done that years ago, and chose not to do so.  I do hope that they aren’t just putting lipstick on a pig.

Maybe you are right - would it be a seismic adjustment for Traditional Medicare to absorb the top 3 MA Insurers’ patients if these insurers pulled out of the program?  So CMS is treading lightly?  

I am just trying to remain positive about all this.  I worry about how all of this impacts some of the seniors that I meet when I volunteer at the food pantry - many who just don’t have the strategies to navigate through this morass of choosing a Medicare program that is right for them.  I know that, until I turned 65, my employer chose what Medical Insurance/Prescription Plan I received - I never even had to think twice about it.   Then, POW! 65 and a bazillion choices! 🤔

To veer off topic and to provide an example of just how cumbersome even non-Medicare Programs are for Seniors, last week I showed two Seniors in their mid- 80s how to go online and apply for the new “Stay New Jersey” Initiative.  New Jersey now has three Property Tax Relief Initiatives:

https://www.nj.gov/treasury/taxation/staynj/
There’s the Anchor Rebate ($1,500), the Senior Freeze (Seniors within a certain income will receive a refund check for any Municipal tax increase paid), and the NEW “Stay New Jersey”, which will halve (up to $6,500) Municipal property taxes.  (Well, what is left after the Anchor and Freeze are sliced off the top. 😇)

This was a cumbersome process for them.  First, I had them register for ID.me, which was required (and rightly so due to past fraud) on the state’s application site.  (Neither one had ever even attended a Zoom meeting, so this was a novel experience for them. ). After this, I gave them a well deserved break before having them gather tax paperwork, then apply for these three programs online.  They both did great navigating the application, which was very user-friendly, and  I was just so thankful that they’ll be getting this Property Tax relief.  They had just fallen through the cracks and had no idea that they were entitled.  (Just one more hoop for Seniors to jump through.)

Gail, I wish I were certain that CMS is taking steps that will actually improve the current situation.  As I wrote in my post, I’m trying to remain optimistic, but I have lingering doubts.

Thanks for your post.

  ~ Lisa 🛶 ⚡️ ⛈️. (..scurrying indoors due to lightning! )

[CBtoo]

IF the top 3 MA insurers pulled out what would likely happen is the sickest would move to original medicare (since there is guaranteed issue and no need to pass medical underwriting if your plan is closed) and the rest would move to another advantage plan. That would drive up the cost of supplements since a higher percentage of people in them would be sicker. 

[GailL1]

@CBtoo 

Any of them could go to traditional Medicare if their MA plan closed down in their area.   But Only if they could afford a Medigap plan.  

Otherwise, they would just pick another MA plan.

But yes, I agree that it would drive up the cost of Medigap plans especially if they were sicker.  

[Tonster521]

@LisaS961881, I replied to GaiL1 with an analysis of the MA funding issue. I do not know how to copy you with the reply. So, maybe you can take a look at my reply to GaiL1 which is for all readers to read and review. Additionally, I found a fact sheet regarding the MA Payment Structure. https://www.bettermedicarealliance.org/wp-content/uploads/2020/03/BMA_OnePager_Payment_Structure_201...  Of course, there are more complex terms to developing adequate funding for MA Plans. However, obtaining a copy of the CMS manual and regulations that govern the process is a reading challenge that very few will undertake. I think the Fact Sheet will help understand the process in 2 pages, 

[LisaS961881]

   Tonster,

       Thanks so very much for providing this link!  I’ve just finished reading it while sipping my morning coffee. ☕️      

        Maybe I’m just being a “Monday Morning Quarterback”, but, after reading these two pages, I have a better understanding of how and why those upcoding shenanigans might have readily occurred.   I also remember gaining a better appreciation of this process when reading Senator Warren’s  conversation with Dr, Oz that was on her website months ago.  I appreciate that you took the time to share this.

     I’m trying to move forward and not dwell on why CMS didn’t tweak this system when the DOJ requested that they review it.  I guess I’m a bit of a Pollyanna in that I am trusting CMS to correct this now.  So much money has already been misspent.

Thank you,

       ~ Lisa 💰🌈☕️🙏

[LisaS961881]

Susan,

   I agree.  Now that this complex issue continues to be in the spotlight, I am more optimistic than I had been just a few months ago.

  ~ Lisa

[CBtoo]

PS Gail - I think the other issue that would help is if medicare didn't give advantage plan issuers more money than they give to original medicare for people. That would help keep medicare solvent. 

[CBtoo]

Think twice about getting care? So I choose not to get chemo and die? (I've had 3 major cancers close together). I choose to puke 24/7 because I can't afford full price for anti nausea drugs? I just deal with having a UTI until it turns into a kidney infection and have to go the ER at a place that won't turn you away if you can't pay your copay up front? Around here there are 4 "systems" that 90% or so of the doctors are part of (as employees, At 3 of the 4 if your bill goes to collection care is cut off and you are sued. I already go without some of my meds.

I don't think providers can modify some of their prices that much simply because of the costs of things they have no control over. And hospitals are paid more for the same services that doctor offices are paid for so maybe, for starters they need to even that out. 

The people who have the most problems, even with insurance, paying their medical bills are those who are above the income to get medicaid help on premiums and drugs through about 400% oft he poverty line for their family size. Those are the people who will die younger because they can't afford care. I am in that group. I saved a fair bit for retirement and then what happened was the cancers. This state did not expand medicaid so I had to spend all my retirement money to pay for that. Now I am broke. I guess that is my fault and I don't deserve medical care if I can't afford it?

I have no clue what "other arrangements" I can make to pay for my care. Dumpster drive? I am already working. Either you have enough money or you don't. People in other civilized first world nations have universal health care. Yes they have some problems too and some countries the system is better than in other countries ( worked and lived in 6 countries). At least people can get care and don't go bankrupt due to the cost of health care. 

[Winter2025VA]

[Monday 3/24/25] Carolyn @CBtoo , I too have read about HEALTHCARE in some countries. It seems the UNITED STATES has forgotten about us as WE AGE.

YOU WROTE: I have no clue what "other arrangements" I can make to pay for my care. Dumpster drive? I am already working. Either you have enough money or you don't. People in other civilized first world nations have universal health care. Yes they have some problems too and some countries the system is better than in other countries ( worked and lived in 6 countries). At least people can get care and don't go bankrupt due to the cost of health care.

Take Care,

Nicole  👵

[GailL1]

@CBtoo 

So what kind of healthcare coverage do you have now?  

[CBtoo]

Traditional medicare and G+ (no plain G when I first was eligible or I would have signed up for that) AARP/UHC. No way I'd get an advantage plan. I want care in any state where the facility accepts medicare. And because health care is so awful in this state good thing I could go to MD Anderson Cancer Center (which doesn't accept most advantage plans, even in state ones, nor does they Mayo just for starters) who gave me a chemo that locally no one had even heard about. I just miss the cutoff for medicaid assistance with premiums now. And due to this state not expanding medicaid pre age 65 with me and having to spend all my retirement on health care since I then didn't make enough for ACA care that pretty much wiped me out financially.

[CBtoo]

As much as I'd like to get our state to change I doubt that will ever happen. We are last in the nation for health care, didn't expand medicaid, and our university medical center is joint commission D rated and the people who run this state don't think that the poorer people in the state deserve anything because, acording to them, the poorer people brought their problems on themselves (adults not working at least half time can't get snap, there is no medicaid for adults under 65 even if they are working, etc.). Unfortunately the state insurance commission has their own issues as well. The voters likely won't vote for a change as, I believe it was last year, voters no longer have any way to get anything on the ballot to be voted on. Our state government outlawed that as a way for voters to make changes. Too bad global warming won't bury the entire state under the Gulf of Mexico, only just part of it and that won't include the capital.

I have no clue what you are talking about with respect to how gap plans are rated. I know insurance companies are rated for customer service, paying bills in a timely manner, denials,  etc, but I didn't know each and every gap plan has a rating. I don't know how this works for the disabled under 65 either other than they eventually get medicare. That wasn't part of anything I was talking about anyway though. 

And I never said anything about getting rid of either supplements or advantage plans so not sure why you are addressing that in a reply to me either. Personally I'd never ever get an advantage plan due to network limitations, changing networks, the problems with denials, the max out of pocket that you get hit with if you actually have medical issues where you actually need to use your plan (and then likely will fail medical underwriting where you'd save money with original medicare and a supplement), etc. I'd rather have the freedom to go to any practice in any state that accepts medicare. And if you look at places like the Mayo and MD Anderson Cancer Center - good luck to people with nearly all advantage plans if you want to go to either or them (or a number of other top places). 

As someone who lost her job over 2 cancers in one year and had to buy health insurance on the open market (I didn't make enough for ACA care and this state didn't expand medicaid) I am well aware of just how expensive health insurance is for crappy coverage when you are buying an individual plan outside of ACA, an employer, etc. I went through most of my retirement money paying for that so I wouldn't die of cancer. Most seniors wouldn't have the money to do that year after year after year. The life span in the USA would drop even lower as many seniors would have to do without at least some of their needed health care for financial reasons (some are already doing that, especially with meds) so I am not advocating for dropping that.

I do think that there needs to be some sort of action on the part of AARP to make sure that their royalty relationship is in line with what they state is their mission and that they step in if there are issues or drop UHC and get their for profit arm money from some other endorsements that create less issues for the users whether or not they are AARP members. I think the issues are likely more on the advantage plan side since on the original medicare side there isn't the approval/network issue, although likely there are premium issues that include a significant amount of money tacked on to premiums due to the need for UHC to pay for the royalties. 

I don't know if UHC has figured out how to put us into community rated blocks which will drive up costs as they close blocks (rather like is happening with F with no younger people in that - which is why I didn't join even though I was the last year that had that option as I knew what would happen in a community rated plan). My understanding, talking to someone in the USA (USA fortunately as talking with many in their foreign customer service operation can be frustrating at times) several levels up the UHC hierarchy is that G, without extras, was also an attempt to get the healthier (thus more likely to be younger too) people into that one rather than the original G with extras, so that premiums would be lower (not just lower because they didn't have to pay the fees when users used the extras - which many don't, but also lower due to healthier people in there - and those who can pass medical underwriting may want out of G+ into straight G which would make those in G+ collectively less healthy and so costs would go up). They used a different subsidiary to do that. 

[GailL1]

@CBtoo 

Just a few corrections in what you said 

MEDICAID:

You wrote:   . . . . there is no medicaid for adults under 62 even if they are working, etc. 

Of course people less than 62 can get Medicaid.  In Federal law they can get Medicaid IF THEY ARE  LOW income disabled people or elderly or blind with few assets.  

The ACA only widened the scope of MEDICAID to childless, abled bodied adults that meet the (MAGI) low income threshold.  

Even then most states have increased their Medicaid coverage to children under the CHIPS program and to pregnant women, some even cover the woman and the child after birth for an extended period like 12 months.

MEDIGAP plans rating options

You wrote:  I have no clue what you are talking about with respect to how gap plans are rated.

Premiums for a Medigap plan can be rated in one of three ways  to set the initial premiums and then as part of the increases in premiums going forward.

1.  Community Rated 

2.  Issue Age 

3.  Attained Age

You wrote:  I don't know how this works for the disabled under 65 either other than they eventually get medicare.

People who have been declared disabled who are less than 65 get access to Medicare after receiving a SSDI (Social Security Disability Insurance) payment for 24 months or have a diagnosis of ESRD (End Stage Renal Disease) or ALS (Lou Garrett Disease or      )  for which they get immediate access to Medicare. 

Federal law does NOT give people less than 65 years old access to any Medigap or Medicare Supplemental policy.  So these folks are either forced into a Medicare Advantage plan to protect themselves financially OR the state where they live passes a state law giving them access to SOME Medigap plans usually Plan A and/or Plan B - which are both less than the lucrative benefits in Plan G or the others.  Even when they, as disabled folks, are given access to certain Medigap plans by a state because of the high utilization they have of health care, their premiums are pretty astronomical in some states.  I am talking $500 - $ 1000 a month just for a Medigap plan over and above the Medicare Part B premium.  

So in many states, these disabled folks opt for a Medicare 
Advantage plan to save in premium, and medical cost.

When they turn 65 years old, they get a “do-over” with Medicare and can re-enter the program under their 65 year old guaranteed issue period and enroll in a Medigap plan without underwriting under their initial Enrollment Period (IEP).  

Yes, having Traditional Medicare with a lucrative Medigap plan, at present, gives a beneficiary access to a lot of providers that accept assignment or even some that have signed up as “non-participating).  “Non-participating” providers can charge a beneficiary up to 15% more and some Medigap plans cover this too.  Those providers who have “opted out” have to do so for a minimum of 2-years and the only way they will work with you as a Medicare beneficiary is under a contract basis - Providers who have opted out, do not bill Medicare and neither do they get any reimbursement from Medicare either.  Opt-out providers are on your nickel and under contract which usually has their cost outlined.  

Yes, MOST AARP/UHC Supplemental plans are community rated.  However, in those states that have expand their guaranteed issue rights in some way - all of their premiums are much higher than in other states because the insurers in those states have to contend with a much higher risk.  

There are (4) states where a beneficiary can pretty much sign up for a Medigap plan at any time, at any age and without underwriting - these are the states with the highest Medigap premiums - and they are all, I believe, community rated.

CT, MA, ME and NY.

Then the other states that have expanded GI rights let the beneficiary CHANGE plans without underwriting during some set time of the year.  (i.e. around ones’ birthday so some of them are known as birthday rule states). Premiums are still high in these states too - CA, MO are a few of them but there are others.  In these states, if one wants to switch a Medigap plan it’s has to be to an equal or lesser (in benefits) plan.  

I hope I have just added to your knowledge of the program of Medicare.  I do know that an Independent Medicare Plan broker in your state and area will know better than anybody else which insurers are likely to rate you during underwriting more or less leniently based on your health.  

Sometimes BCBS (and perhaps others) might open up their Medigap coverage with no underwriting if they are wanting to build their Medigap business.  Again, an independent Medicare plan insurance broker will  be aware of these types of offerings.

Also know, you might already know this, that a Medigap insurer can refused coverage to a beneficiary outside of IEP and the surrounding period, they can also charge a beneficiary more out side of that IEP and the surrounding period, or they can not cover any preexisting condition for around 6-months.  

If there is anything different in your state about Medigap plans, your state’s SHIP office or the state Dept of Insurance should know about it and they usually have it somewhere on the states website all the particulars.

Goo Luck in finding and getting the coverage that you need and want. 

[CBtoo]

IN MY STATE THERE IS NO MEDICAID for "regular" (eg non-disabled) people under 65 because it was not expanded. Not even if you work 1/2 time. I live in one of the states who won't give out food stamps to people under 62 not working 1/2 time either. Apparently their goal is to kill the poor to solve the poverty problem. 

I am not disabled so this is not relevant to me. Not to mention your entire post is irrelevant to what myself and shamit are talking about which you are sidestepping by changing the subject.

I don't have minor children so CHIPS and pregnant women are irrelevant to me as 20 years after menopause if I were to have a child at my age that would be a miracle. I am sure if that happened the Catholic church would be interested and I'd be set for life. LOL

Rating. I thought you were talking about number of stars rating. What you are talking about is the RISK POOL. That is not a rating. That is a risk pool (community, etc.). They are entirely two different things.

I am well informed about medicare for 65+. I am sure most of us are aware of network issues and accepting medicare. Most insurance you have when you work is that way too. 

Brokers have a financial incentive to steer to people to the plans where their commission is higher (usually advantage plans give the highest commissions - often twice what supplements do and D is the least with some now not giving any). I am on an insurance forum for agents and am floored at what some of them post. While not all do that many do. I am not sure I'd trust an unknown to me broker because of that. And brokers usually don't write for all plans available in a state. 

On medicare.gov I put the zip code in for a nice residential area in a major city in each of the states as I was looking for which states offered G and G+ (15 of them) that also had a birthday rule or equivalent (a total of two of them: IL and OK) because moving there and back would also solve my problem if I fail medical underwriting to switch. The rates were NOT higher in each and every one of those states, only some of them. One was lower and several were within a couple of dollars. I saw the rate for someone my age, sex, etc. in medicare.gov as I checked it in each state. I also checked on UHC via the AAPR link to get over there. Same results. So that is not correct information. Sure the odds of them being higher would be there as sicker people could move from advantage plans where now that they actually needed care they couldn't afford the out of pocket and limited networks so that would increase the number of sicker people in medigap but it is NOT true rates are higher in all those states. I was surprised at that. 

[SusanM664094]

Maybe some of us are suggesting we'd like to see other options available. The "AARP" name on products does carry some intrinsic weight. Otherwise it's just another marketplace without much value as intellectual property....it's somebody else hawking their wares.

[robin24]

I also brought this up in a post last week, but my post was removed.

[CBtoo]

Hmm I discussed royalties in a reply today. I wonder when that post of mine will be taken down. AARP owns these forums so freedom of speech is not our right when we post here. AARP though might find it useful to read about complaints and then think about how they can make folks happier or discuss it with UHC (and others they get royalties from) to see if they can get them to fix issues. That certainly would be in the mission of AARP if they so choose.

[SoulSurvivor61]

Regardless if it's United Health Care or what ever medical plan you have and how benefits are severely cut each year. The truth of the matter is, The United States does not and never has, properly cared for Seniors and/or disabled citizens. It's shameful... a disgrace compared to other countries. This country was built on capitalism, greed and it is a detriment to survival.  Dare I say, I wonder who will be shot next?