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

[GailL1]

@SummerOnTheWay1 @SethF456578 

Personally, I think people should buy what they need and can afford and get the best coverage for their needs and forget many of these bells and whistles which just ups the price of [whatever-type Medicare] policy.

I put the blame pretty much on the insured beneficiary for not learning about Medicare and how it works - sometimes for them and sometimes against them.

I believe that since so many people had employer coverage while working that they really didn't have a lot of deciding on which policy and thus never learned how to pick what they need rather than what bells and whistles they are getting.  

I have never found a membership benefit [any group] to be any better than what I might be able to find on my own.  

[MarjorieM238987]

Sorry GailL - we're not talking about bells and whistles, we're talking about coverage for basic health care and life threatening illnesses. My 25% premium increase this year was for basic, bare bones coverage. Want to tell me how predict and plan for future increases? 

My best guess is we should probably talk to UHC's lobbyists in Washington. 

By the way, things like gym memberships actually Lower healthcare costs. 

[GailL1]

@MarjorieM238987 

I assume you are speaking about Medicare Supplemental coverage or Medigap.  Medigap really isn’t health insurance, this type of coverage does not make any healthcare calls - it’s basis is purely under the Medicare lead - Medicare pays, Medigap pays.  Medicare does NOT pay, Medigap does NOT pay.  

Medigap coverage is more financial protection insurance to protect one from a financially catastrophic medical event paid up to the Plan of choice’s coverage - all or some - since the traditional program of Medicare has no annual or lifetime limits in what a beneficiary may have to cover as their part of the cost;  some definitely need some protection.

Remember that if you have a AARP-UHC Medigap plan that has a declining premium discount based on age,  that % increase may also be in the increased premium mix depending on your anniversary date.

Yes, this has been an especially high cost year for Medigap plans - not just AARP-UHC - Allstate has terminated itself from the Medigap market.  They will sell no more of these policies.  From my understand ACE, which use to be a subsidiary of CHUBB, don’t know their relationship now, who offered some  Medigap plans in some states, raised their premiums by 38%.  

A recent NAIC report showed that a lot of medicare supplemental plans have a bad risk ratio - IOW, they are not doing well as a medigap insurer - more claims than they planned fior - 

Much of the financial rules of a Medigap insurer is in the hands of the various states.  Pass the Plan benefit definitions and the basic initial enrollment period and who is covered by Fed law (65 and over) - everything else is under the state control.  States can add additional enrollment periods (guaranteed issue - without underwriting) and a few have continuous enrollment no matter what - they can also review their premium increases and they can set the reserve amount which the insurers have to maintain.  So if your state has made any of these type changes to a medigap insurer - your premiums will increase.  Some states also legislate that those less than 65 years old can buy any Medigap plan they want - these are people with disabilities so they could be high Medicare users and thus high Medigap users.  

But of course, health care cost under Medicare is also getting more expensive - not so much in how much is paid for a particular procedure or providers but the added cost of new discoveries - like the image testing of people if their doctor thinks they may have the beginnings of Alzheimer’s and then the monitoring images if they are put on the medication to test its results.  It all adds up.  

Then there is the usage of Medicare benefits - more and more people are going into the program and more and more are using the services provided and if they are in the same group for a Medigap plan then cost go up for the chosen plan.

I would plan for it to continue to go up.  There is little a medigap insurer can do about the health care cost that they pay - that’s what Medigap does pays the part that Medicare does not cover.  They can try to set fair premiums - not too high and not to low - because those with low “intro” type premiums do go up eventually.  And I don’t see what lobbying would do for the Medigap market - every insurance marketplace has its own numbers -

You might be right that gym membership lowers healthcare cost at least for some -so you can pay for that benefit if they continue to offer it - it isn’t legislated as a benefit, only a cost - maybe a loss leader as in BUY ME !! 

[SethF456578]

While I generally agree with the idea that you should be mindful and research your options, my point is that I did just that and they changed the benefit with no notice mid term and then acted like ‘so what’.

if you bought a car including oil changes for 2 years and 14 months in the said ‘no more free oil changes’, you might be a bit annoyed. Some would even sue. My point is they did just that and didn’t care at all. 

I don’t think anyone would disagree that our healthcare system is failing. Just look at the facts. We are rank terribly compared to the rest of the developed countries in pretty much everything from infant mortality and maternal mortality to financial destitution as a result of a bad health incident. I am not expecting AARP to fix this. But I do expect them to vet their partners and ensure those that they allow to use their seal of approval, their brand, are doing the best for AARP members. But apparently that is too much to ask these days. 

It’s a shame. 

[GailL1]

@SethF456578 

One must be careful to separate what is contractual and what is a lost leader - You get the contractual cause that has law behind it but as for those “extras” you have to read the small print indicating that they can cancel these at any time.

[SethF456578]

Not to belabor the point, but my issue was not that they couldn’t cancel it (although that sucked) but that there was no notice of any kind and their customer service was unsatisfactory to say the least.

[DirkB349973]

I didn't choose an Advantage plan for some of the reasons you mentioned. Here is an article on the pros and cons of Advantage plans.

https://www.consumerreports.org/money/health-insurance/pros-and-cons-of-medicare-advantage-a68341678...

[GailL1]

@DirkB349973 

Good article and I will add a bit more in describing how Medicare, the whole program works. 

i work as a volunteer patient advocate and I will say that prior approvals and denials of services are usually cleared up with some work.  

1,  Sometimes the provider of the service had their codes mixed up.  OR their records haven’t been fully updated with the patient’s diagnosis and plan of care and the procedure or treatment looks like it is just pulled out of thin air.

2.  The reason for a denial is important because both Traditional Medicare and Medicare Advantage insurers should be working from the same best practices info.  So initially, that’s where the investigation has to start - with the CMS.gov -  Medicare National or Local Coverage Determination.

3. Then if the procedure is definitely not covered - it isn’t covered under either  Traditional Medicare or a Medicare Advantage plan.   Then comes the explanation to the patient as to why something isn’t covered- and that is probably the hardest part.

Many times the process is long and detailed.  The Center for Medicare and Medicaid Services is the government entity that makes all the rules for both Medicare and Medicare Advantage plans.  They are also the ones that pays the insurers in the managed care part of Medicare - Medicare Advantage plans.  CMS supports utilization management in Medicare Advantage plans - but sometimes they do leave an opening when the insurers can add to the amount they are paid be that a bonus for a high star rating or a higher payment if the MA beneficiary brings with them a higher risk.  

As with anything government, it is very complicated and personally I think it could be simplified but even more than that, there is a need for beneficiaries to understand how Medicare [all parts of it] actually work.  

[SusanM664094]

Another post recently removed...That's how they're dealing with it....

"DwightH318517 (Newbie) posted a new reply in Medicare & Insurance on 12-12-2024 10:34 AM:

Re: Stay Away From United Healthcare"

[CBtoo]

I clicked on the Re:Stay away from uhc link in your post and got "access denied". LOL I guess they don't want to hear about negatives about one of their money makers for them (eg from royalties). 

[LisaS961881]

https://www.cnn.com/2025/05/15/business/unitedhealth-stock-ceo-investigation
  

[b118512t]

I commented on several posts on this topic yesterday (12/12), and today they are all gone.

[GailL1]

@JimG454455 

What endorsement?  You need to read the fine print.

The thing is the AARP is NOT endorsing anything that bears their branded name.  It is purely a financial arrangement between the organization and the third party vender and they do seem to reintegrate this on their benefits page and the venders do the same on their AARP-branded products.

In fact, these deals are initiated by the profit making arm of the AARP -

AARP Services, Inc.  

Now perhaps the “endorsement” is implied or so it is interpreted by members by the use of the branded name but ALL of the disclosures I have read from the AARP does not support that implication.  

Like this:

AARP.org - Medicare Related Options 

quote:  Paid for by funding provided by companies that make available AARP-branded products and services for AARP members. Content is managed by AARP Services, Inc.

Then further disclosures on all the different Medicare related plans:

[quote] 

DISCLOSURES

AARP commercial member benefits are provided by third parties, not by AARP or its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Some provider offers are subject to change and may have restrictions.

Plus, these type of product - specifically insurance products - should not be purchased based on any recommendation - they should be purchased based on the needs and pocketbook of the beneficiary or member.  

[CBtoo]

Regardless of whether or not AARP is endorsing UHC (or Oak Street Health or anything else for that matter) is sort of a technicality (yes a legal technicality but I am using the more general use of the word). Most people assume AARP wouldn't associate themselves with the dregs of the earth companies so to speak and would want their name associated with something that is good.

Yes the fine print says legally what they are doing but many don't read the fine print - or can't read it as it may be in tiny type or hard to find. And a very well done International research study documented that if you are German or Japanese you are most likely to read instructions, fine print, or anything else before you even took the laptop computer out of the box (they were rigged to have a self fixable problem where how to fix it was in the user manual). And...if you were American you were the least likely of all first world countries in the study to read that stuff prior to trying to use it. This means companies need to design what they do around that since this is a society thing and they will get less blow back from consumers if they take that into account when they do something.

Certainly I'd suspect there'd be fewer complaints if AARP made that obvious with their relationship with UHC. And people would be less likely to jump to conclusions, Many would then realize that AARP likely (and I don't know this as a fact) allowed UHC to use their name as a marketing device (rather than another insurance company) as they were willing to pay them more in royalties than other insurance companies. I'd guess (and again I don't know this for a fact) that likely some of what they get is also dependent upon how many sign up, or share of the market for the person's age (or some other metric) and so it gives incentive for AARP to put what they do on their website even though we are then directed to the UHC site (this way UHC can see how we got there to pay AARP IF IN FACT this is part of their royalty agreement. As that one article I posted already indicates both AARP and UHC are pretty secretive about the details of their relationship. 

But before people trash AARP and UHC for this (despite it does, in my opinion, imply a conflict of interest with respect to what AARP's mission although the money goes to their for profit arm and not their non-profit arm), what they both are doing is VERY common in the business world and not an anomaly. Do I think AARP should be far more upfront and open about getting paid to advertise UHC's products - YES!. We need to trip over it because of AARP's mission and what can easily be implied, and not have to find it in the fine print - if we even were to go looking.

.This next bit only read if you care about details of risk pools and other more technical things (inclosed in === lines, final more general comment on the other side of the second === at the end).

======

If there had been more than one community rated supplement company in my state I would have compared them critically and not been influenced by AARP's advertising of UHC's products (but I know many are). BUT there is only this one it is what it is. And in some degree it is a mixed product for it's "price" pool. The underlying risk pool is community (eg all of us in one risk group so generally healthier younger people keep the overall price down) however the rates are more like age attained -  eg what they call their "discount" structure which makes the full price premium more expensive due to giving discounts to younger people (up through 75 or 80 depending on when you first turned 65 - I also wonder if they have separated us into two different risk blocks as well but I have no way to find out).

But they have to give the discounts so younger people will even sign up. Many don't think to ask what their premium would be if they were 80 or older and see that community rated risk pools are generally cheaper at that stage of their life. However the pot of money needs to be the same to meet expenses regardless of how the company structures their premiums. As a result if some pay less others have to pay more to meet the needed amount.

Based on how the discount has now been changed for newer signees to get a discount through basically the average of men and women's average life span (eg 80 vs the earlier 75 - so averaging the male and female life span and rounding) it really is driving up older people's premiums the same way age attained risk pools do even though the underlying risk pool is community. The advantages of this being a community risk pool is diluted that way for older people. When I checked when I first signed up I did see that other companies tended to charge more if I had been 80 or 90 (ages I asked about) and found those companies/agents were really reluctant to give me those figures. 

Of course if you don't pass medical underwriting (and don't live in some of the states that allow you to switch every year without medical underwriting) and can bail to a different plan if you are ticked enough then it is what it is. You can switch to an advantage plan (and suffer the consequences of networks (which exclude places like the Mayo, MD Anderson Cancer Center, and many others for out of state advantage plans even those that are PPO, HMO, or SELECT) out of pocket maximums that tend to be more than premiums plus supplement deductible than an advantage plan premiums (if any) plus out of pocket minus money saved by dental, etc (well unless you have a supplement with those "extras" then that part is closer to break even).

If you get an advantage plan and the move such that it isn't accepted in that state then you have guaranteed rights to switch supplement insurance companies with no medical underwriting (and I do NOT know the situation with UHC's advantage plans across state lines other than your premium may change) and you can get a supplement back without medical underwriting (some states say it has to be with the same company others don't have rules about that). 

=======
But I'd guess for most of us if we don't pass medical underwriting (and eventually most won't if they live long enough) we are "stuck" with our UHC supplement and the AARP royalty (which no doubt is added to our premium costs) and it is what it is. And it is a shame AARP doesn't take a more active roll in addressing complaints about what UHC does regardless of the technicality of a royalty and no responsibilities with respect to that. One would have hoped that AARP's larger mission of elder concerns and protecting senior citizens would mean they would become involved to address repeated complaints either with their for profit arm (where the royalties go) or their non-profit arm (the organization we pay membership to). By the way after you sign up for a supplement and are accepted you can drop your AARP membership and keep your supplement (medicare rules; by the way you don't need a membership to sign up for an advantage plan). In the end some of the people reading this can bail from UHC and some of us can't and for those of us who can't it is what it is.

[ng8463]

Wow! Lengthy! Like that fine print. 

[GailL1]

@CBtoo 

If you and others in your state have a problem

• with the way Gap plans are rated
• or when a disabled beneficiary may obtain a Gap plan or not
• or when added GI rights are added

Then solicit your state’s legislature to change it - there are plenty of states at present that have done such things, albeit premiums are higher in those states since they added to the risk involved by offering such lenient plan designs.

What about if we got rid of both Medicare Advantage plans and Medigap plans - beneficiaries would then have to become much more frugal where they spend their part of their healthcare dollars.  

I guess since I was self-employed my entire working career, I am use to reading contracts down to the last minute detail and discount things I don’t need for my dollars.

Yes, it is a selling point to offer these auxiliary benefits - anything to set themselves apart from the rest of the pack in completion for your dollars - like loss leaders, so to speak.

Of course, they know the buying habits of many Americans to want something for nothing - but that nothing really never exist.

I do get upset at beneficiaries when they use these extra things as a decision making tool rather than their own medical or financial needs. 

In most metro areas, one can find a great MAPD plan - harder to do when there are fewer providers.  Many will not chose a Medigap plan where they don’t have as close to 1st dollar coverage as possible.  But just like CMS cancelling the sale of Medigap plans H, I, E, J (in 2010) and plans C & F (2020), the next one to go will be G - then they become closed book plans (by the government) and premiums will rise and rise since there will be no younger and healthier added into the plans - and the plans will continue to pay out more and more because those left in it will keep getting older and older, and most likely sicker and sicker.  

[AndrewC394210]

People can also solicit their federal representatives to support Jayapal and Sander's  Medicare for All Act, which expands Medicare to completely cover all non-elective procedures and adds dental and vision.

[shamit]

@GailL1 .  I also don't know where the following from you came from:

"What about if we got rid of both Medicare Advantage plans and Medigap plans - beneficiaries would then have to become much more frugal where they spend their part of their healthcare dollars.  

My mother spent a lot of time in the hospital and had 3 surgeries to save her life back in 1994.  The hospital cost was over a million dollars.  I hate to think what it would cost now.  Most seniors wouldn't have that kind of money to pay the 20% that Medicare does not cover.  I guess to be frugal the only solution was for her to refuse surgery and die. 

I usually agree with you on a lot of things but I simply can't agree with this.

[GailL1]

@shamit 

Think about it - you are right, most seniors wouldn’t be able to handle their part of the cost.  Thus a few things might happen:

1.  Providers would have to modify their pricing so that these multitudes of seniors would still be their clients - or maybe they would just have to accept what Medicare pays now for that negotiated rate.

2.  Seniors would think twice about getting some care - The reason that CMS has discontinued some of the more lucrative Medigap plans - the ones that allowed for 1st dollar coverage like Plan F, Plan C or even a longer time ago, Plan J, is because they know that when there is some out of pocket cost, it saves health care dollars for Medicare because beneficiaries think twice about getting some care.  Yes, I am talking more about Part B coverage.  Utilization of Part B coverage makes our Part B premiums go up.  Part A which covers inpatient hospital care and skilled nursing facilities is already paid for during a senior’s working years - that’s where the payroll contributions go along with the employers match - to the Medicare HI Trust Fund.

3.  Medigap isn’t health insurance - it is financial protection insurance that works with Traditional Medicare to pay or help pay the beneficiary’s out of pocket cost.  If it were not available, beneficiaries, who don’t have some other type of help with out of pocket cost, would have to make some other arrangements to cover their part of the cost.  In 2022, over 3 MILLION seniors did not have any outside help with paying their part of these cost.  They didn’t have a Medigap, they didn’t have Medicaid, they didn’t have some other type coverage that filled the bill in paying these cost - they either paid them themselves, using their credit or made a payment plan with the provider or they cashed in or borrowed against some of their investments to pay these cost or they got hit with a delinquent notice and damage to their credit standing.

4.  OR perhaps with only having Medicare, the Traditional program, and nothing else to lessen the financial blow of an illness or disease, it might force the powers that be to change the program of Medicare to allow for AT LEAST an annual or even a lifetimes limit on Traditional Medicare’s out of pocket cost.

Many beneficiaries have gone thru a life time of not planning for what happens when they can no longer work.  Then they are hit with the  realization that they have had a misconception of Medicare - 

What happens if the powers that be decide to end Medicare Part C -  it sounds to me that is what many on this board and others which I frequent want - to get rid of Medicare Advantage.  

Then we will be hit with many beneficiaries coming over to Traditional Medicare.  It will probably be a tremendous medical cost because in many states those that are disabled who are less than 65 years old, and high users of medical care only have a choice of a Medicare Advantage plan.  

We are all gonna have to understand how Medicare works and what we can do to help the system last for those who come next.  I have lots of ideas to which some may agree and others who will think I am a bit crazy - which could be because I am pretty old. 

I am glad that your mom got the care she needed - but for me, I would rather have some other choices than to have a long, excruciating illness or disease if surgery and a long hospital stay are my only options especially if there was a question about how my life would be after treatment.  

We probably aren’t gonna end Medigap or Medicare Advantage plans but there are changes made to Medicare that could be very beneficial finance-wise which we are gonna have to face sooner rather than later.

[SusanM664094]

If the Congress performed proper oversite of the Medicare Plans, we might see some different outcomes. UHC has been in the courts for a decade now, fighting with the Feds for overbilling. And losing. And bringing more suits. [They have a lot of money] https://www.cbsnews.com/news/medicare-advantage-overbilling-feds-kill-bill-after-industry-opposition...

[GailL1]

@SusanM664094 

Recently UHC won the court case that you posted the article about.  They won this battle, IMO, as they should have because they are only doing what CMS has approved for them and the other insurers to do.

KHN.org 03/05/2025 - UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments 

from the link~

The Justice Department’s years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback Monday when a special master ruled the government had failed to prove its case.

In finding for UnitedHealth, Special Master Suzanne Segal found that the DOJ had not presented evidence to support its claim that the giant health insurer exaggerated how sick patients were to illegally pocket more than $2 billion in overpayments.

more at the link ~

[SusanM664094]

Certainly a step forward for them. "A special master assigned to the case by the judge issued a recommendation late Monday in favor of UnitedHealth. The judge will use the recommendation to determine whether the case will proceed"

And maybe another arrow for Dr. Oz, the new Administrator of the Centers for Medicare and Medicaid Services , who vows to go after Medicare Advantage plans. Story to continue....Lol. Stay tuned.

[LisaS961881]

Susan,

   I just found some very recent discussion about this in a very public forum:

https://www.warren.senate.gov/newsroom/press-releases/dr-oz-agrees-with-sen-warren-cracking-down-on-... 

that $83 billion a year figure shocked me.  Hopefully there will be some action as this becomes public knowledge.  

[SusanM664094]

Lol. The info about the money connection is being aired now. More news to come. https://www.foxbusiness.com/fox-news-politics/shameful-aarps-partnership-healthcare-giant-faces-back...

[LisaS961881]

….and just today:

https://www.newsweek.com/unitedhealth-group-medicare-fraud-investigation-doj-wsj-2072533 

[GailL1]

@LisaS961881 

That Newsweek articles sound like a WHOLE lot of speculation - Is there a DOJ criminal case - they don’t know.

Is there a judge appointed - they don’t know.

Is the judge gonna make a decision on moving forward with the case from last year - again they don’t know.

[SusanM664094]

It's an ongoing situation. Apparently there's multiple investigations.

https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-shares-drop-after-report-cr...

[LisaS961881]

Thank you for sharing this link.

~ Lisa

[TRL1111]

It's based on an anonymous source, which is different from speculation.  

The original reporting comes from the Wall Street Journal (Newsweek and other news outlets are just repeating it), and the Wall Street Journal is who did the excellent reporting recently about Advantage plans upcoding to obtain bigger payments from the government for their Advantage enrollees.  

But all of them upcode, and in the article a Congressman is quoted as saying this about upcoding:  "It's not necessarily fraud because some of this is legal but they're pushing the boundaries, and it's really immoral in fact."

As with everything once you scratch the surface...it's complicated.

My question is why isn't the government investigating ALL of the Advantage plans?

[LisaS961881]

I appreciate your reply and agree with everything that you wrote.   Thank you for highlighting that specific quote.