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UnitedHealth, AARP hit with another lawsuit over co-branded Medigap plans
Hello, My wife and I are both AARP members and also are AARP UnitedHealthcare Medigap Plan G subscribers. We are becoming increasingly concerned about AARPs skimming revenue from this plan. Perhaps we are misinformed but we have seen several articles recently (such as this one: https://www.fiercehealthcare.com/payer/unitedhealth-aarp-lawsuit-medigap-supplemental-medicare-royal.... It appears to us that AARP has lost its path and focus in putting seniors first over its funding. Please reconsider the huge amounts of money that AARP is collecting from associating with health plans and other services. We think it is a conflict of interest.
Check your date on this example - pretty sure that it was May 2018
AARP has a royalty agreement with UHC for [branded] Medicare Advantage plans, Medicare Advantage plans (MA)with a Prescription Drug benefit (MAPD) and Medigap plans- they have no say in the pricing or coverage - Medicare and state governments have more say over these Medigap plans - and Medicare (CMS) is the overseer of the MA plans.
You do not even have to be a member for the MA plans but do for the Medigap, last I looked.
The royalties that AARP receives from UHC or any other entity that uses it brand is a funding mechanism for the non-profit works that AARP does for the benefit of seniors, members or non, since that is where their work as an organization is focused.
Feel free to give more info if you have it.
@RobertaT749475 the Part B "giveback" is a marketing gimmick incorporated into SOME, not all, Medicare Advantage plans only . . . not available in Medigap plans.
Carriers are give $X for each MA enrollee to design plans as they see fit. Each carrier and plan is different . . . some have small HMO networks, others have slightly broader PPO networks . . . but all are managed care with steerage, pre-authorization, step therapy, etc . . . all designed to minimize carrier payout while shifting as much of the cost as possible to the policyholder.
"Give back" plans often have smaller networks and higher cost sharing vs plans that do not incorporate the give back.
Bark less. Wag more.
The newest event is some Carriers are offering Advantage plans which make no difference between in and out of network. The provider just bills the carrier and are paid what Medicare or the plan would pay for that service to in network. With this path the carrier can offer the plan to anyone who has a provider willing to bill the Carrier. If the provider will not bill the Carrier then the person can pay the provider, and bill the Carrier who will remib. them.
From Cigna's website . . . you will find similar language for ANY PPO plan
If you choose a PPO health plan, it’s important to know:
- We recommend you choose a primary care provider (PCP) to serve as your personal health advocate and coordinate your health care, but it is not required.
- If you choose to get care outside of the network (such as a physician, hospital, clinic or pharmacy), those out-of-network services will be covered at a higher cost to you and will have to submit claims yourself. You will also need to meet a separate out-of-network deductible. However, eligible emergency care is always covered, even out-of-network.
Pay no attention to the man behind the curtain . . .
Bark less. Wag more.
You have the wrong information as you are reading the indv material. This is a group policy and they use it with employers who can now keep their retirees under a employer sponsored program.
There is a difference between you and I. I am in the program and covered under the policy. You are reading about the standard approach and do not realize this is something new.
Here are the facts period that neither you nor I can change.
1. You choose any provider you want period.
2. That provider does not have to be in the Carriers network, or join the Carriers network just be willing to bill the Carrier as they do for people using their normal employers group medical policy
3. If the Provider will not bill the Carrier they can bill you for what they would have been paid by Medicare plus the non medicare services they gave you, and you can summit the bill to the Carrier and will be paid by the Carrier. The way a lot of group policies used to work.
4. There is no cost difference between in and out of network providers to the insured.
5. You do not need a pre authorization to see any specialist.
6. Deductibles are the same for both in and out of network.
Now as I said before I am in the plan and using it, and have the correct material about it. You are trying to find out about it, and you are in the wrong place for that information.
What this should show all is never take advice from anyone in here but go to a local expert, and be very careful when purchasing Insurance from a sales person (agent). I can testify to that as in here I was given unasked for advice on Medicare that would have cost me over $1,000 a year extra if I followed it as the person was using the standard material they knew about.
Now what are you trying to say or prove. You put part of the CIGNA web site up. It changes nothing that I posted.
I gave you facts, I am in the program and use that Web site all the time. Have Car Insurance, Home Insurance, Discount programs etc through it. Found my Denist through it, and provider of my eyeglasses, plus just got a new car quote on it. Have used it to solve a number of problems. They have an 800 number to back it up, and I have used that over the years.
None of what you post changes anything I have said in here. Yes they have now and have had the standard advantage programs which I could never use since there is no network here for them. On Dental they use a network they have an agreement with. They owned a Hospital system and local Insurance Co. in this State for about 4 years, and sold it. Even during that period they had no network where I am so I could not use their advantage plans due to the in and out of network costing..
You have no understanding of what they are doing now. With the new advantage plan they set up I can use it as there is one cost. They benefit since there will be less use of their Indemnity products with Medicare. The provider benefits as they now deal with one location for the entire medical coverage so they get one check not 2 as before. CIGNA gets more people in its advantage programs, and overall reduces costs. Employers make out since when an employee goes on Medicare they stay under the employee benefit program, and the employer can continue to pay part of the premium as my employer has done, and the retiree gets a cheaper price. My price dropped about 40% with this change and the coverage is the same as I have always had. Now as you say Bark less, and wag more after you learned something.
Is this what you are talking about a (Cigna) PPO - see page 9 under
but I haven't heard of the reimbursement part -
Remember the carriers are only gonna pay their MA rate for the out of network provider - OR LESS.
This . . ."Cigna Medicare Advantage Preferred Provider Organization (PPO) Plan: Generally, customers are not required, but encouraged to select a PCP and referrals are not required to see Medicare accepting providers in or out of the network. Customers are not limited to their home service area for routine care." . . . is not new nor is it unique.
The non-par provider may, at their discretion, bill the carrier or not. The non-par provider is not obligated to accept payment by the carrier as "paid in full". The non-par provider may, at their discretion, agree to sign a "contract" stating they will comply with the terms of service and billed rate . . . and they may also decline to sign an agreement regarding care and reimbursement for services rendered.
In other words, the policyholder that ELECTS to use a non-par provider may (and often will) pay more than they would have with a par provider.
In some MA contracts only in-network approved charges accrue towards the MOOP. Other contracts have an in-network MOOP and a higher MOOP for out of network claims.
I have not witnessed a situation where a carrier paid a non-par provider LESS than they would have paid a par provider, but I suppose it can happen.
There are a number of folks, including agents, that THINK they know how their plan works only to discover the carrier still has discretion as to whether they will pay a claim or not . . . and how much they are willing to pay.
Using only par providers does not mean your claims will be paid. There is a reason why some call managed care "MANGLED care".
Bark less. Wag more.
It always helps if you get the correct material as that prevents misinformation. CIGNA has True choice Medicare plans for 2022. As they say to providers: CIGNA Medicare Adv PPO plan customer can go to any Medicare provider in or out of network with no referral. Providers just bill CIGNA for payment using Medicare billing coding and coverage and Medicare fee schedule is used. The provider will get one check now instead of 2 now. The medicare amount plus the medicare supplement which was what used to be paid by Cigna.
I have used this program this year and it works. My Primary Care Dr. was not in the CIGNA network and has had no problem being paid. My plan has Dental Insurance in it not dental discount. My Denist is in the Network. My eye Dr is not and no problem. I have better vision coverage now than before and part of it comes from coverage outside of Medicare. People in this plan do not pay more when they use an out of network provider. If a provider does not want to accept the plan they can let the person pay them, and the person bills CIGNA who reimburses them in full. CIGNA is acting as Medicare did with claims.
Suggest you become current with what is going on. There is a good reason why Carriers are going this route. One reason is they can offer it any where in the USA, and employers can use it.
I know you are right. I have a doctor that is out of network with United Health Care. My doctor has no problem being paid. I have seen her for over 9 years and she is a super good doctor. I understand that. I know you are right. I don't have employer coverage insurance. Only United Health Care. I am wondering how these people are getting $170.00 back every month. I know you said this is a gimmick and you are right. I don't think they get the same coverage as others. John you are right. I agree with you 101%.
The medicare amount plus the medicare supplement which was what used to be paid by Cigna.
MAPD is not a supplement plan
FWIW, Cigna True Choice was available in 2021 and possibly earlier.
Nothing to see here . . . move along folks.
Bark less. Wag more.
Cigna for one as I am in it. There are some in the State of NM, and I am told United Health has one.
You do realize that when the change to Medicare came years ago the Carriers did this only they did not have to offer anything but what Medicare did. Obama stopped that as the carriers were using it to replace medicare at govt. exp. This time they offer all the same add on programs as they do for the in network programs.
My point is that if AARP is there to advocate for us it would make more sense to negotiate a lower premium rate and pass the savings to us, not take almost 5% to fund AARP. The article is just an example. They appear to be taking this strategy with many services like auto insurance, etc. I still think it is a conflict of interest for them to be doing this. But just my opinion, that's all! Thx.
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