The Centers for Medicare & Medicaid Services (CMS) suspended enrollment in not one, but three Medicare Advantage plans offered by UnitedHealthcare.
What happened? Well, the Social Security Act requires that health insurance plans have to spend 85% of the money they bring in on premiums directly on medical benefits and claims, and United apparently didn’t meet that threshold.
Why does this matter? The federal government pays private insurance companies to manage Medicare for millions of seniors. Ostensibly, the government wants those tax dollars actually spent on seniors’ care, not spent on corporate profits. In other words, private insurers have limitations, and can’t treat Medicare like a cash cow.
Because with more than 26 million people enrolled in a Medicare Advantage plan, we’re talking a lot of seniors and a lot of cash.
According to the article in MedCity News, if the health plans miss the mark three years in a row, coverage is suspended—which sealed the fate of UnitedHealthcare of the Midwest, UnitedHealthcare of New Mexico, and UnitedHealthcare of Arkansas.
United’s excuse? They blame the pandemic, claiming members deferred care and produced fewer claims. And this may be true: United’s record profits in 2020 were partially because so many people skipped out on regular services and procedures.
But again, this was the third year in a row. So what happened in 2019, United? How about 2018?
Private health plans that manage the care of millions of governmentally insured people continue to get busted for getting more than they give. And despite UnitedHealthcare got their wrist slapped, we just aren’t sure it’s enough to deter other bad actors.