Any retiree having problems?

UC offers emeriti and retirees a Medicare Advantage plan as part of its retiree health program. As blog readers may know, Medicare Advantage plans are essentially privatized versions of traditional Medicare. The feds pay private insurance companies to offer plans that are supposed to provide whatever Medicare would, often with added bells and whistles such as gym memberships. 

Medicare Advantage plans, it has been reported, have been over-compensated by the feds on a risk-adjusted basis, so they have been widely promoted by the private carriers that offer them. Over half of the Medicare-eligible population is now under Medicare advantage plans, such as the one offered by UC through United Healthcare. Recently, the feds seem to have become aware of the overpayment and have begun to squeeze. Some providers have begun to remove themselves from Medicare Advantage networks because of low and slow reimbursements. There is another report that some services are being restricted.

From Stat News: Getting physical, occupational, and speech therapy is about to get a lot more burdensome for people who have a UnitedHealthcare Medicare Advantage plan. A friendly neighborhood tipster alerted me to new prior authorization rules put out by UnitedHealthcare, the insurance arm of UnitedHealth Group. As of Sept. 1, Medicare Advantage members who need PT, OT, or ST in a physician’s office or an outpatient hospital clinic will need to get approval from UnitedHealthcare.

Getting PT, OT, and ST in your home is cheaper than getting them in an outpatient clinic, but that’s not necessarily feasible for everyone. This will create headaches not just for UnitedHealthcare MA enrollees, but also the therapists who will have to file more paperwork to justify the sessions.

There’s another financial angle here for UnitedHealth, beyond potentially paying out fewer claims for therapists. UnitedHealth is also directing more of these services to itself. (Sound familiar?) People who get these services in their house are excluded from the prior authorization requirements — UnitedHealth just so happens to own a bunch of firms that offer PT, OT, and ST at home...

Full story at https://www.statnews.com/2024/10/15/healthcare-news-united-health-insurance-medicare-advantage-physical-therapy-health-care-inc/.

If you are a UC retiree under Medicare Advantage and have noted recent changes, please let us know.