Chad Davis (CC BY 2.0)
Police outside the corporate headquarters of UnitedHealthcare in Minnetonka, Minnesota, December 2024.
My mother was excited—a UnitedHealthcare Medicare Advantage representative was offering her a new Medicare plan that includes dental coverage, which her standard Medicare plan did not.
Medicare Advantage plans are funded by the government and administered privately, and often include benefits that traditional Medicare does not. Rather than pay seniors’ medical expenses as they come up, Medicare Advantage insurers receive a lump sum for each senior they enroll.
More than half of all those eligible for Medicare are now enrolled in Medicare Advantage rather than traditional Medicare. For younger, healthier seniors, Medical Advantage plans are often less expensive.
My amiable mother knew nothing of the distinction between Medicare Advantage and traditional Medicare. She was just glad to be able to chat with the nice person on the phone, excited about the benefits the new plan would provide.
Though I had power of attorney for my mother’s health care, I didn’t learn about the change until weeks later. That’s when I got a panicked midday phone call because one of her doctors couldn’t see her anymore. My mother, a forgetful ninety-one-year-old widow, hadn’t informed me of the change.
Surprised, I called the federal Medicare office to get my mother’s Medicare Advantage enrollment reversed. The person there told me I had missed the open enrollment period, and thus couldn’t switch her back until the next one opened in nine months. UnitedHealthcare (UHC) had mailed her information on her enrollment but I hadn’t seen it. Later, I found it in a pile of my mother’s old newspapers.
Exercising what I thought was within my power of attorney, I asked Medicare to put a lock on my mother’s account so she could not again be switched without authorization from me. They told me this is not permitted. As a result, this insurance switch happened two years in a row.
I’d call one Medicare representative after another, pleading, demanding, “Why can't you stop this!?” I’m embarrassed to admit how astonished I was that Medicare was allowing private companies to mislead vulnerable seniors. (I emailed UnitedHealth Care to explain the thrust of my story and invited it to provide a comment, which it did not do.)
Meanwhile, I’d attempt to get my mother, a cancer survivor with a heart problem and a pacemaker, the health care she needed. She had a small corps of doctors with whom she had worked for years and often decades, and it was important that she see them, as opposed to new doctors who knew nothing about her complicated medical history. I quickly learned that this was impossible—she could only see doctors on UHC’s list of providers.
We had been happy with the physical therapist that Medicare provided; a young gentleman named Adam came to her unit twice a week, got her out of her wheelchair, and guided her as she practiced walking with her walker. Every couple weeks I exchanged text messages with him and he would report my mother’s progress.
Once my mother signed up with Medicare Advantage, Adam’s visits were abruptly terminated because he wasn’t on UHC’s provider list. I called those who were, but none would treat her unless we came to them for each visit, which was very difficult for my mother to do.
After many weeks of battling over this, I brought Adam back by paying him in cash. That helped my mother, but she never got back to the modest level of functionality she had had before her enrollment with UHC.
There were other difficulties. It was often hard to get whomever I was dealing with to allow me to represent my mother fully. Sometimes I needed to have my mother next to me so we could be on the phone together. Given my schedule and her confusion and distress, this was not easy.
Moreover, navigating such issues involves a lot of phone tag, and at my job it is very difficult to accept or make phone calls during the day. In the American health care system’s coverage denials, appeals, and myriad other limitations, there is an implicit devaluing of the senior’s adult children’s time. In the majority of households, this time-grinding burden falls on women.
I often explained the situation to my mother and begged her not to agree to any Medicare change over the phone. She would apologize and promise not to, but would forget and sign up again.
One year, in the weeks leading up to and during the open enrollment period, I was so desperate to keep my mother out of Medicare Advantage I even considered disabling her phone.
Similar situations are happening all over the country. U.S. Senator Ron Wyden, a Democrat from Oregon and chairman of the Senate Finance Committee, has flagged the beginning of open enrollment in the fall as “the start of a marketing barrage as marketing middlemen look to collect seniors’ information in order to bombard them with direct mail, emails, and phone calls to get them to enroll.”
A Commonwealth Fund survey found that during the open enrollment period for 2023, for example, a third of seniors received seven or more phone calls weekly from Medicare Advantage marketers.
The Medical Advantage salespeople are clever—a couple of my mother’s friends told me that they would get calls from one company or another every fall who would tell them that their Medicare was “expiring” at the end of the year and ask them if they wanted to “renew” it. When the senior “renewed” it, it would be for that company’s Medicare Advantage plan.
Brandon Novick of the Center for Economic and Policy Research explains that Medicare Advantage companies bombard seniors with ads but don’t disclose the serious drawbacks, such as eliminating enrollees’ ability to choose their own doctors and “dangerous delays and denials of necessary care.” The salesmen calling seniors don’t explain these things either. Novick calls Medical Advantage a “scam.”
UnitedHealthcare, in particular, is known for its high denial rates. In fact, according to a Forbes article from December, recent data shows that “the insurer refused an estimated one-third of claims submitted . . . a rate nearly double the industry average.”
Dr. Craig Albanese, the CEO of Duke Health, told Becker’s Hospital Review that UHC “denies payment for care 40 percent more than other national insurance carriers we contract with” and that Duke employs 236 full-time workers to appeal all denials from payers.
As the Wall Street Journal reported last November, the difficulties that Medicare Advantage customers are experiencing in getting their care covered is prompting an exodus of customers, especially those with the greatest health care needs. The paper’s analysis found that Medicare Advantage insurers “actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use.”
Many doctors are denouncing the Medicare Advantage programs entrapping their patients. In a recent Journal of the American Medical Association article, the authors—three medical doctors—accuse the programs of cherry-picking and lemon-dropping. That is, they work to avoid accepting customers with greater needs and chasing away those who become too expensive.
The authors are skeptical about fixing the program, saying the “failure of past efforts to rein in” Medicare Advantage providers “does not bode well for incremental reforms.” Instead, they say, “the time has come to declare [Medicare Advantage] a failed experiment and abolish it,” while taking steps to improve the government’s Medicare program.
I hope such changes come. For years, I approached every fall with apprehension over how my mother might get ensnared, and what this could mean for her health and perhaps even her survival. My mother’s bad experience with Medical Advantage plans in general and UnitedHealthcare in particular ended when she died in January 2022, at age ninety-three, her last years on earth marred by a profit-hungry industry’s pernicious deception.