CT Sen. Blumenthal slams UnitedHealthcare Medicare Advantage ads as &apos;deceptive&apos; [Journal Inquirer, Manchester, Conn.]

Jan. 3—Blumenthal said that the U.S. Centers for Medicare and Medicaid Services should also force UnitedHealthcare to allow people to re-enroll under regular coverage, as there were no advantages to its Medicare Advantage plans.

"There were no extra benefits, only additional burdens imposed on Medicare-eligible low-income senior and disabled patients," said Blumenthal. "There are more restricted access to health care because of limited provider networks and requirements for clearance, that is preapproval, before any patient could use these services."

Blumenthal's statements were echoed by Toubman, whose Disability Rights Connecticut organization had written a letter to CMS urging them to investigate.

"The consequence for these folks we represent, and elderly folks, is that they are losing something," said Toubman. "Part of the problem with Medicare Advantage is they have a more narrow network than traditional Medicare."

Toubman explained that many elderly people were eligible for both Medicaid and Medicare. In Connecticut, the HUSKY program falls under Medicaid and covers dental care, vision and other services that might not be covered under Medicare. When people sign up for an Advantage Plan they are restricted to the Medicare Advantage network without gaining additional benefits, Toubman said.

"People discover, oh I can't keep my doctor," said Blumenthal. "People will go to their doctor and be told 'We don't take Medicare Advantage — sorry.'"

Consumer advocate Ralph Nadar, who lives in Winstead, told CT Insider "it was about time" that a senator went after "the most deceptive and harmful and devious marketing campaign in our country."

"These deceptive promotions do not mention the loss of choice of doctors and hospitals due to being pushed into narrow networks," Nadar said. "They do not mention the prior authorization bureaucracy that drives physicians to anger, nor do they mention that traditional Medicare beneficiaries are subsidizing Medicare Advantage."

Blumenthal, who is one of the chairmen of the Permanent Subcommittee on Investigations for Congress, said his subcommittee would investigate Medicare Advantage plans.

"We are investigating Medicare Advantage plans nationwide for these kinds of abuses and others," said Blumenthal. "The message to UnitedHealthcare and others is we will not tolerate these kinds of predatory and improper ad practices that lure innocent, low-income seniors and disabled people into plans that promise extra benefits, but only impose extra burdens."

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CT Insider reached out to UnitedHealthcare on Tuesday for comment. They called the allegations "completely baseless" in an email received Tuesday evening.

"All UnitedHealthcare DSNP plans in Connecticut allow members to see any provider that accepts Medicare, and they offer better benefits when compared to Medicaid alone, including enhanced dental and vision benefits and a monthly healthy food, OTC and utilities credit," wrote Heather Soule, UnitedHealthcare spokesperson. "Our plan benefits are filed and approved by CMS and our advertising factually describes these benefits and is filed in accordance with CMS guidance."

Medical Disadvantage

Medicare Advantage has a long and complicated regulatory history that extends back to 1986. According to a 2011 history of the program in the economic journal The Millbank Quarterly, it didn't take off until the 2003 Medicare Modernization Act under the second Bush Administration.

"I caution my students whenever somebody mentions modernization because it generally involves taking away something you already have," said Dr. Fred Hyde, an Ashton-based medical doctor and adjunct professor of policy at the School of Nursing and Health at Georgetown University.

Hyde said Medicare Advantage programs were federally funded, but administered by insurance companies like old managed care programs. According to an article in the Journal of the American Medical Association, approximately 5 percent of the federal budget is spent on Medicare Advantage. One federal estimate puts that at about $12 billion spent in 2020. Kaiser Health News reported last year that Medicare Advantage plans dodged auditors and overcharged taxpayers to the tune of millions of dollars.

These programs have steadily gained market share in recent years. About half of all Medicare recipients are on Advantage plans. Hyde said that, in effect, this was the privatization of a public service that was immensely profitable for the insurance industry.

Hyde said these programs entice elders to sign-up and are successful primarily because they require prior authorization, a bureaucratic roadblock between a doctor's recommended care and receiving treatment.

"Prior authorization means that while your doctor may think you need this, we (the insurer) will decide whether or not you need this," Hyde said, adding: "It's a nightmare for the practicing physician."

Nadar said that while Medicare Advantage plans demand less in premiums and cost-sharing, they end up costing patients more in the long term.

A 2022 Inspector General's report from the U.S. Department of Health and Human Services found that Medicare Advantage patients frequently experienced delayed or denied services. Providers were sometimes denied payments for care authorized by state coverage. Roughly 13 percent of treatments denied under prior authorization likely would have been approved under traditional Medicare, the report found. A study last year in the Journal of Clinical Oncology found that patients had a lower likelihood of surviving cancer surgery if they were on a Medicare Advantage plan.

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