To Boost Profits, Medicare Advantage Giants Move to Kick Over a Million Seniors Off Their Plans
Two of the largest Medicare Advantage insurers in the US, UnitedHealthcare and Humana, have signaled in recent days that they plan to exit certain "underperforming" markets and curb benefits in an effort to boost their bottom lines, a strategy that's expected to kick more than a million seniors from their coverage.
On Thursday, Axios cited an analyst note published earlier this week indicating that UnitedHealthcare "has dropped around 13% of plans offered across 18 states." Healthcare Dive reported that the company "expects to end 2026 with up to 1.1 million fewer MA members than it had last year."
"UnitedHealthcare—the largest MA insurer in the US—offered plans in one fewer state and 109 fewer counties this year, cut allowances for certain over-the-counter health and wellness items, and prioritized plan designs with more limited provider networks," Healthcare Dive noted. "The company also shifted commissions to brokers to incentivize enrollment in more profitable plans."
As for Humana, the company's chief financial officer said during an earnings call in late July that its exit from certain markets and dropping of specific plans would "impact approximately 600,000 members" as the firm implements "the changes necessary to drive the intended margin expansion."
Seniors who lose their MA plans in response to the insurance giants' moves will have to either find a new plan during open enrollment, which begins next month, or switch to traditional Medicare. MA plans currently cover more than half of all eligible Medicare beneficiaries.
Mark Meiselbach, a healthcare economist at Johns Hopkins University, has estimated that nearly 3 million people enrolled in MA will be forced to switch coverage this year due to insurers canceling their plans—which Meiselbach describes as "forced disenrollments."
“For most enrollees, they will likely be able to still find a comparable MA plan,” Meiselbach told Investopedia last week. “However, no two plans are exactly the same. They may still have access to their same primary care provider, but have to undergo new prior authorization for a medication or lose a supplemental benefit they relied on.”
The companies laid out their profit-boosting strategies months after the Trump administration provided a substantial payment increase to Medicare Advantage plans, which are run by private companies and funded by taxpayer dollars. MA companies are notorious for denying necessary care and overbilling the federal government through practices such as upcoding, whereby patients are made to appear sicker than they are to reap a larger federal payment.
"President Trump, Dr. Oz, and leaders in Congress have talked a big game for two years about reining in waste, fraud, and abuse, but instead they increased insurer payment by multiple times more than what the administration originally proposed," Anthony Wright, executive director of Families USA, said in response to the April payment hike.
During his remarks to the GOP midterm convention on Wednesday, President Donald Trump vowed to "stop all government payments to big insurance companies"—an apparently inadvertent call for the elimination of privately run Medicare Advantage plans, which received over $534 billion from the federal government last year.
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2 replies
United Healthcare getting real confident again
As an outsider looking in (but with a bit more knowledge about the system than most non-Americans), Medicare Advantage seems like one of the worst parts of the whole rotten system. Tax-payer funded and still goes through private insurance companies, fucking hell.
The US government, if you sum up federal and local governments, spends more money (as a percentage of GDP) on healthcare than mine (Estonia). But we have near-universal coverage (if you're NOT covered, you just have to register as unemployed and you're covered again). So universal healthcare coverage necessarily costing more money in taxes is a myth in the first place. Especially if you consider that the tax base increases if poor people can be healthy and work. Medicaid doesn't cover everyone who should be covered by it even under its original intention.
Worst part is, the US has it so easy when it comes to just finding money. Print it, nobody gives a fuck because the whole oil industry is in USD, dollar doesn't devalue easily unless you put Trump in charge. Or just take on more debt, nobody gives a fuck anyway. It's low interest. The benefits would more than make up for the costs anyway.
Not that I expect anyone here to think there's anything good about the system.