Patient groups criticize UnitedHealthcare's Medicare Advantage marketing

Photo: Manuel Breva Colmeiro/Getty Images

Patient advocacy groups have sent a letter to the Centers for Medicare and Medicaid Services criticizing UnitedHealthcare's Medicare Advantage marketing, asking the agency to investigate potentially misleading advertising tactics.

Signed by the National Health Law Program, National Disability Rights Network, Disability Rights Connecticut and the Center for Medicare Advocacy, the letter claims that an ever-increasing percentage of Medicare beneficiaries and being persuaded to move to Medicare Advantage plans – in part by offering extra benefits not covered under the traditional Medicare program, but also in part through misleading advertising.

While these plans do in some cases provide additional benefits not covered by traditional Medicare, such as a limited amount of coverage for dental services, the groups claim the advertising fails to tell people about the provider network that's substantially smaller than under traditional Medicare, as well as "excessive" prior authorization under MA.

"Not being told the downsides of choosing one of these privatized plans, they are led to believe there are none," the letter states.

The groups go on to say that the "extras" offered by MA plans often mean little when a patient also has Medicaid: Dually eligible patients are already entitled to these benefits, they said. 

In Connecticut, for example, all individuals with full-benefit Medicaid are entitled to unlimited dental services without hard financial caps, routine eye examinations and a new pair of glasses at least once every two years, as well as unlimited non-emergency medical transportation to get to and from any medical appointments covered under the Medicaid program (or jointly under the Medicare and Medicaid programs). 

There also are no copays in the CT Medicaid program for these or any other healthcare services. And there are no premiums for Medicaid enrollees in Connecticut, and the Medicare premiums and copays are all covered for them under the Medicare Savings Program. 

WHAT'S THE IMPACT?

Specifically, the groups singled out UnitedHealthcare for taking out full-page or half-page ads in the front section of the primary newspaper in Connecticut, the Hartford Courant, specifically targeted at getting dual eligible individuals to sign up for their MA plan.

One of the ads touts the company's extra healthcare benefits under MA, but the patient advocacy groups say these "extras" are fully covered under the full benefit CT Medicaid program, and with no premiums or copays. The "extra" benefits cited by UnitedHealthcare include a $2,500 allowance for covered preventive and comprehensive dental services; $0 copay for 24 one-way rides to or from doctor visits or the pharmacy; and $0 copay for a routine eye exam and lenses, plus a $300 allowance for eyewear.

"Unquestionably, this misleading advertising is intended to induce, and has induced, thousands if not tens of thousands of older adults and disabled low-income individuals we are charged with representing to sign up for UnitedHealthcare's plan, having been led to believe this means they can get extra healthcare benefits," the letter read. "And, because the advertisement does not mention either the limited network or the restrictive prior authorization rules applicable under UnitedHealthcare's plan compared with traditional Medicare plus Medicaid, these individuals have no idea that they are giving up something valuable."

The advocacy groups urged action from CMS. They want the agency to: issue substantial fines against UnitedHealthcare for its Connecticut advertising; issue a ban on any further direct advertising by the insurer in the state; require UnitedHealthcare to mail letters to dually eligible patients saying they may have received misleading marketing; and conduct other outreach to duals in the state generally advising them that the December 7 sign-up deadline does not apply to them, and that they may opt out of an MA plan at any time.

The groups also want CMS to begin a full-scale investigation of all print, electronic, televised and otherwise broadcasted advertising throughout the country, by any insurance companies offering MA plans, specifically directed at dual eligible individuals, to see if they also are offering as "extra" benefits any health services already covered under the relevant state Medicaid plan.

THE LARGER TREND

CMS has had the issue brought to its attention before. Last year the agency responded to complaints that recent Medicare Advantage advertisements and marketing materials have been "confusing, misleading or inaccurate," at least in the minds of consumers.

Kathryn A. Coleman, director of the agency's Medicare Drug and Health Plan Contract Administration Group, sent a letter to all Medicare Advantage Organizations (MAOs) and prescription drug plan sponsors saying CMS will enhance its review of MA-related marketing materials. Such materials should be submitted under the "File and Use" regulatory authority for MA and Part D drug plans.

CMS said the number of Medicare beneficiary complaints about private sector marketing for Medicare Advantage plans more than doubled from 2020 to 2021.

A September Commonwealth Fund story found seniors over 65 have reported experiences with Medicare marketing that violate federal rules, including marketers asking for Social Security or Medicare numbers outside the enrollment process, and advertising special, time-limited discounts – which are not permitted. 

The problem is especially prevalent among low-income seniors, who are twice as likely to file complaints regarding what they perceive as shady marketing practices, compared to higher-income beneficiaries.

About one in 10 said they had enrolled in a plan under the impression that their doctor was covered, only later to learn there were limitations on seeing that doctor, or that the doctor was not in the plan's network, the survey found.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com