People who know me have heard me voice significant concerns about Medicare Advantage plans. From a consumer perspective, there is a lack of transparency of what many plans offer and a wide range of plans available … some better, some substantially worse.

In addition, it’s a zero-sum game. If you’re being offered a perk above what traditional Medicare typically offers, it’s because that plan has most likely eliminated or reduced elsewhere in the plan. You will frequently discover this when you need your insurance most, when you’re in the hospital or needing outpatient or home health care services.

No greater example of the problems in the Medicare Advantage system can be found than in United Healthcare, the largest and most profitable health insurance company in the U.S., with a reported $22 billion profit last year.

As nonprofit organizations, VNAs have a long history of providing vital services in our communities. Services such as home care, which includes nursing, physical and occupational therapy to help people recover from injury or illness, or Hospice services for people at the end of life, play a crucial role in the health care continuum by keeping patients where they would prefer to be — at home, rather than in hospitals or nursing facilities.

The primary threat to VNAs from United Healthcare is that they reimburse well below cost for home care services provided to its beneficiaries. If a beneficiary chooses traditional Medicare, or a handful of other Medicare Advantage insurances, VNAs get paid enough to cover their costs and they stay in business. No business in any industry stays in business if they can’t cover their costs. So, why does United Healthcare choose to reimburse VNAs well below cost?

To maximize their profits.

In short, United Healthcare has told us to take it or leave it. We can either; 1. Accept their poor reimbursement, which means nonprofit VNAs subsidize a health care insurance company that made $22 billion last year or 2. VNAs stop seeing United Healthcare patients as they can’t afford to lose hundreds of thousands of dollars, which means these patients will go without services until they are able to enroll in another Medicare plan. This is not only bad for a patient who no longer has access to vital services, but it also drives up overall healthcare costs, making health care insurance more expensive next year.

We all pay into the Medicare system expecting to have good health insurance when we turn 65. And when we turn 65, there are options: You can consider keeping traditional Medicare, which is a robust and comprehensive insurance.

However, if you are considering a Medicare Advantage plan, do research to understand what you are getting, and most importantly, what you’re not getting. Also, tell your state and federal legislators that it’s time to rein in health insurance companies that care little for the people of New Hampshire other than generating greater revenue and passing that $22 billion profit to their shareholders.

Jim Culhane is president and CEO of the New London-based Lake Sunapee Region VNA & Hospice.