Home health insurance options limited amid changes in Medicare Advantage plans
Published: 10-10-2024 6:30 PM |
NEW LONDON — While some people are choosing Halloween costumes and carving pumpkins, many older adults and people with disabilities are shopping for Medicare coverage.
Ahead of the Medicare open enrollment period, which begins Tuesday, supplemental insurance options for seniors and disabled people in the Upper Valley are increasingly limited.
Lake Sunapee Region Visiting Nurses Association and Hospice, or Lake Sunapee VNA, is a New London nonprofit that provides home health care and hospice services in Sullivan County and parts of Grafton and Merrimack counties. In several Upper Valley communities, Lake Sunapee VNA is the sole provider of these services. Lake Sunapee VNA reports about 400 people served or enrolled in programs on any given day.
The VNA will not accept United Healthcare Medicare Advantage insurance for 2025, according to an Oct. 1 letter that was sent out ahead of the Medicare open enrollment period that runs through Dec. 7. United Healthcare is the largest Medicare Advantage provider nationwide. As one of only two VNAs in the Upper Valley and the only VNA in several communities — Orange, Grafton, Springfield, Sunapee, New London, Newport, Grantham and Croydon — the decision could leave some older adults and people with disabilities without coverage for home health and hospice care.
During the open enrollment period, adults over 65 or who have certain qualifying disabilities can purchase, drop or change their Medicare Advantage plan, a form of optional, privately-managed Medicare insurance that often expands coverage and sometimes reduces out-of-pocket costs. The letter is part of a broader VNA information campaign aimed at reducing confusion around the Medicare open enrollment period.
The VNA said it decided to stop doing business with United Healthcare because the insurance provider proposed reimbursement rates that would not cover its cost of providing care.
“United Healthcare's approach is to take advantage of the mission that we (visiting nurses associations) all have and to use that against us by offering well-below-cost reimbursement rates, and that puts the VNAs in a bind. That bind that we're in is our obligation to provide care in the communities while being financially viable,” VNA President and CEO Jim Culhane said in a Monday interview.
The VNA negotiates with insurance companies to set rates that fully cover the cost of care, Culhane said. If rates are insufficient, the VNA will have to cover the difference through private contributions and divert funding from other free and reduced-cost care programs, he added.
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Lake Sunapee VNA’s contract with United Healthcare expired in May 2023. Another round of negotiations in early 2024 was also unsuccessful.
In the most recent contract negotiations between United Healthcare and Lake Sunapee VNA, Culhane said the insurance company proposed reimbursement rates that were about 20-25% below the VNA’s costs of providing care. If Lake Sunapee had taken this deal, the VNA would eventually go out of business, he maintained.
Meanwhile, United Healthcare, which is headquartered in Minnesota, maintains that it is Lake Sunapee VNA that is being unreasonable.
Lake Sunapee VNA “is demanding a more than 40% price hike in one year. Lake Sunapee’s proposal would make it significantly higher cost on average than any other home health provider in our commercial network in the market,” Cole Manbeck, a spokesperson for United Healthcare, said in a Wednesday email statement.
“We have proposed meaningful rate increases that would ensure they continue to be reimbursed at market-competitive rates. We remain open to continued discussions should Lake Sunapee provide a proposal that’s affordable for the people and employers we serve,” Manbeck said.
United Healthcare reported $198.6 billion in revenue from Jan. 1 through June 30, 2024, with $70.3 billion attributed exclusively to United Healthcare’s Medicare and retirement programs. United Health Group, which operates United Healthcare, reported over $22 billion in profit in 2023.
Issues with United Healthcare are not unique to Lake Sunapee VNA. Throughout 2023, UVM Health Network — Vermont’s largest health care provider — was in ongoing negotiations with the company after United Healthcare refused to accept terms that would cover the hospital system’s cost of care. The two parties reached a multi-year contract in February of this year.
Across New Hampshire, Medicare Advantage options recently became more limited when other insurers eliminated their Medicare Advantage plans for 2025, including Harvard-Pilgrim, Human and Ambetter.
The Dartmouth Health-affiliated Visiting Nurse and Hospice for Vermont and New Hampshire, or VNH, is the other visiting nurse association in the Upper Valley. Its service area is largely in Vermont; in New Hampshire, its coverage extends as far south as Charlestown and as far east as Enfield and Grantham.
The VNH is contracted to accept United Healthcare Medicare Advantage insurance “through most of 2025,” CEO and President Johanna Beliveau said in a Wednesday email statement.
“We understand the difficult position many regional agencies are in when deciding whether to continue with this program, and we share their concerns about Medicare Advantage reimbursement rates, which do not reflect the actual cost of providing care in Northern New England,” Beliveau said.
The Oct. 1 letter is part of an information campaign the VNA is doing to help people through the open enrollment period, which he described as “at best, a confusing and incomplete system,” Culhane said.
“You're asking people to choose what health care would be best for them by, frankly, sending them an email, giving them a flyer and maybe a nice pamphlet that shows up in the mail. These are very important decisions, yet there's a stunning lack of information,” Culhane said.
To combat the confusion, the VNA is encouraging community members to reach out for advice, or to contact other local resources like county-based Service Links. Culhane also emphasized that keeping a traditional Medicare plan is an option, and if choosing Medicare Advantage plans, beneficiaries should think about what they might not be getting from that insurance plan.
“You need to be cognizant that that increased or more robust plan that now covers your vision, your dental and whatnot, is definitely offset by a cut somewhere else in your benefits,” he said.
ServiceLink is a New Hampshire resource with offices in every county and experts available to answer questions about Medicare. ServiceLink locations can be f ound online at dhhs.nh.gov/servicelink/contact-servicelink.
In Vermont, Area Agencies for Aging can provide resources. Find locations and contact information at dcf.vermont.gov/contacts/ partners/aaa. People with questions can also call 1-800-Medicare for help.
Clare Shanahan ca n be reached at cshanahan@vnews.com or 603-727-3216.