Legislative Update: February 2014

Legislative Update: February 2014

Another Broken Obamacare Promise – This One Hits Medicare

By Jessie Gibbons, Legislative Assistant

Back in 2010, before Obamacare became law, the President made the following promise to the public: "If you like your doctor, you will be able to keep your doctor. Period."  Fast-forward four years, and many seniors enrolled in Medicare Advantage – the privately-run alternative to traditional Medicare – are finding themselves doctor-less.  As it turns out, yet another Obamacare promise has been broken.

UnitedHealth, the largest provider of Medicare Advantage plans, announced in mid-November that they would be dropping thousands of doctors from their networks in at least ten states.  By the end of 2014, the company expects its network of doctors to be 85 percent to 90 percent of its pre-Obamacare size.

This unexpected policy adjustment is largely attributable to the $716 billion in cuts to Medicare that Obamacare calls for.  More than one-fifth of the cuts – approximately $156 billion – are to the Medicare Advantage program, which insures more than one-quarter of all seniors over the age of sixty-five.  It's important to note that the savings from the cuts are not going back into the Medicare Trust Fund; instead, the money is going to help pay for the health insurance of younger, working adults under Obamacare.

Downsizing doctor networks is one way that Medicare Advantage insurers are dealing with the sizable cuts.  Some insurers have also begun to increase premiums and out-of-pocket costs that enrollees pay.  Austin Pittman, President of UnitedHealth, told the Wall Street Journal: "It's no secret that we are under substantial funding pressure from the federal government … That's what’s driving our actions."

Since the November announcement from UnitedHealth, doctors have started to receive termination letters citing "significant changes and pressures in the health-care environment."  Doctors who receive the notices had only thirty days to appeal the decision, and if they are dropped from the network, their patients may not find out until they go to schedule their next appointment.

For Medicare Advantage enrollees whose physicians are dropped, this means one of three things. They will either have to scramble to find a new doctor, pay more to see their out-of-network doctor, or switch to a Medicare Advantage plan with a better network of providers.  Seniors who did not choose the third option last fall will have to wait until October – the start of Medicare's open enrollment period – to find a new plan.

The Senior Citizens League is disappointed that another Obamacare promise has been broken, and we are hopeful that the impact on seniors will be minimal.  While UnitedHealth is the first Medicare Advantage insurance provider to announce doctor cuts, we do not expect them to be the last.  For tips on checking your plan’s provider networks or for other Medicare Advantage information, see "Out – Of – Pocket Costs Catch You By Surprise?  How To Avoid “Sticker Shock"


Sources:  “Do You Like Your Doctor? Obamacare Drives UnitedHealth to Downsize its Medicare Physician Networks,” Avik Roy, Forbes, November 18, 2013.

“UnitedHealth Culls Doctors from Medicare Advantage Plans,” Melinda Beck, Wall Street Journal, November 16, 2013.