AARP Medicare Advantage United Healthcare plan refuses to cover non-hospice medical services
Both of my parents have had an AARP Medicare Advantage plan from United Healthcare (UHC). In both cases, after they went onto hospice, UHC refused to cover any non-hospice services (those that are not related to their terminal prognosis), even though the Evidence of Coverage contract says they would. (Note that hospice-related charges shift to Original Medicare, even if one is on a Medicare Advantage plan.)
For example, my father has a pacemaker, which undergoes routine evaluations. Those evaluations are not hospice-related. Just because someone is on hospice does not mean that they are ready to die based on a problem with their pacemaker. However, UHC is refusing to pay claims related to the pacemaker and insisting that the claims be submitted to Original Medicare instead.
In addition to having a higher cost for patients (deductible and co-pay that the Medicare Advantage plan does not have), this also presumably is more expensive for taxpayers, because UHC continues to get collect the premiums from Medicare but then refuses to pay the claims and re-directs them to be paid by Medicare.
For reference, here is the language in the Evidence of Coverage:
"For services that are covered by Medicare Part A or B and are not related to your terminal prognosis: If you need non-emergency, non-urgently needed services that are covered under Medicare Part A or B and that are not related to your terminal prognosis, your cost for these services depends on whether you use a provider in our plan's network and follow plan rules (such as if there is a requirement to obtain prior authorization):
· If you obtain the covered services from a network provider and follow plan rules for obtaining service, you only pay the plan cost-sharing amount for in-network services
· If you obtain the covered services from an out-of-network provider, you pay the cost-sharing under Fee-for-Service Medicare (Original Medicare)"