Medicare Advantage offers better access, superior outcomes at a lower cost
What's more, satisfaction among Medicare Advantage enrollees is exceptionally high, with 95% of MA beneficiaries satisfied with their health care coverage. [2] This successful program delivers real value to people while driving improvements in health quality and patient outcomes.
Ultimately, the move from fee-for-service to value-based care, championed by Medicare Advantage, is a paradigm shift for a health system that historically pays for volume, not value. It has ushered in a new way of thinking about early detection and disease prevention.
This shift directly challenges the status quo, which has relied on treating a constant influx of sick patients and is burdened with misaligned financial incentives. But UnitedHealthcare sees a different way forward — one that cares for patients before they are too sick for viable treatment and provides higher-quality care at a lower cost.
Medicare Advantage drives affordability for plan members and helps reduce costs for the broader health system, with supporting data including:
People enrolled in Medicare Advantage plans have saved 45% on premiums and out-of-pocket costs each year, which translates to an average savings of $2,200 annually compared to those in fee-for-service (FFS) Medicare. [3]
In 2024, 75% of Medicare Advantage plans with Part D coverage, including those in UnitedHealthcare plans, paid no monthly premium. [4]
Medicare Advantage beneficiaries are hospitalized less frequently, with a 43% lower rate of avoidable hospitalizations for any condition. [2]
People with three or more chronic conditions who are enrolled in a Medicare Advantage saved over $2,500 annually. [5]
[2] About Medicare Advantage, Better Medicare Alliance
Disclaimer
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.
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Newsweek
40 minutes ago
- Newsweek
Medicare Will Start Using AI to Help Make Coverage Decisions Next Year
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. Starting in January, Medicare will test out an artificial intelligence (AI) pilot program to decide whether patients get certain procedures covered or not. The Centers for Medicare & Medicaid Services (CMS) will use AI to help make prior authorization decisions via the new Wasteful and Inappropriate Service Reduction (WISeR) Model, but the final decision will be made by an employee, according to the agency. Why It Matters AI has made a significant impact in the workforce, education, health care and beyond. While some remain hesitant about its usage and the possibility of it eliminating human jobs, AI tools have been linked to greater efficiency for many companies. While traditional Medicare has typically had fewer prior authorization requirements than Medicare Advantage, the use of AI could speed up coverage decisions and also potentially lead to higher denials of coverage, experts say. A sign in front of the Centers for Medicare & Medicaid Services building is pictured on March 19 in Woodlawn, Maryland. A sign in front of the Centers for Medicare & Medicaid Services building is pictured on March 19 in Woodlawn, To Know While the final decision by Medicare to approve or deny coverage will come down to an employee, critics of the AI test pilot say that companies conducting the review process will be incentivized to deny coverage because they receive payments when they lower costs. The move toward AI arrives as the Trump administration has made it a priority to reduce government fraud and waste, and Medicare Part B premiums are likely to increase by $21.50 per month, from $185 in 2025 to $206.50 in 2026, according to MarketWatch. Some of the specific services included in the AI-powered prior authorization decisions will be skin and tissue substitutes, electrical nerve-stimulator implants and knee arthroscopy for knee osteoarthritis. In the past, traditional Medicare enrollees face fewer prior authorization decisions. The average number of them required per Medicare Advantage enrollee was two in 2023, compared to just one review per 100 traditional Medicare beneficiaries. "For seniors, the impact could be substantial, especially when immediate care is critical," Kevin Thompson, CEO of 9i Capital Group and host of the 9innings podcast, told Newsweek. "The current administration is focused on removing so-called waste, fraud, and abuse, pulling every lever to show their program is working. What used to require a single prior authorization could now face multiple layers, which means more delays and higher denial rates." The AI pilot will take place over the next six years and will not apply to inpatient-only services or for procedures that carry high risks if delayed. At the moment, the pilot program is limited to Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. What People Are Saying CMS Administrator Dr. Mehmet Oz, in a statement: "CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare. Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures." Alex Beene, financial literacy instructor for the University of Tennessee at Martin, told Newsweek: "For many Americans, the term 'Medicare Advantage' has left them asking what the real advantage was, as plans haven't worked out in some parts of the country as efficiently as originally promised. With that in mind, the announcement Medicare will start piloting the use of AI as a possible pre-authorization procedure for potential recipients in six states and the citing of Medicare Advantage's additional authorization steps is raising concerns - and rightfully so." Thompson also told Newsweek: "AI may speed up processing times in theory, but mistakes are inevitable. The bigger concern is how the financial incentives are structured. If contractors are rewarded for reducing or denying coverage, that's exactly what will happen—more denials. It's as simple as following the money. Whether a treatment is truly necessary or not becomes secondary to the incentive structure." What Happens Next The AI usage could have significant impacts on the number of procedures that Medicare beneficiaries get approved for coverage. According to a 2024 Senate committee report, AI tools have been linked to higher rates of care denial, 16 times higher than decisions made without the technology. "Medicare recipients want an easy process with as many barriers removed as possible when qualifying and receiving services," Beene said. "AI can certainly be used to refine the process, but as it's been presented, there's justification for the red flags being raised."
Business Insider
2 hours ago
- Business Insider
Luigi Mangione's 120-page healthcare history was accidentally shared by Aetna and his own lawyers, prosecutor says
Luigi Mangione's confidential, 120-page medical history was accidentally emailed to his New York prosecutors not once, but twice — first by Aetna and then by his own defense lawyers, according to a new court filing. Prosecutors took "appropriate measures" both times, forwarding the confidential health records to the judge and deleting their own copy, the lead assistant district attorney, Joel Seidemann, wrote in revealing what he described as a double-snafu on Friday. "Mistakes do occur," Seidemann wrote in his three-page filing — meaning on the part of defense lawyers and Aetna, but not himself. "Aetna erroneously sent us materials," he wrote. "Like Aetna, the defense then erred, compounding Aetna's mistake," by attaching the very same confidential health records to an email they sent him. "Once again, we complied with our ethical obligations by asking counsel if she intended to send us the file," Seidemann wrote. "When she indicated that she did not and asked that we delete it, we complied with her request and did not take advantage of her error." Aetna, meanwhile, defended its own role in the records relay, saying through a spokesman that they got a subpoena, and they answered it. "Our response is the same as before," wrote Phil Blando, executive director for communications for Aetna's parent company, CVS Health."Aetna received a subpoena for certain medical records, and we provided them appropriately." It's the latest round of finger-pointing in a month-long battle between state-level prosecutors and defense attorneys over the confidential medical records of Mangione, the 27-year-old Maryland native accused in the December shooting murder of UnitedHealthcare CEO Brian Thompson. The records included "different diagnoses as well as specific medical complaints made by Mr. Mangione," his lawyers complained in their own filing last month. Both prosecutors and the defense agree that Seidemann's May 14 subpoena asked Aetna for very limited data, just Mangione's health insurance account number and the period of time he was covered. Past that small patch of common ground, the sides diverge widely. The defense, led by attorney Karen Friedman Agnifilo, wrote last month that Seidemann should never have asked directly for Mangione's health insurance account number, arguing that it is protected under HIPAA, the federal Health Insurance Portability and Accountability Act. "The requested information does not appear to be protected by HIPAA, since it did not relate to a condition, treatment, or payment for health care," Seidemann countered in Friday's filing. The sides also differ on what happened once Aetna attached Mangione's entire health history, in four files, to its June 12, supboeana-response email to Seidemann. Seidemann wrote in Friday's filing, that his subpoena "was lawful and properly drafted," and that, as required, it directed Aetna to return the materials to the judge. The defense accuses Seidemann of sitting on the sensitive records for 12 days before forwarding them to the judge, and they want to know how the health insurers ended up sending the records directly to the prosecutor. They've asked the judge, New York Supreme Court Justice Gregory Carro, to order "a full evidentiary hearing" to determine possible penalties, including kicking Seidemann off the case. They've asked that the hearing include sworn testimony and the surrender of correspondence between prosecutors and Aetna. The judge had not issued a decision on calling such a hearing by Friday afternoon. A defense spokesperson declined to comment on Friday's filing. Mangione is also charged with murder in a federal indictment that seeks the death penalty. In another, more behind-the-scenes battle, prosecutors in both venues, state and federal, have said they intend to bring Mangione to trial first. The order of trials has not been worked out. State court has an advantage, in that Mangione's case is proceeding more quickly there, given the lack of complicated capital-punishment issues. The feds, too, have an advantage, in that Mangione is in federal custody, and they have physical control of where he goes. Judges in both venues have said they hope to bring him to trial in 2026.
Chicago Tribune
6 hours ago
- Chicago Tribune
Weiss hospital, set to lose Medicare funding this weekend, appears closed. Supporters to rally this afternoon.
Weiss Memorial Hospital appeared to close Friday morning, just a day before it was scheduled to lose Medicare funding. The emergency room and other facilities closed as of 7 a.m., emergency room registered nurse Daniel Maser said. Three other hospital staffers, who asked to remain unnamed, told the Tribune Thursday that the facility was slated to close. The hospital was quiet on Friday morning, and one person was seen walking out of the facility with a cardboard box. Dr. Manoj Prasad, the head of the company that owns the hospital, and other hospital officials did not respond to requests for comment Thursday. Prasad is scheduled to speak at 11:30 am today at a news conference at West Suburban Medical Center in Oak Park, which his company also owns. Maser said he was told of the closing two days ago by his direct supervisor. 'A lot of people are panicking and scrambling to find jobs,' Maser said of the Weiss hospital staff. 'It's brutal,' Maser said. 'The loss of the hospital is going to make care much less accessible for many people.' Doctors, nurses, and community supporters plan to hold a 1 pm rally outside Weiss' shuttered emergency room to call for keeping it open two more months until an operational plan can be implemented. On Thursday, the hallways in the Uptown hospital were mostly empty. The emergency room was deserted, and some of the offices and waiting rooms had signs reading 'permanently closed.' A white folding table at the entrance of Weiss held four flyers with instructions for patients about how to get medical records, ask billing questions and find their doctors at other locations. 'It's devastating,' said Marianne Lalonde, an Uptown resident and past president of the Lakeside Area Neighbors Association, of the possible closure. 'It serves a population that is really in need. I think people are really going to struggle to find care and especially more vulnerable populations are going to struggle.' Worries about closure follow news last month that the federal Centers for Medicare & Medicaid Services planned to terminate Weiss from the Medicare program Aug. 9, which is this Saturday. The federal agency issued a public notice, at the time, saying that the Uptown hospital would lose its ability to participate in Medicare because it was out of compliance with rules related to nursing services, physical environment and emergency services. The notice did not elaborate on specific problems, but it came after the Illinois Department of Public Health conducted an on-site investigation at the hospital in June in response to complaints of high temperatures after air conditioning equipment at the facility failed, according to a state health department memo obtained through a Freedom of Information Act request. The state health department found temperatures as high as nearly 89 degrees in the hospital's intensive care unit and nearly 87 degrees in the emergency department, according to the memo. At the time, the hospital moved all of its inpatients to West Suburban Medical Center in Oak Park and other hospitals because of the heat, according to a previous news release from the hospital. The air conditioning was supposed to be fixed by the end of June, according to the state memo. The air conditioning appeared to be working again Thursday, at least in parts of the hospital. The state health department said in a statement Thursday that no patients were currently housed at Weiss. The department said it was continuing 'to monitor developments around the status of Weiss Memorial Hospital.' The Illinois Department of Healthcare and Family Services confirmed Thursday that if the hospital loses Medicare funding, it will also lose Medicaid dollars, under federal regulations and state law. It would be difficult for any hospital to keep its doors open without Medicare and Medicaid funding, and especially so for Weiss. In 2023 about 88% of Weiss' inpatients and nearly 67% of its outpatients were on Medicare or Medicaid, according to the Illinois Health Facilities and Services Review Board. This week, a number of local elected officials and community organizations wrote a letter to the Centers for Medicare & Medicaid Services asking for an eight-week extension and a reevaluation of conditions at Weiss before the hospital's Medicare participation is terminated to give the hospital more time to become compliant with the agency's standards. 'Our communities stand to lose not only a critical healthcare provider, but also a key employer and stabilizing force in the Uptown neighborhood,' they wrote in the letter. Signers included Ald. Angela Clay, 46th; Rep. Kelly Cassidy, D-Chicago; Rep. Hoan Huynh, D-Chicago; and Sen. Mike Simmons, D-Chicago, among many others. The elected officials said in the letter that they've convened emergency meetings with leaders at Weiss, the state and city health departments and officials from the mayor's office, among others, to help find solutions. 'It's been a critical safety net hospital for working families and seniors and communities of color, immigrants and refugees, and so we want to make sure that this hospital is here to stay,' Huynh told the Tribune. Ruth Castillo, with the Lakeside Area Neighbors Association, said that if the hospital closed, it would be 'heartbreaking.' 'It's such an important resource for the community,' she said. 'There are so many neighbors that are on Medicare and Medicaid. They won't have a resource (that's) walking distance or a short bus ride away.' She said, however, she thought years ago that something like this might happen. The hospital has gone through a series of ownership changes in recent years. A previous owner, California-based Pipeline Health, agreed several years ago to sell a Weiss parking lot to a developer, angering community members who worried, in part, that it was the beginning of the end for Weiss. 'A hospital that has a future plan is not going to sell the last bit of land that it has to develop,' Castillo said. Pipeline later sold Weiss and West Suburban Hospital in Oak Park to a new company called Resilience Healthcare led by Prasad, who touted, at the time, his ability to turn around struggling hospitals. 'Over the past 30 years I've had the privilege of leading numerous health care organizations and have rescued a number of challenged facilities,' Prasad told the Health Facilities and Services Review Board in 2022 as he sought to buy Weiss and West Suburban. WBEZ and the Chicago Sun-Times first reported news of the hospital's potential closure.
