Were you a member of one of these UHC plans? Wondering what it means, and what, if anything, you need to do about it?
You aren’t alone. This article is for you.
But first, let’s go over the situation.
What Are Medicare Advantage Plan Ratings?
Medicare Advantage plans are evaluated annually by CMS using a Star Rating system.
These Medicare Advantage plan ratings, ranging from 1 to 5 stars, measure the quality and performance of a plan in areas such as:
- Customer service
- Member satisfaction
- Health outcomes
- Preventive care
A 5-star plan is considered “excellent,” while a plan rated below 3 stars is categorized as “poor.”
These ratings help beneficiaries compare plans and make informed decisions during enrollment.
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Why Are UnitedHealthcare Medicare Advantage Plans Getting Rated Down?
The recent downgrade of several insurers’ plans reflected concerns raised by CMS about specific aspects of plan performance.
According to CMS reports, the issues included:
- Reduced quality of care—Beneficiaries may have experienced delays or denials in accessing certain medical services.
- Administrative challenges—Problems with claims processing and customer service negatively impacted members.
- Compliance concerns—CMS flagged areas where plans failed to meet federal standards.
UnitedHealthcare disputed these downgrades, claiming the assessments are unfair. They were downgraded specifically based on one complaint from a call that lasted only 8 minutes.
A Texas federal judge recently sided with United Healthcare against CMS, “determining regulators messed up calculating its Medicare Advantage quality scores for next year”.
Other insurers also sued CMS and received at least a partial judgment awarded to them.
What Are Your Options If Your Medicare Advantage Plan Rating Is Downgraded?
If your plan has been downgraded, you have three basic options to consider.
You can stay put, take advantage of a special enrollment period SEP, or switch during the Medicare Advantage Open Enrollment Period.
Option 1: Stay put
With this option, you do nothing.
You simply stay in your current plan. This is a perfectly valid option, especially if you like your doctors and your plan. Not every plan downgrade is the end of the world. Sometimes the reasons for the downgrade aren’t relevant to you.
Or the downgrade could have been mistaken.
For example, In this case, United Healthcare challenged the downgrade in court and won.
Also, staying put could be best if you have already made progress toward meeting your annual deductible or maximum out-of-pocket cost under the plan.
Starting over with a new plan could mean you have to meet a deductible or out-of-pocket cost all over again.
And if you switch to a different Medicare Advantage plan, your favorite doctors or hospitals may not be in your new plan’s network.
So it’s a good idea to look before you leap. Often, the best move is not to switch plans at all. At least until the new plan year rolls around.
Option 2: Take Advantage of a Special Enrollment Period (SEP)
When a plan is downgraded to fewer than 3 stars, beneficiaries may qualify for a Special Enrollment Period (SEP) to switch to a higher-rated plan.
This SEP allows you to change plans outside the standard enrollment periods.
What to do: Contact a licensed Personal Benefits Manager (PBM) to check your eligibility for an SEP and explore higher-quality options.
Option 3: Switch During Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31.
During this time, you can switch from one Medicare Advantage plan to another.
This annual window provides an opportunity to move into a plan better suited to your needs.
Tips for Switching Plans
- Compare ratings and reviews for potential new plans, as well as premiums.
- Ensure the plan’s network includes your preferred doctors and hospitals.
- Verify the coverage and costs for prescription drugs, as these can vary significantly.
- Compare with Medi-Share 65+.
Should You Switch Plans?
There’s no one-size-fits-all solution; Everyone is different.
The decision to switch plans depends on your individual circumstances.
Consider the following factors:
- Quality of care. If your downgraded plan is no longer meeting your expectations, moving to a higher-rated plan may improve your experience.
- Health needs. Review whether your current plan adequately covers your medical and prescription needs.
- Cost concerns. Lower-rated plans often result in higher out-of-pocket costs due to limited coverage or higher co-pays.
If you’re still satisfied with your coverage and network, it may be worth staying in your plan while monitoring its future ratings.
Is MediGap or Health Sharing Right for You?
If you’re dissatisfied with Medicare Advantage altogether, it may be time to explore alternatives:
- MediGap (Supplement Plans). Plans like MediGap G or N provide broader access to healthcare providers and limit out-of-pocket expenses.
MediGap can be especially appealing for those who want stability and predictable costs.
- Health Sharing Plans. These plans offer an alternative approach to managing healthcare costs. While not insurance, they provide flexibility and lower monthly contributions for those comfortable with the sharing model.
Switching to MediGap or health sharing may be a good option, but it’s not always necessary. A PBM can help you weigh the pros and cons based on your health and budget.
Learn More: Transitioning to Medicare: Can You Keep Health Sharing with Medi-Share 65+?
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Get Help Navigating Your Options
Understanding your Medicare options can feel overwhelming, but you don’t have to do it alone.
A MediGap Advisors Personal Benefits Manager can:
- Clarify your eligibility for a Special Enrollment Period.
- Compare plans and ensure your doctors and prescriptions are covered.
- Discuss alternatives like MediGap or health sharing if a switch makes sense.
If your Medicare Advantage plan has been downgraded, don’t wait to act.
Contact a Personal Benefits Manager today to explore your options and secure the coverage that best meets your needs.
By staying informed and proactive, you can ensure you have access to the quality care and benefits you deserve.
For Further Reading
Mike Montes is a Personal Benefits Manager at MediGap Advisors. Mike has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Mike on his Bio page.