UnitedHealthcare Exit May Leave Patient in Surgery Bind

A 72-year-old woman is scheduled for knee replacement surgery in January through her UnitedHealthcare Medicare Advantage plan. However, she recently learned that UnitedHealthcare may leave her county in 2027, which could change her coverage and impact the surgery.

UnitedHealthcare has filed a preliminary list of counties it may exit in 12 states, affecting approximately 20,000 members. The company stressed that this list is not final, but plan changes will be announced in early October.

The woman's broker found this information in August, and although her surgeon and hospital are part of the current plan, she needs to confirm coverage for the surgery with a new plan if UnitedHealthcare exits the area. She also needs to consider the transition protection that allows her to continue treatment without disruption during the switch.

With three paths to compare - another UnitedHealthcare plan in her county, another insurer's Advantage plan, or Original Medicare with Part D and Medigap - she must carefully evaluate each option to ensure continuity of care and coverage for the surgery and recovery. Additionally, returning to Original Medicare may allow her to purchase a Medigap policy without medical underwriting due to federal law.

Annual Enrollment runs from October 15 through December 7, with coverage starting January 1. If her plan is not renewing, a special enrollment period runs from December 8 through the last day of February. It's essential for her to confirm coverage and authorization before heading to the hospital in January.