Citrus County resident George Smith received a disturbing letter this month about his Medicare coverage. The AARP managed care network he had relied on for years will drop all eight of his and his wife's doctors as of Jan. 1.
"I couldn't believe it. I have my house and car and everything insured through AARP,'' said Smith, 73. "I thought, 'They are not going to drop me. I've been a member for years.' ''
Smith and thousands of Tampa Bay residents are caught up in major changes by UnitedHealthcare, the Minnesota-based insurer that markets Medicare Advantage plans under the AARP brand.
Patients have received letters telling them to seek new physicians if they want to stay on the plan. Doctors — United won't say how many — have learned that AARP plans will stop paying for their services next year.
The changes affect some of the area's larger providers, including St. Luke's Cataract & Laser Institute, Tampa Eye Institute and Moffitt Cancer Center.
More than 50,000 Tampa Bay residents currently belong to AARP Medicare Advantage plans. (AARP Medicare supplement policies, drug plans and UnitedHealthcare commercial plans are unaffected by these changes.)
UnitedHealthcare is shrinking AARP networks and focusing on doctors, hospitals and clinics that will "enhance health plan quality, improve health care outcomes and curb the growth in health care costs,'' spokeswoman Jessica Pappas wrote Monday in an emailed response to the Times. Hospitals and doctors that "demonstrate the highest quality at the greatest value will be rewarded for their efforts.''
Pappas could not say how many doctors will be dropped from the network or how many patients are affected. That analysis "is ongoing,'' she wrote. About 19,200 Florida providers will remain in the network.
Medicare Advantage plans receive a monthly stipend from the federal government to manage members' health needs. The plans create networks of providers and negotiate payment rates. Joining an Advantage plan can be cheaper for patients who remain in network than staying on traditional Medicare. But leaving the network means higher rates.
Some jockeying over networks and payments occurs every fall during open enrollment, which ends Dec. 7.
Last year, when UnitedHealthcare and BayCare Health System haggled over rates, both sides used advertising to plead their case to the public before resolving their dispute. Similar spin control has broken out over the AARP changes.
"Make sure Moffitt is on your plan,'' read a half-page ad from the Tampa cancer center in Sunday's Tampa Bay Times. Pick the wrong plan and "you will pay higher out-of-network costs for Moffitt's world-class care.''
UnitedHealthcare had a full-page ad Monday: "We will continue to offer broad choice in access to care''
The ad cited "severe funding reductions for Medicare Advantage plans that have come from Washington,'' a theme Pappas repeated in her email.
Actually, the federal government announced this year it is increasing payments to Medicare Advantage plans 3.3 percent, while still pursuing the goal of eventually bringing the cost of Advantage plans down to those of original Medicare.
UnitedHealthcare believes that overall funding won't keep up with the growth in health care costs, Pappas wrote, and shrinking the network will help AARP plans maintain current benefits.
"We regret that these decisions will create disruption for some of our members, but they were necessary,'' she wrote.
Some local doctors said AARP patients are responding to the changes by switching their Medicare Advantage plans to stay with their doctors.
Gastroenterology Associates in Crystal River has 1,600 patients on AARP Medicare Advantage plans, said billing manager Ginnie Hawes. The practice has seven doctors who cover almost all the gastroenterology shifts at Citrus County's two main hospitals.
"Patients were panicking at first. We had so many calls and visits,'' Hawes said. "Now they are just mad and saying that they are changing plans.''
George Smith is one. He has already switched to a BlueCross BlueShield plan.
"These are good, prominent doctors. We have been going to them for years,'' Smith said.
Hawes and others said UnitedHealthcare did not try to negotiate a lower rate.
"They didn't come talk to us at all. They just sent a letter and said they were terminating,'' said Brad Houser, administrator for St. Luke's, based in Tarpon Springs. "The last time we negotiated rates with them was 2009.''
AARP Medicare patients made about 12,000 visits last year to St. Luke's, about 10 percent of its case load. Houser said he checked the plan website and noticed other large practices were also dropped.
"Most of the smaller practices are still in the plan,'' said Houser, who hopes UnitedHealthcare will reconsider.
Pappas wrote that the insurer decided which doctors to drop based on factors such as geography, the size of a doctor's Medicare Advantage case load and "the provider's ability to deliver high quality care for the most members in the most cost efficient manner.''
Last week, UnitedHealthcare announced it was extending its relationship with AARP through 2020. By lending its name, AARP gets a slice of proceeds, which helps to lower dues, said spokesman David Allen.
"While AARP is aware of these changes,'' he wrote in a statement, "we have no direct influence or control over decisions.''
Stephen Nohlgren can be reached at 727-893-8442 or [email protected]