CMS blocks 3 UnitedHealthcare Medicare Advantage plans from 6 states

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CMS placed sanctions on three of UnitedHealthcare's Medicare Advantage plans, barring them from being sold in six states. 

The penalties come from a CMS oversight and enforcement group that found that between 2018 and 2020, the plans did not meet the 85 percent threshold of premium revenue spent on Medicare Advantage members, according to the Star Tribune

As a result, UnitedHealthcare cannot offer select Arkansas, New Mexico and Midwest plans to new members until 2023, assuming it hits the 85 percent threshold in 2022.

Failure to hit the required threshold for five years in a row will result in the termination of the government contract.

"UnitedHealthcare spends at least 85 percent of the premiums we take in on care for the people we serve," the company said in a statement to the Star Tribune. "In a few, we were not able to do that because so many of our members deferred going to get care due to COVID-19."

The sanctions affect 86,000 members throughout six states, who can remain on their plans and receive increased benefits, according to the Star Tribune. UnitedHealthcare's total Medicare Advantage enrollment is 7.5 million.

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