United Healthcare has advised that beginning with dates of service 10/1/2025, all fully insured and level funded small groups will turn off Medicare Estimation (ME) except for groups sitused in New York.
What does this mean for claims?
- ME will no longer be applied to claims with dates of service on or after 10/1/25. Prior claims will not be reprocessed.
Will groups/members receive information about ME?
- Yes, a uniform modification bullet will be included indicating ME will no longer apply. COC’s and SPD’s will also be updated.
What markets are excluded?
- New York sitused groups are excluded.
New York 1-100 continues to apply estimation, for all Medicare COB reasons.
For all other markets, Estimation will no longer happen on group sizes 2-50 (regardless of reason) but will continue 51+ (Mid-market segment) for applicable reasons.