A Florida retirement haven is thrown into chaos as a $360 million Medicare overbilling scandal and a Humana–UnitedHealth standoff leave seniors scrambling to keep their doctors.

Behind the gates of The Villages (the pastel Shangri-La of Florida retirement lore) is a place where American seniors zoom around on golf carts like 1977 Thunderbirds and keep wrist stabilizers on the ready for impromptu pickleball matches. It’s a community built on the promise that retirement is a time for sunshine, camaraderie and — most importantly — a health system that doesn’t leave you out in the cold.

HEALTH CARE un-covered has published stories about The Villages in the past – and how the retirement community is rife with Medicare Advantage shenanigans. And today, many Villagers have been blindsided by these shenanigans like they’re part of a Big Insurance hostage crisis straight out of an episode of Days of Our Lives or General Hospital.

A TVH / UnitedHealth dispute leaving seniors “duped”

Earlier this year, The Villages Health (TVH) — the health system serving more than 55,000 retirees — promised a smooth handoff as it prepared to sell itself to CenterWell, Humana’s senior-focused primary-care chain. TVH’s CEO assured residents that “no change in care” was coming, according to News 6.

But then came the bankruptcy filing. And then the revelation that TVH owed more than $360 million to the federal government for “Medicare overbilling.” And then the sale. And, according to Village-News, then a bankruptcy judge confirming that, yes, TVH was indeed being swallowed by CenterWell for $68 million.

In other words: the health care version of a soap-opera plot twist. Only with fewer glamorous outfits and more Chapter 11 filings.

On November 7, the very day the sale of TVH closed, patients received a message warning them that their UnitedHealthcare Medicare Advantage plan — the plan they were nudged toward back in 2016 when TVH tried to push all patients into UnitedHealth’s grasp — might not be accepted after Dec. 31, 2025. If negotiations fail, residents must switch doctors or switch insurers.

“Not to be notified until basically the last minute that there isn’t a contract between CenterWell and United at this time is very alarming,” Villager Phyllis McElveen told Spectrum News. “We had already gone out and selected our UnitedHealthcare plan for 2026. We had already done everything. And now to know we might have to make a change is just not a pleasant feeling.”

At The Villages, you can imagine that picking the right Medicare plan is akin to competitive sport — one step removed from a pickleball tournament. The residents do their homework and many reportedly attend “Medicare prep presentations.” So for Villagers, being blindsided is a big deal.

Longtime patient Nancy Devlin told News 6 that she dug through Humana’s and Aetna’s plans to find a plan that might allow her to stay with the physicians she’s seen for six years. But for Devlin, her digging was to no avail. None of the plans matched what she currently had with UnitedHealthcare. Not the same covered medications. Not the same premiums. Not the same out-of-pocket costs. Not the same networks.

“They duped us,” she said. “It’s more expensive and doesn’t have my medications, or I have to pay for them, and I don’t pay for my medications now.”

For retirees on limited incomes, doubling drug costs is a gut punch that can mean one less trip to visit their grandkids or postponing that cruise to the Bahamas. Or for some, putting enough food on the table.

A deal gone sour

To understand how this crisis happened, go back to 2016, when TVH urged residents to switch into UnitedHealthcare Medicare Advantage or lose access to their doctors. Fast-forward to today. TVH is bankrupt, Humana now owns the centers, and UnitedHealth, the world’s largest health conglomerate (and the once-preferred partner for Villagers) is persona non grata unless a deal is reached.

The timing could not be worse. Open enrollment ends December 7, which means that tens of thousands of retirees have just around two weeks to decide whether to switch insurers or switch doctors.

What’s happening here is not simply a contract negotiation gone awry, but a symptom of something deeper. TVH didn’t just owe “some money” to Medicare. It owed about $360 million because of what Humana and The Villages described as a gigantic “Medicare coding error.”

UnitedHealthcare, in turn, accused The Villages’ controlling Morse family of quietly pulling out $183 million between 2022 and 2024 – funds UnitedHealth argued were siphoned off just before the bankruptcy filing.

If that allegation sounds familiar, it’s because we’ve seen versions of this story across the health care industry: private companies treating Medicare Advantage plans like piñatas stuffed with taxpayer dollars. Sometimes, the bat misses the piñata and smacks a whole village of seniors.

Here’s what happens next

The Villages, for all its mid-century charm and retirement-resort quirks, is a microcosm of a national problem that Medicare Advantage is, too often, run for Big Insurance’s advantage with seniors just an afterthought. Corporate acquisitions, bankruptcies, risk-coding schemes, contract disputes and Wall Street demands that lead to fewer and fewer in-network doctors and hospitals and covered drugs. Meanwhile, billions in taxpayer dollars flow through this system with relatively no accountability. Medicare Advantage is corporate welfare on steroids, with the “invisible hand” of the market misleading and then slapping the hell out of vulnerable American seniors to enrich the big guys in control with cushy government handouts.

For Villagers, it’s either/or:

• Either CenterWell and UHC strike a deal: The crisis cools, residents keep their current doctors in 2026.
• Or no deal is reached: Tens of thousands will either change doctors, change plans or risk being turned away at medical appointments starting Jan. 1, 2026.

And remember: If the retirees of The Villages — a community that votes, organizes and documents everything — can be blindsided like this – anyone can – whether it’s CVS / Aetna pulling out of the Affordable Care Act marketplace or Cigna pushing ambulatory surgical centers out of it’s network and “exiting” all of its Medicare Advantage markets. Regardless, until this is figured out, these retirees should take it easy on the pickleball court and drive carefully on those golf carts.

Representative Mark Pocan (D-WI) yesterday introduced eight bills aimed at strengthening traditional Medicare and reining in some of the worst practices in the privately-run Medicare Advantage business. For years, lawmakers have danced around the mounting evidence that private Medicare Advantage plans overbill taxpayers between $80 and $140 billion annually and quietly impose barriers to seniors’ care to boost profits.

Traditional Medicare remains one of the most successful public programs in American history. It was built around a simple promise: If your doctor says you need care, you get it. But as Medicare Advantage has grown, that promise has eroded for millions of people. MA plans are largely run by big insurance conglomerates – like UnitedHealthcare, Elevance and CVS/Aetna – and those insurers decide what care is covered, which doctors you can see and how long you can stay in a hospital. Each cent they have to shell out for your care is a cent they can’t keep in their pockets or split with their shareholders. Wall Street’s relentless demand for more and more of that money incentivizes them to deny or delay care that mean life-and-death for millions of American seniors.

And it’s not just health care policy nerds like me that have been focused on this issue – even the U.S. Department of Justice (DOJ) has taken aim at Medicare Advantage. In February, news broke that the DOJ had launched a civil fraud investigation into UnitedHealth Group, the largest MA insurer, for the company’s alleged use of diagnoses that trigger higher Medicare Advantage payments. And in July, the company confirmed it is the subject of a DOJ criminal investigation. The DOJ reportedly questioned former UnitedHealth Group employees about the company’s business practices.

You can see the entire package of bills on Pocan’s website. They include the Denials Don’t Pay Act, which would force Medicare Advantage plans to face real consequences if too many of their prior-authorization denials are overturned; The Right to Appeal Patient Insurance Denials (RAPID) Act, which would ensure every denial is automatically appealed, sparing sick and elderly patients from navigating a process many never even know exists; and the Protect Medicare Choice Act which would stop insurers and brokers from pushing seniors into Medicare Advantage by default.

Pocan and his co-sponsors understand that Medicare Advantage’s prior authorization hurdles and widespread denials are just Wall Street-directed obstacles that second-guess physicians and delay care. Patients pay the price. Doctors pay the price. And taxpayers pay the price.

A package like this was long overdue.

More Perfect Union has just posted a video breaking down a truth that Big Insurance hopes you never hear: rising “health care costs” are really rising health insurance profits.

As I explained in the video, UnitedHealth, Cigna, CVS/Aetna are part of a cartel of corporate conglomerates that have built a business model that relies on overpayments in Medicare Advantage, shrinking doctor networks and a sprawling web of vertically integrated subsidiaries that vacuum up our premiums, deductibles and tax dollars — and turn them into shareholder returns as Wall Street relentlessly demands.

Here’s a bit of what I said:

“Your premiums, deductibles and pharmacy bills are all going up. We’re told it’s because medical costs are rising, but the bigger story is who’s capturing the money. In just three months, UnitedHealth Group made $4.3 billion in profits on revenues of $113 billion.

Over the past five years, the cost of a family premium has increased 26%. This year, the average cost of a family policy was almost $27,000.

Just about everybody with private insurance will be paying a lot more than that next year, regardless of whether you get it from your employer or buy it on your own. That’s because UnitedHealth and other big insurance companies cannot control rising health care costs.

In fact, insurance companies benefit from medical inflation. They just jack up their premiums enough to cover the additional cost and guarantee them a tidy profit.”

The video points out the real drivers of cost growth — from UnitedHealth’s nearly 2,700 acquisitions to Medicare Advantage overpayments that funnel billions from taxpayers into corporate profits.

If you haven’t watched it yet, I hope you will and share it with everybody else you know. It’s clear that Congress must pass common sense guardrails to stop Big Insurance from writing the rules of American health care and squeezing Americans.

Wall Street reacts to the failed ACA subsidy extension — and to the president’s swipe at “money sucking insurance companies.”

Wall Street got the jitters yesterday after Donald Trump’s pointed remarks about “money sucking insurance companies” and a Congressional deal that failed to extend the enhanced subsidies under the Affordable Care Act (ACA) marketplace plans. According to one market analysis, shares of Centene (CNC) plunged about 8.15% in pre-opening trade, while competitors such as Molina (MOH) fell 4.6%, Elevance (ELV) dropped 3.7%, UnitedHealth Group (UNH) slipped 1.9% and Humana (HUM) declined 1.45%.

Why the sell-off? Because the enhanced ACA subsidies — which reduce premiums for some marketplace enrollees — expire at the end of the year and without renewal, an estimated 3.8 million people could lose coverage, and premiums would rise significantly for others. Insurers that rely on the stability and growing enrollee base of the ACA marketplace face heightened risk when that funding is in question – especially when the dollars are guaranteed – like when they are shoveled out from the federal government.

Still, it’s worth noting that the ACA marketplace business is not the primary profit engine for most large payers. Their bigger gains typically come from taxpayer-funded programs like Medicare Advantage, Medicaid managed-care contracts and veterans’ / VA contracts.

Here’s how five of the major players fared in 2024 profits:

• Centene: $3.2 billion (+590% since 2014)
• UnitedHealth Group: $32.2 billion (+214% since 2014)
• Elevance: $9.1 billion (+78% since 2014)
• Humana: $2.6 billion (+8.3% since 2014)
• Molina: $1.18 billion (+780% since 2014)

Because most of their gains have not come from ACA exchange plans (and especially not the thin margin employer market) but through their other government-subsidized businesses, investors can have some certainty their investments in those companies are still largely safe and Big Insurance will be able to weather this storm.

For instance, the industry has always been able to strongarm rough patches in the consumer market – as long as they can stave off any meaningful changes to their bread and butter taxpayer-funded programs. As we reported last month, the industry’s outside PR and lobbying friends – Better Medicare Alliance and Medicare Advantage Majority – have hit the airwaves and the halls of Congress to halt the advancement of the No UPCODE Act. The bipartisan bill, sponsored by Senators Bill Cassidy (R-LA) and ​​Jeff Merkley (D-OR) would end wasteful, fraudulent practices in Big Insurance’s Medicare Advantage businesses that funnel taxpayer money into the pockets of industry executives and Wall Street shareholders and could save taxpayers as much as $124 billion over the next decade and keep the Medicare Trust Fund solvent for years longer.

As of this morning, insurers seem to be fairing better. Centene, UnitedHealth Group, Elevance, Humana and Molina are all back in the green.

As open enrollment begins and Congress remains deadlocked on whether to extend the ACA’s enhanced premium subsidies, one question looms large: Where does all the money we pay for health coverage actually go?

It’s a fair question. Premiums and out-of-pocket costs have risen relentlessly over the past decade. Since the Affordable Care Act was fully implemented, the average premium for an ACA marketplace plan has doubled, and the average deductible for a Silver plan has increased by 92%. Every year, families pay more, yet the coverage often feels thinner.

What the Insurers Say

Health insurance companies routinely claim these increases simply reflect rising medical costs and higher utilization. For example, when justifying rate hikes in 2024, Cigna of Texas wrote:

“The increasing cost of medical and pharmacy services and supplies accounts for a sizable portion of the premium rate increases.”

But the financial filings of these same companies tell a different story.

What the Numbers Show

As Wendell Potter recently wrote, from 2014 to 2024 the seven largest publicly traded health insurance companies, UnitedHealth Group, CVS/Aetna, Cigna, Elevance (formerly Anthem), Humana, Centene, and Molina, reported that they collectively made more than half a trillion dollars in profits.

That’s money collected from individuals, employers and taxpayers for health coverage — dollars that didn’t go to medical care but instead flowed to corporate shareholders and executive bonuses. To put this in perspective, those profits alone could fund the enhanced ACA premium subsidies for another ten years, at an estimated cost of $350 billion.

Stock Buybacks: Enrollees’ Money, Executives’ Reward

Over the same period, these seven companies spent $146 billion buying back their own stock or, in other words, using premium dollars from patients and employers to boost share prices and executive compensation (the CEOs and many other top executives of big insurers are compensated primarily through stock grants and options).

Stock buybacks don’t lower premiums, expand networks, or improve care. They simply make investors and executives richer. If that same money had been reinvested in enrollees, it could have provided premium-free health coverage to more than 5 million families for an entire year, based on the average employer-sponsored plan cost of $27,000 in 2026.

Lobbying With Our Premium Dollars

Insurers aren’t just rewarding shareholders, they’re also shaping the political system that protects their profits. Since 2014, the seven largest insurers and their trade association, AHIP, have spent $618 million on lobbying.

That’s money that could have been used to lower out-of-pocket costs or improve patient care, but instead it’s spent to influence Congress and federal agencies to maintain the status quo.

The Real Problem — and the Real Solution

As the cost of health insurance continues to climb, politicians debate how to control those costs and expand coverage. But the truth is, there’s already enough money in the system to cover everyone. It’s just being siphoned off by insurance corporations for profits, lobbying, and stock buybacks.

Though some have been calling for less regulation of Big Insurance, that is not the answer and is partly how we ended up in this situation. Right now, Big Insurance is allowed to use premium dollars and tax dollars on things that do nothing to improve anyone’s health – such as stock buybacks and lobbying – instead of on medical care.

Rather than asking families and taxpayers to pay more, it’s time to demand accountability from insurers. At a minimum, they should not be allowed to use premium dollars, or taxpayer dollars, to enrich shareholders through stock buybacks (which wasn’t even legal until the 1980s) or lobby for policies that drive up costs.

If we want to contain health care costs, the first step is simple: Stop the profiteering by Big Insurance.