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GailL1
Community Champion ⭐⭐⭐
July 16, 2025

HEADS UP: New York - 2026 - Medicare Supplemental Rate Increase Applied for by Insurers for 2026

  • July 16, 2025
  • 10 replies
  • 13629 views

Medicare Supplemental plans have asked the New York Dept of Financial Services to approve a rate increase at the % of increase stated per each company.

 

New York Dept of Financial Services 07/02/2025 - Summary of 2026 Medicare Supplement Requested Rate Actions NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES 2026 MEDICARE SUPPLEMENT INDIVIDUAL AND SMALL GROUP REQUESTED RATE ACTIONS 07/03/2025 

 

NewYork is one of the few states in the Union that has continuous enrollment into Medigap plans without any Underwriting.  Thus it opens the door for Adverse Selection - where beneficiaries that are, perhaps, sicker and using a lot of Medicare can obtain a Medicare Supplemental plan at anytime without underwriting and the cost is shared by everybody.

 

Adverse selection occurs when lower cost or healthier patients opt out of more expensive plans or forego buying insurance until they need it, while higher cost or

sicker patients actively buy more protective insurance (with additional out-of-pocket protections and/or benefits) to protect them from risk. This imbalance in enrollment

results in fewer lower cost or healthier enrollees and a greater number of higher cost or sicker enrollees in insurance products. The higher use of services by higher

cost or sicker patients causes premiums to increase in that insurance product.

 

Any expected increase in Medicare Supplement premiums from assuring Medicare Advantage enrollees who switch to Traditional Medicare can access affordable Medicare Supplement coverage would depend on the degree of adverse selection. It would also depend on the number of beneficiaries who, when switching to Traditional Medicare, enroll in Medicare Supplement compared to the number of overall Medicare Supplement enrollees. The degree of adverse selection for those switching to Traditional Medicare would likely increase if beneficiaries leaving Medicare Advantage had assured access to affordable Medicare Supplemental coverage.

 

They have this assurance in New York with its continuous enrollment in Medicare Supplemental plans without underwriting.  The avoidance of this situation is why other state’s Medigap insurers are given the right to underwrite.  

 

New York Dept of Financial Services.gov - Information for Medicare Beneficiaries 

From the above link: [copy/paste]

Open Enrollment

New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee's application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services. However, eligibility for policies offered on a group basis is limited to those individuals who are members of the group to which the policy is issued.

 

While every Medigap insurer offers both plan A and B for policies sold before June 01, 2010, plans A, B and either C or F for policies sold on or after June 01, 2010, and plans A, B and either D or G for policies sold on or after January 1, 2020, not every company offers all standardized plans.

 

    10 replies

    Contributor ⭐
    July 17, 2025
    AARP Supplemental Healthcare through UnitedHealthcare premiums are going up in 2026.
    The rate increase proposed is 17.9% equates to about $50 more. This rate increase is outrageous and unjustified. It is also criminal. With the cost of everything on the rise 17.9% is going to be devastating to millions of people.
    I hope AARP will contact the New York State Department of Financial Services Superintendent and persuade him or her to disapprove the proposed rate increase. I follow the activity on Wall Street, and it's no secret that UnitedHealthcare has been taking some hefty losses, this may account for them unjustly proposing such a massive rate increase. 
    GailL1
    GailL1Author
    Community Champion ⭐⭐⭐
    July 17, 2025

    @w607000c 

    Did you look at the link I posted on the NY DFS site - it isn’t just AARP UHC that is proposing the increase in premiums - all of them - some a lot more than what AARP-UHC is proposing.

     

    NY is getting a kind of a double whammy in their Medicare Supplemental premium prices.

    (1) Usage is way up in millions of beneficiaries using their traditional Medicare programs - Part B especially.  We still have until 2030 when all the baby boomers turn 65 and are eligible for Medicare.

    (2) since NY has continuous enrollment of Medigap plans without underwriting, and allows beneficiaries to switch plans, premiums reflect this Adverse Selection* phenomenon to which everybody with a Medigap plan will pay.

    (3) plus in NY, I believe that those who are less than 65 who have access to Medicare (the disabled - SSDI) and to any Medigap plan just like those who are over 65 - Federal law does not give any protections to those who are less that 65 and their access to a Medigap - in many states, they either cannot get a Medigap plan or they have access to only certain plans and are charged a much higher rate to help cover their increased healthcare cost. 

     

    * Adverse selection occurs when lower cost or healthier patients opt out of more expensive plans or forego buying insurance until they need it, while higher cost or sicker patients actively buy more protective insurance

    (with additional out-of-pocket protections and/or benefits) to protect them from risk. This imbalance in enrollment results in fewer lower cost or healthier enrollees and a greater number of higher cost or sicker enrollees in insurance products. The higher use of services by higher cost or sicker patients causes premiums to increase in that insurance product.

     

    But what are your griping about - you can change your medigap plan at any time in NY - so pick another one that is cheaper - well if you can find one in NY. 

     

    From the looks of some of these increases, I bet some insurers may consider moving out of the Medigap market in NY especially if the higher priced ones keep loosing members. 

     

    BTW, your complaint should be registered with the NY Dept of Financial Services who are now contemplating these premium increases - let your voice be heard.  

     

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
    GailL1
    GailL1Author
    Community Champion ⭐⭐⭐
    July 18, 2025

    @pacase1 

    Nope, never worked in the insurance industry- in fact, I have been retired for 20+ years and on Medicare since God was a baby (that’s a long time).  My hobby has been reading everything I can about all types of insurance especially Medicare  and associate coverage.  

     

    Yes, Medigap premiums rise with time.  Medigap is really NOT medical insurance, it is financial protection insurance to prevent a catastrophic medical loss cost.  So, in most states, premiums are primarily based on usage of the gap that it fills - Medicare Part A and Part B.  Plus any reserve that the state may want the insurers to put up for access to their state’s beneficiaries.  

     

    In NY and a few other states, they have what is called an extended guaranteed issue period (open enrollment) where beneficiaries can switch plans AND actually even buy plans outside of the initial enrollment period.  When this happens, a beneficiary with whatever health care condition or cost can buy or switch Medigap plans - this also shifts their RISK to that other plan - thus the Adverse Selection.  

     

    I quoted from the NY DFS.gov site because it explained the NY concept of who can get a Medigap plan and when well.  

     

    In other states, their Medigap rules of eligibility and enrollment is pretty much based on what the Federal law says.  They keep down adverse selection by having specific initial enrollment periods to which are very strict or well defined special enrollment periods.  Risk is minimized or paid for by having UNDERWRITING - which NY and a few other states don’t have.

     

    Premium rates for Medigap are based on state laws.  The more usage by shear numbers, the more risk which state laws allow, the higher the premiums.  

     

    Insurers also vary by state - some insurers may offer very low rates in their beginning in a state - soon they increase rates rapidly to catch up.  One insurer, ACE- went up 30% in 2025.  And Allstate is taking such a hit, they have decided to leave the Medigap marketplace,  In some states, they do not have community rating in all insurers like in NY and a few other states.  They may have rates that are initially set and continue to be raised by other rating methods like attained age.  This would be in addition to the usage and the risk factors.  The older one gets the more the premiums. 

     

    Please do not use the abbreviation of SSI - that is the welfare program of disability - Supplemental Security Income - it does NOT mean Social Security Insurance.  

     

    Medigap premiums have nothing to do with what a Social Security benefit might be - nothing to do with COLA either.  A beneficiary’s pocketbook is what it is - a little or a lot, they budget what they can afford if not they have to make other plans.  

     

    Medicare Part B premiums are also not set by what a beneficiary can afford although low income seniors do get a subsidy to pay for them.  Part B premiums are based on USAGE - and the last Social Security Trustee Report forecast these to be along the line of $ 206 a month in 2026 - up from $ 185 in 2025 - but with only a COLA of around 2.5%.  We will know in October 2025 if these forecast is accurate.  

     

    Yes, any Medigap plan may outprice themselves but in NY and a few other states,  the beneficiary can switch to another insurer with lower premiums.  In most states, this is not possible if the beneficiary cannot pass underwriting.  If they can’t they are either stuck with what they have or they drop it and go to a Medicare Advantage plan OR pay out of pocket the amount that Traditional Medicare does not cover.

     

    Having a Medigap plan is not required by Medicare at all.  

     

    AARP has nothing to do with the premiums or the running of the AARP/UHC Medigap plan - they only get royalties from the sale of such branded plans.

     

    California is now proposing a new Medigap law in their state SB242 - it would allow those who want a Medigap plan to buy them at anytime and they already have a birthday rule where those with a Medigap already can switch their plan.  The analysis done by the state on this new proposal states that therewould be an immediate $ 40 a month increase in cost just for this proposal being enacted.  That’s on top of any other cost increase for usage or birthday rule risk.  It too, I believe is a community rated state.  

    I wrote about this in another post that you can find here:

    https://community.aarp.org/t5/Medicare-Insurance/CALIFORNIA-Senate-Bill-SB242-Medicare-Supplemental-Policies/td-p/2618754 

     

    If you are in NY, take advantage of the laws in your state - at least you have this option.  In fact, switch to another insurer and switch to another plan and share in the risk and really lower your premiums - like to a High Deductible Plan G.

     

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna