Huge UHC medigap increase in past year

[JackieMF]

September 2024 my premium was $223.60. In Oct 2025 it will be $271.87. Plus, as I live in the DC area, I will lose access to Johns Hopkins drs and hospitals. Although based in Baltimore, they run two major hospitals near DC and have the strongest network of doctors. Johns Hopkins dropped UHC due to poor coverage. 

[GailL1]

@JackieMF wrote . . . . Plus, as I live in the DC area, I will lose access to Johns Hopkins drs and hospitals

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as @TRL1111 said

 NO, YOU WILL NOT - John’s Hopkins and UHC MEDICARE ADVANTAGE and Dual Eligible Medicare and Medicaid Advantage PLANS are the ones that they have not come to an agreement with -

Traditional Medicare (including your Medicare supplemental - Medigap ) is continuing.  They will not terminate doing business with Traditional Medicare like you have.  You do know the difference, right?.

I posted a link about this just the other day on this same forum.

AARP Medicare & Insurance Board - Johns Hopkins, United Healthcare are Parting Ways - Includes Medic... 

As to your Medigap rate increase = happening all over with all kinds of plans.  Beneficiaries are using their Medicare benefits - especially Part B - BIG TIME. 

DC Medigap plans are regulated by the District of Columbia Department of Insurance, Securities & Banking - (DISB) - that DC body is in charge of approving the rate increases from the insurers on Medigap plan.  

I do not think you have any special guaranteed issue rights in DC to switch plans but do not know for sure - You can read over this Medicare Guide to see if there are any special Medigap rights available to you in DC as far as changing plans or insurers. 

Medicare Guide- Medicare Supplement Plans in the District of Columbia UPDATED 08/25/2025 

[asafchuk]

Where was the link posted? There is no real clarity in this. 

[GailL1]

@asafchuk wrote . . . . . Where was the link posted? There is no real clarity in this

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From the post that I made the other day on this same AARP board entitled:  

Johns Hopkins, United Healthcare are Parting Ways - Includes Medicare and Medicaid Advantage plans

Fierce Healthcare.com 09/17/2025 - Johns Hopkins, UnitedHealthcare officially end talks after failin... 

Negotiations went nowhere so they are ending it -

from the link [copy paste]

Hopkins providers have been out of UnitedHealthcare’s network for an estimated 60,000 patients, mostly in Maryland, but also in Washington, D.C., and Virginia, since Aug. 25, the Baltimore Banner reported.

Those 60,000 patients will have to find new providers or pay higher out-of-pocket costs to continue to see their doctors and get care at Johns Hopkins hospitals. 

Johns Hopkins Medicine spans more than 50 total care locations, including six hospitals, and serves patients in Maryland, Virginia, Washington, D.C. and Florida.

Both parties are warning patients that Johns Hopkins’ hospitals and other facilities are now out of network for enrollees in UHC’s employer-sponsored commercial plans, Individual Family Plan, Medicaid and Medicare Advantage plans, including Dual Special Needs Plan and Group Retiree. Johns Hopkins physicians, who only participated in UHC’s employer-sponsored commercial plans, are also now out of network. 

Johns Hopkins All Children’s Hospital, in Florida, remains in network. 

Any UnitedHealthcare member that was already approved for transplant services at Johns Hopkins at the time they went out of network will continue to have in-network access for those services at Johns Hopkins, UHC said.

Patients in active or ongoing treatment for a serious or complex condition with a Johns Hopkins provider at the time it left the UHC network are eligible to continue care for a period of time at in-network costs. Continuity of care allows patients to continue accessing care with their provider at in-network rates for a minimum of 90 days, though it could be longer depending on the course of their treatment, the insurer said.

Conditions that would be eligible for continuity of care include people in active treatment for cancer and women who are pregnant

end copy / paste 

is that what you needed?

[asafchuk]

Thank you! I was able to access this but would like to see it somewhere that the AARP Supplement from United Healthcare is still being accepted. UHC says yes but a scheduler at JH sent me a letter saying UHC may not cover my cataract surgery at in network rates. How do I confirm? i have called both. 

[CBtoo]

The network issue shouldn't affect you (as they still accept Original Medicare and original medicare determines what they reimburse, your UHC supplement just pays what original medicare doesn't minus any copays or deductibles your plan may have; now advantage plans are a different story - those people are cut off) outside of how to deal with getting them paid for what your supplement covers. If they will bill UHC then problem solved (outside of scheduling that needs educated to the difference between an advantage plan and a supplement with original Medicare). 

If they won't bill them and you have to do that yourself then you need to find out how billing will deal with the balance owed while you wait until the supplement finally pays. It can take several months for a facility to bill medicare and medicare to send them the money. Then usually what happens next is once that has happened then the facility bills the supplement.

You also need to find out from UHC what you need to do and get in order for you to submit what is needed for your supplement to pay if Johns Hopkins won't submit it.

The amount of time that may pass until Medicare has processed everything so you can even send the bill to UHC may mean that Johns Hopkins will have sent you to collection (many places cut off care if that happens - you need to find that out). You need to work out with Johns Hopkings how your account will be kept current and in good standing while you are waiting at your end for them to deal with their end (original medicare stuff). 

Make sure you get in writing that you don't have to pay up front any copy (unless your supplement requires copays and you haven't met your maximum out of pocket) so that you can show that to people when you check in. Find out if you don't make that upfront payment if they will cancel the procedure or not.

If you are getting the run around at Johns Hopkins and/or need help then contact their Patient Relations office for help navigating your way through this (they may send you to someone else but that is a starting point). This page (and then pick where it is being done for the phone number) will send you in the right direction:
https://www.hopkinsmedicine.org/patient-care/patients-visitors/patient-feedback

Good luck sorting this out and with the surgery.

[GailL1]

@asafchuk 

If traditional Medicare is accepted it will pay it’s share of the cost and then your Medicare supplemental plan (Medigap) will cover the amt not covered by Medicare up to the amount specified in your selected Medicare Supplemental plan (Medigap)

Here is the info directly posted by Johns Hopkins Medicine

Johns Hopkins Medicine.org - Johns Hopkins and United Healthcare: What you need to know - updated 09... 

copy/paste from the above link 

We remain in-network with almost all other insurers. A list of insurance plans accepted at Johns Hopkins Medicine can be found here.  ⬇️

Johns Hopskin Medicine.org - Billing and Insurance 

This takes you to a list of insurance plans which they accept and they speak specifically about Medicare.

per the above link - [copy / paste]

Medicare Coverage

Please be advised that Johns Hopkins Medicine hospitals and most Johns Hopkins University physicians participate with Medicare, but we are not contracted with most Medicare Advantage Plans. If your Johns Hopkins Medicine hospital doesn’t participate with a Medicare Advantage Plan, you can use out-of-network benefits if your plan has them.

end copy/paste

IF Traditional Medicare approves and pays for a service, your Medigap plan pays - that is actually all that a Medigap plan does - it pays based on the parameter of the Medigap Plan that you have chosen as your Medigap plan.

A Medigap plan is NOT health insurance - the Medigap plan does not make any health care decisions - It is financial protection insurance against a  medical event covered and approved  by Traditional Medicare and it picks up the financial shortfall between the negotiated Medicare price which Medicare pays a portion of and your part of the bill.  Your chosen Medigap plan pick up the remainder ( your part of the bill) based on the Medigap plan you picked.

Just make sure that your provider for the service and the facility accepts Medicare ASSIGNMENT.

Medicare.gov - Does your provider accept Medicare as full payment? 

To find out if your provider and facility accepts Medicare assignment, you look them up on this Medicare locator and it will tell you specifically if the provider / facility accepts Medicare Assignment. 

Medicare.gov - Find Healthcare Providers  

With using Baltimore, MD and searching hospitals - Johns Hopkins name comes up with (3) 

Johns Hopkins Hospital, The - Wolfe Street address

Johns Hopkins Bayview Medical Center

Johns Hopkins Howard County Medical Center

There are a ton of Opthalmologist listed on the Medicare Locator so you will have to pick the one you are using.  If they accept Medicare Assignment, they will have it listed in their listing as “Charges the Medicare-approved amount (so you pay less out-of-pocket)”

As an example,  this is a link to one of the Medicare Find pages showing “OPHTHALMOLOGIST” under the parameters that I listed.

Medicare.gov Search Results Opthalmologist zip 21287 -15 mile radius - Providers accepting Medicare-... 

Hope this helps -

BTW, you do know the difference in Traditional Medicare (the plan that works with a Medigap or Supplemental policy) and a Medicare Advantage plan ( the Medicare plan type from private insurers )

Another helpful Medicare page 

Medicare.gov - Cataract Surgery 

from the link

Costs

• For covered cataract surgery in a hospital outpatient setting or ambulatory surgical center: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to both the facility and the doctor who performs your surgery.
• For covered cataract surgery you get in a doctor’s office: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for both the intraocular lens and the surgery to implant it.

end copy/paste - 

Your Medigap plan will pick up its part of your 20% out of pocket

[TRL1111]

Supplements have no say whatsoever over what's covered.  Medicare makes the decisions.  If Medicare pays its 80% of its approved charge, the supplement pays its 20%. It's automatic.  In fact, the provider doesn't even have to know you have a supplement--Medicare knows you have the supplement, and Medicare bills the supplement.

Also, traditional Medicare has no networks.  Providers either accept Medicare or they don't.  There are no in-network rates with traditional Medicare.

Do you still have the letter the scheduler sent you?  I'd love to know exactly what it says because if you have traditional Medicare and a UHC supplement, that letter is 100% wrong.

Now, if you have a UHC Advantage plan that you think is "supplemental" coverage, then you do not have a "supplement"--you have an Advantage plan.  Advantage plans DO make the decisions and DO have networks, because they are not Medicare; they are a substitute for Medicare.  Johns Hopkins has chosen not to accept UHC Advantage plans any more, which means that any care they provide to UHC Advantage members will be billed at out-of-network rates (assuming the Advantage plan approves the procedure in the first place).

[asafchuk]

Thank you so much.  This is the clearest information I have received to date.  I do understand the difference and my phone calls with UHC have all centered on this issue. It was the letter from the scheduler that gave me pause.  One note is:Since August 25, 2025, any provider or facility that is part of Johns Hopkins Medicine, EXCEPT FOR Johns Hopkins All Children’s Hospital in Florida, has been considered out of network by UnitedHealthcare. 

The note from the scheduler reads:Also as we discussed due to your secondary insurance United Health Care Beginning Aug 25, your insurance may be Out of Network with Johns Hopkins. If you are Out of Network, you will be responsible for any out of pocket cost.   For questions about benefits, eligibility, or status, call UnitedHealthcare at the number on your card.  

I have called UNHC several times and once they said they would call scheduling because scheduling refused to even book my surgery. Finally I was able to book, but according to the above note it is still not clear to JH that I am covered.  I guess it could seem that they are just covering themselves, but until I started asking to have my case reviewed further up there was only blocking..

[GailL1]

@TRL1111 wrote . . . . . In fact, the provider doesn't even have to know you have a supplement--Medicare knows you have the supplement, and Medicare bills the supplement.

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While that is true for 99% of the cases where beneficiaries have Traditional Medicare and a Medigap plan - there are a few of the Medigap insurance carriers that do not use the cross-link process and have some other way to do the crossover than thru Medicare.

This coordination covers a lot of plan and each should be shown on a beneficiaries Medicare account IF the cross link has been done and the insurer does use the COB. 

CMS.gov - Coordination of Benefits  (COB)

from the link 

Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan).

.. . . .  Note: An agreement must be in place between the Benefits Coordination & Recovery Center (BCRC) and private insurance companies for the BCRC to automatically cross over claims. In the absence of an agreement, the person with Medicare is required to coordinate secondary or supplemental payment of benefits with any other insurers he or she may have in addition to Medicare.

Beneficiary can look at their Medicare account and see what coverageS they have - whatever type - Beneficiaries should check this periodically if the insurer is a COB participant.

~Medigap plans, Part D plans, employer supplemental plans, self-insured plans, the Department of Defense, title XIX state Medicaid agencies, VA and CHAMPVA, TriCare For Life and others - even workman’s comp claims although those are more complicated. 

[TRL1111]

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@JackieMF wrote:

Plus, as I live in the DC area, I will lose access to Johns Hopkins drs and hospitals. 

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No you won't.

[JackieMF]

That’s good 

[GailL1]

Arrrrrr 🤯