Recent premium increase for United Healthcare coverages

[jphorenci]

I am absolutely appalled at the just announced price increases for United Healthcare coverage. The increase in RX (over 90%) announced during the last open enrollment was enough force me to make a change and now the supplemental health coverage increase (22%) is astounding. As their primary selling agent, you should anticipate my changing to another, more affordable carrier at my first opportunity and hopefully a boatload of others doing the same. Shameful, unjustified, heartless, and ridiculous. Shame on both you and United Healthcare.  

[CBtoo]

However if you look at an advantage plan realize:

1) the out of pocket costs, if you use your health care much, are higher than premiums plus those out of pockets on a supplement, 

2) network limitations and some don't even cover out of network, some don't cover out of state

3) needing prior approval for many things you don't on original medicare

4) to get a supplement plan back you will need to pass medical underwriting (exceptions are "birthday states" and similar and a few other rarer circumstances)

[GailL1]

@CBtoo wrote

1) the out of pocket costs, if you use your health care much, are higher than premiums plus those out of pockets on a supplement, 

That’s gonna depend on the health of the person and in any given year.  A beneficiary that has a Medigap plan to supplement their traditional Medicare, pays the premiums for the Medigap every month regardless of their use of Medicare.

But a beneficiary with a MA plan only has to pay the copays and/or their cost sharing when and IF they use any health services.  

2) network limitations and some don't even cover out of network, some don't cover out of state

Again, the choice of type of a MA plan is up to the beneficiary to choose.  As with any other health insurance, the better the plan, the better the coverage.   Yes, in emergency situations, out of state coverage is covered on the better plans.  

Even in traditional Medicare, some providers don’t accept the coverage.  Or they are “non-participating” and can bill you up to 15% more.  

Medicare SELECT plans are a type of Medigap policy that require you to use a specific network of hospitals and, in some cases, doctors (except in emergencies) to receive full benefits, potentially offering lower premiums than traditional Medigap plans. 

3) needing prior approval for many things you don't on original medicare

Yep, that is all apart of the managed care which MA plans are - traditional Medicare could do this too and do it in certain situations.  

Personally, I think this is advantageous in holding down Medicare cost and I see in the future that traditional Medicare might move to more managed care to save money.  This is nothing more than just a doctor validating their treatment methods to agree to scientific or cost saving protocols.

Any appeal if the doctor has followed treatment protocols and  has coded previous treatments properly will be approved when the doctor files an appeal.

Many times what happens is the appeal is never filed.

Prior approvals has long been a standard process in other health insurance policies.

4) to get a supplement plan back you will need to pass medical underwriting (exceptions are "birthday states" and similar and a few other rarer circumstances)

That is ONLY if you have certain conditions - Most times,  you had to have a Medigap plan to begin with - there are only (4) states where you can drop a MA plan and buy a Medigap plan outside of the initial open enrollment.  

Other times there has to be more major changes in a persons life to leave a MA plan and get a new Medigap plan after the initial enrollment period - like you have to move to a different area.  

Other than  those few states that do allow picking up a Medigap outside of the initial (6) month window or switching like  the birthday rule states.  all states will allow you to switch if you go thru underwriting and the underwriting may come with higher Medigap premiums and/or a specific time when anything pre-existing could be denied coverage.

All things considered, the main reason that many beneficiaries don’t pick up a Medigap plan during the initial sign up period or even after is because they cannot afford the monthly premiums of the Medigap plan.  Could be the very same reason why they pick a skimpier MA plan.  They buy what they can afford based on their monthly cost factor.  

I know older beneficiaries that are now having to consider this - they can no longer afford the monthly premiums for their Medigap plan because it has escalated over the years so they are moving to some of the higher rated MA plans - a PPO with out of network coverage and then they have their Prescription drug coverage included in their MA plan - a MAPD. 

[CBtoo]

GailL1 You are side stepping one huge issue - they may be healthy now and so it is cheaper NOW - but what if they later get serious health issues like many older adults eventually get? THEN it becomes far more expensive to stay in an advantage plan than if they had a supplement.

If they can't afford the premiums now they sure as heck won't be able to afford the even higher maximum out of pocket costs that advantage plans have (higher than G+ med B deductible) when they actually have to use their health insurance. THAT IS HUGE for people who have to use their health care to any great degree.

Then, unfortunately for them (but not for supplement premiums as it keeps the sicker people from switching when they are sicker and not using them when they are healthier), many of those folks, when faced with that, fail medical underwriting and so have a maximum out of pocket of (this is locally with UHC, depending on the plan), $5900 (two plans), $6700, and $8900. All of them have a $10,100 in and out of network out of pocket. Locally two of the hostpial systems outsource a number of things and those outsourced services (lab, radiology, ER, etc.) may be out of pocket.

Now which is cheaper if you use a lot of health care? Premiums + B deductible for G (or for one with a higher deductible then add that in) or an advantage plan? And advantage plan people still have to pay the B premiums. If people can't afford the premiums with a supplement to begin with, how on earth are they going to be able to afford to use their health care with those kinds of maximum out of pockets when they actually need it? Just for example with cancer and you hit the max pretty early on. 

Unless they are using a facility that will treat them without paying their copay in advance, will continue to treat them and not cut off care when they get sent to collection for owing several thousand dollars, and won't sue them when they are in collection and haven't yet come up with the money to pay, then they are in deep trouble with getting any medical care at all except through an emergency room if they can't switch systems and thus lose all their doctors In rural communities or smaller towns that likely will involve a long commute to get health care as many of those areas only have a few doctors/systems.

Where I live we have 4 systems, one of which doesn't even have some specialities at all, including primary care (it is a failing system), two out source a lot and the forth has most of the specialists (is a university system). Here is would only take 3 years of debt, one at each system tbut one (who doesn't cut off care but if you are in collection you have to pay your copay when you check in for the appointment or they won't see you) to have nearly no health care (except one system where you pay in advance if in collection) in a 4 county region (the local city metro area crosses 3 counties). Then what will people do for health care? The ER doesn't give chemo, monitor chronic conditions, etc.

It's not ALL about what is cheapest now. People need to look ahead into the future to try to second guess what they will need when they are 80 or 90 or beyond (if they live that long). If almost all of their family dies without ever having anything much wrong with them then likely an advantage plan is a decent gamble. If they are not planning to live in two states - one in the winter or one in the summer (although they could keep switching their advantage plan if they meet the criteria for residence in both states serially), or spend a month or so visiting out of advantage plan area then likely are reasonably safe with an advantage plan. If the family history of health issues (or theirs that are in the early stages) is not the greatest then likely having a supplement while they can still get one makes more sense.

Note - what I have said does not apply to states where you have guaranteed issue once a year (eg birthday states, etc.).

[GailL1]

@CBtoo 

Whenever a beneficiary starts to use a good bit of health care, then other cost start up like the deductible and added copays.  But if they have gone a long period of time without having to pay their part of the coverage then it only occurs when the begin to use it.  Some people never use it - 

But it would also be that way for a traditional Medicare beneficiary that did not have a Medigap plan - except that there is NO maximum out of pocket on traditional Medicare.  That’s th protection that a Medigap plan gives - Medigap coverage is not health insurance at all - it is financial protection insurance for those on traditional Medicare to prevent a catastrophic financial event due to an illness or accident.  The old 20% that Medicare does not cover - it can be very, very big if the illness or accident is very costly. 

In that way, a Medicare Advantage plan is better because when a person hits the maximum out of pocket for that year - if they do, then after that the plan pays it all for the rest of the year.  

Many of us that had coverage before Medicare always had to deal with the deductible and copays so for many this isn’t anything new - you just pay your part of the cost and continue on, hoping that the next year things will again even out in your cost.

Today when a medical event could reach several hundreds of thousands of dollars, paying a big deductible for ones’ part of their care is no biggy.  The insurer may be paying $ 100,000.00 or more but a beneficiary is only paying whatever their deductible might be.  

But of course, their health may not improve either - ask the many beneficiaries that get their Medicare based on their disability and not their age.  Federal law does not guarantee a person less than 65 years old has access to a Medigap plan - that’s up to their state. Some states give them no access to a Medigap plan so they have to pick a MA plan.  Then some states give those less than 65 only access to certain Medigap plans - the ones with the least benefits like Plan A.  Then since everybody in this pool are high health care users, the premiums turn out to be astronomical.  Then if their state has expanded the guaranteed issue rules and also included them - then because of the health risk these folks bring to the states Medigap pool, everybody with a Medigap plan in the state has higher premiums to help those who are disabled and have a Medigap plan.  The one positive for disabled people on Medicare is that when they reach the age of 65, they get a DO-OVER on their plan selection based on age and not disability.

You seem to think that most people on Medicare are poor or don’t have the funds to cover their part of the cost on a MA plan.  It isn’t that way at all.  You also must think that those with a Medigap plan always want the one that pays the most - nowadays, that Plan G - that isn’t the case either - many people pick one of the High Deductible plans cause premiums are very low for a HD Plan G or HD Plan F -then they pay the annual Medigap deductible  for their plan before the Medigap picks up anything - The  High Deductible Medigap Plan G or F is this year $ 2870.

You know this wouldn’t even be up for any discussion IF traditional Medicare had an annual out of pocket limit - then nobody would have to buy a Medigap plan at all.  I read somewhere on a university site that they had done an analysis and the amount they thought this would be to work out and save Medicare money would be about $ 8500 a year.  

I mean, really, if you aren’t destitute, then why do people think they should not pay anything for their healthcare - well, now I think they do have to pay the Part B deductible of $ 257.

[CBtoo]

1) You are addressing issues I wasn't addressing. 

2) I never said people shouldn't pay something for health care. I was comparing how much they'd pay if they used their medical care not that it should be free.

3) For many people $8500 to pay in one year is huge. Nearly 1/2 of retired people only have social security as their income and the average social security is less than $2000/mo.. While they may not be below the poverty line (and if they were with few asserts they'd be dual eligible and have medicaid so problem solved for them), they may not have the money for huge medical bills. And $8500 is far more than what someone would pay with a supplement even when you add in premiums.

4) With a supplement when they hit the max out of pocket care is free the rest of the year too. And even counting in the premiums it is cheaper than advantage plan out of pockets. Sure they may not use a lot of medical care for years, BUT IF THAT CHANGES - and we do not know for sure our future although some have lower odds than others for bad medical things happening - then they may not be able to change to a supplement where their out of pocket + premiums are less and be trapped in a plan with much higher costs those years. 

5) D is now identical with the rules between advantage plans and original medicare so that doesn't count. That $2000 is now separate from the medical out of pocket (well maybe not in the the couple of states that have their own rules but in the rest of the country). 

Just like car insurance - you buy insurance based on what might happen. You don't wait until you have had an accident to buy car insurance because if you do then you have to pay to repair the car (which could easily be thousands of dollars or worse if you were totaled out)  yourself and your premiums will be higher due to the accident. Same with life insurance. If you wait until you are about ready to die you may not get it and the cost would be prohibitive. Same with long term disability insurance. 

[AARPConsumerCare]

We're sorry to hear you’re having trouble with UnitedHealthcare, @LauraA422032. We are listening and would like the chance to help as soon as possible. Please visit https://help.aarp.org/s/article/contact-aarp to chat, text, or speak with a representative who can get you in touch with our Member Relations team. - Diana G.

[GailL1]

Medigap premium.increases are reviewed and approved by your state’s dept of insurance.  There is NOT an OPEN enrollment period for Medigap plans - there is only the initial enrollment period except in some states with a “birthday rule” or some sort of state rule that allows you to change plans based on some criteria.  

Open enrollment is only for Medicare Advantage plans or a Medicare Prescription Drug plan NOT a MediGAP plan.

Yes, Medigap plans can go up - they go up because of medical inflation plus based on whatever method they use to rate the MediGAP plan that you picked 

• community rated
• issue age rated
• attained age rated

They could do each of these separately - medical inflation 1st then a rated-based claim next.  Or actually for any other reason that passes your state’s approval system - 

After all, MediGAP policies aren’t health insurance - they are financial protection insurance to protect you from the “limitless” out of pocket cost in Original Medicare which the beneficiary has to bear.  

Some people handle this by getting a Medicare Advantage plan where the Medicare out of pocket cost are restricted under these managed care insurers.  Others get a MediGAP to pay this Medicare out of pocket and continue to pay higher and higher premium as they continue their original Medicare coverage.  Your MediGAP plan will continue to go up in premium cost - how much?  Who knows but the risk pool that you are in within your plan will get older and older and usually this may mean sicker and sicker.

MediGAP insurers are getting hit pretty hard in the last few years because now people are getting back to seeing their doctors regularly  which they stopped doing during the PHE (Public Health Emergency - i.e. Covid Pandemic).  

[LauraA422032]

According to CMS and the benefits company my old employer uses, as well as the UHC plan document, I cannot change plans after the open enrollment period.  There are a few exceptions, and being misled is one of them. My issue is more with how it was done: 8% increase during enrollment, then again a few months later. Had I known the second increase (15%) was coming, it would have better informed my decision on which policy to buy,

[GailL1]

@LauraA422032  wrote

According to CMS and the benefits company my old employer uses, as well as the UHC plan document . . . . 

++++++++++++++++++++++++

For clarity ~

By the above comment do you mean you have Retiree Coverage and that is where you are getting your UHC Medigap plan?

So it isn't an AARP-UHC branded policy?  What does your old employer have to do with it?   

If so, some other Medicare info may be pertinent.

Medicare.gov - Retiree insurance & Medicare

If this is a Retiree type Medigap policy - it is different.  

[LauraA422032]

No, I don't have retiree coverage. My old employer offers a service (a broker?) that helps with medicare coverage. There isn't a difference in cost but I do benefit from an HRA provided by my old employer. I have an AARP branded UHC plan.

[JamesH549418]

Wow! Add me to the list.

I just received my AARP UHC Plan N rate increase notice today. 11.7% increase mid year. My AARP UHC Rx more than doubled last fall after the aforementioned previous increase for Plan N. I too have a broker, ViaBenefits through the employer I retired from.

It seems like in the overall effort to reduce health care and prescription costs for some results in the majority paying more through premium increases.

It will be time to call the broker next open enrollment and shop around.

[AARPConsumerCare]

@JamesH549418, we are also concerned by price increases that in some cases would double the cost of people’s monthly premiums AARP knows that any increases, let alone ones on this scale, are difficult to manage – especially for people on fixed incomes. A major driver of these increases is the underlying  prices of prescription drugs charged by pharmaceutical companies. It is why AARP has fought so hard to bring down those prices, including by allowing Medicare to negotiate for better prices on behalf of consumers. Thanks to the law that passed last year, Medicare now has that ability with the first negotiated prices taking effect in 2026.

If you are interested in learning more about other available plans during open enrollment, please contact Medicare directly at: 1-800-MEDICARE (1-800-633-4227). You can also use the comparison tool on the Medicare website: medicare.gov/plan-compare/ - Diana G.

[JamieK618970]

If AARP really cares about keeping costs low for its members, then why does AARP have an exclusive agreement with United Healthcare to promote UHC’S Medigap and Advantage policies, that also allows UHC to use the AARP name and logo? UHC is having financial problems and has been found to have defrauded Medicare on numerous occasions. Why doesn’t AARP promote alternative provider(s)?

[GailL1]

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@JamieK618970 wrote:

If AARP really cares about keeping costs low for its members, then why does AARP have an exclusive agreement with United Healthcare to promote UHC’S Medigap and Advantage policies, that also allows UHC to use the AARP name and logo? UHC is having financial problems and has been found to have defrauded Medicare on numerous occasions. Why doesn’t AARP promote alternative provider(s)?

---

It is a mutual beneficial arrangement - but AARP has nothing to do with the premiums of a Medigap plan - premiums are set by usage utilization and inflation and in some states the age of the beneficiary cause it also depends on the way a policy is rated.  Some, maybe most or all, I don’t know,  people get that declining discount off their AARP UHC Medigap premiums - that’s a benefit that most other companies don’t offer + sometimes other auxiliary benefits are offered too.

The AARP Online Community Guidelines say to post links to information you are posting. “Sight Your Sources” - 

AP News 05/13/2025 - Business - UnitedHealth Group CEO steps down as company lowers, then withdraws ... 

“ Defrauded Medicare on numerous occasions” ?????

When and where ?

Kaiser Health News 03/04/2025 - UnitedHealth WINS Ruling Over $2B in Alleged Medicare Advantage Over... 

AARP and UHC have a long standing contract on the royalty deal as does other companies that carry the AARP logo - It is how AARP brings in income to support their mission and give what they can to the AARP Foundation.

I don’t see anywhere that either of these entities have said that they are low cost or the lowest cost - especially when the premiums on neither the Medigap plans or the Medicare Advantage plans have anything to do with AARP.  

[CBtoo]

AARP sticks with UHC and Oak Street Health because they get about 1.2 Billion from the use of their name (of course, we, using UHC, etc. pay that fee). That money goes into their for profit arm. UHC is also one of the biggest insurance companies out there. 

[GailL1]

True, it is a mutual beneficial relationship @CBtoo and for the running of the organization and for whatever they share with the AARP Foundation.  And since one has to be a member of AARP to buy an AARP UHC Medigap plan at least for the sign up year, then they make at least (1) year of membership off of new enrollees - maybe even more that (1) year.

[SummerOnTheWay1]

(3/18/24) @LauraA422032 , good for you!!! If enough people complain, MAYBE AARP will care.  🙄  Good Luck.  👵

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[*** LAURA @LauraA422032 wrote:

I just received notice from UHC that my Medigap plan premium is increasing 4/1/2024. When I signed up for the plan during open enrollment, the premium was slightly higher than last years. How can they increase the premium 4 months later, when open enrollment has ended and I cannot change plans until next year? This is bait and switch. I informed AARP and I'm contacting the Govt next. ***]

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[LauraA422032]

AARP called me this morning and is working it.

[maziemoo]

What was the result of aarp working on it?

[GailL1]

@SummerOnTheWay1 wrote

. . . . . If enough people complain, MAYBE AARP will care . . . 

+++++++++++++++++++++++

They may “care” but there is little they can do - they ONLY get royalty payments from UHC for use of their name in the promotion of their product - AARP has nothing to do with the benefits or premiums of the insurance company.

[maeella9]

Hi Gaill.1.

I totally agree with you.  They say the squeaky wheel gets the oil.  Well, there are enough squeaky wheels like myself that are AARP members and we should very well voice our dissatisfaction with them and their attaching their name to United Healthcare's supplemental plan with this unaffordable increase!  They could at least give us some options and/or names of other insurers that are cheaper and help us out rather than tell us "we will look into it!"  Baloney!

[GailL1]

@maeella9 

In my other reply to you this am, I gave the Medicare.gov website page where you can find other MediGap insurers in your area - 

Now what ways can you or others voice your dissatisfaction with AARP in this matter - just a possible one that is at your finger tips.

-  Perhaps Cancel your membership after you have secured your choice of a AARP/UHC Medigap plan of your choice - you only have to be a member of AARP to secure the plan; not to keep it going - so after that sign on,  they cannot cancel your plan for not being a member.

How long do you think AARP would stick with UHC for their branded Medigap if memberships began to be cancelled?

Why is being a member even a pre-requisite to purchasing an AARP/UHC Medigap plan?  Membership isn’t required to purchase an AARP/UHC Medicare Advantage plan.  

If you really want to fix stuff like this for everybody, advocate for Medicare to have a maximum annual out of pocket.  That would pretty much wipe out the need for any MediGAP coverage.  

Only a small number of Medicare beneficiaries have a MediGAP plan - WHY, the reason is simple - they don’t need it because they have something else to take its place.

• Almost 50% of Medicare beneficiaries use a MA plan and not Original Medicare
• Then of the remaining

- many are dual eligible - meaning they share Medicare (primary) and MediCAID (secondary)

- others have some other type of secondary payer - retiree, military or some other government secondary coverage - like CHAMPVA.

.

[DeannaF752445]

Just to add to the analysis of Medigap vs MA:  I chose Medigap as I didn't want to be limited to a particular network.  My sister chose Medigap as she lives out in the country, and there are no networks where she is.   So far I've been happy with Medigap and being able to choose any physician.   My primary is still at a network (Sutter) but it takes forever to see a specialist, and a referral is required.   With Medigap, I can get to a specialist much quicker, and do not require a referral from my primary. 

[GailL1]

@DeannaF752445 

I am sure you are happy with your Medigap plan - it is wonderful coverage to protect ones finances in the event of an expensive  medical event.  

That’s all that a Medigap plan does - gives you payment coverage for what part of the medical expense Traditional Medicare does not cover based on the plan you have.  The Medigap insurer makes no medical determination.  Traditional Medicare leads the way in determining whether a services is covered.  Most of the time, Medicare does not determine if it was a medically necessary service.  They don’t determine if the service could have been handled by a Primary Care Physician rather than a Special, even though they pay the Specialist more.  If they did it would save health care dollars and help to hold down premiums - Part B premiums and your Medigap premiums.

But one of the reasons you like your Medigap is the same reason that many beneficiaries cannot afford a Medigap plan thus they HAVE TO go with a Medicare Advantage plan.

OR they are denied a Medigap plan.  Federal law does not mandate that Medigap insurers have to accept people who are less than 65 years old.  There are plenty of Social Security Disablity beneficiaries that have Medicare after they have been disabled for 24 months.  States can legislate coverage and many have but they sometimes limit which plans a disabled person can get - like Plan A or Plan B.  Then those Medigap premiums are extremely high ( $ 400 or more per month) because of the beneficiaries they are covering - usually very high health care cost beneficiaries.  The good thing is that when they do hit 65 years old, they get a do-over and get to pick and choose like they are in their initial enrollment period and the insurers can’t hold their health condition(s) over them during this do-over selection - because they have guaranteed issue rights at that point (hitting 65 years old).

But in some states, Disabled people less than 65 cannot even get a Medigap plan.

Medicare Advantage plans are for those who cannot afford or don’t want a Medigap plan or have access to Medigap plans.  Medicare Advantage plans are all over the place in type and cost.  Here again, you get what you pay for or what you can afford.  The cheapest is, of course, an HMO with network providers not the type like Kaiser Permanente where they actually have their own providers and facilities.  Then at the other end of the spectrum, there are MA plans that are PPOs and have good networks and the ability to go outside of the network for care for a higher price, of course.

So we have an economic class system in our Medicare program - and we have that same economic class system within the Medicare Advantage program.  In most instance, beneficiaries buy what they can afford.  We also have a discrimination curve in our Medicare program - between the ones that get it because they are age 65 and the ones that aren’t 65 years old yet (the disabled).

Then there are the other rules about changing Medigap plans and it differs state by state.

If you don’t live in a state that has expanded the Medigap guaranteed issue rights then your cannot usually change your Medigap plan without being underwritten.  They can then charge you more if your health warrants it or they can refuse you altogether.  

But if you live in one of the few states that allows changing your Medigap plan without underwriting under specific rules then everybody in the state with a Medigap plan pays a higher premium compared to the other states that don’t allow this leniency.

Now some beneficiaries who elect for a Medigap have selected the High Deductible version of Plan G (or Plan F if they are eligible for it). MUCH Lower premiums but with a (2024) deductible of $2800 and once met the plan pays just like the regular Plan G (or F).  

The good thing about MA plans is that you get to pick and choose and change every year based on your health needs or maybe even for financial needs.  They also offer special needs plans which helps those with chronic conditions and the institution of Medicare supports these.

Many people love their MA plans.  Many of them have had lots of medical cost for some condition and their plan has come thru for them just like they were suppose to do.  

Managed care is what is utilized in many other countries for their universal healthcare.  It is used to control their health care cost.  They also may utilize “gatekeepers” who are personal care physicians that monitor their care and do any referral as necessary.  

Count your blessings that you are most fortunate in your Medicare/Medigap coverage and I hope that the premiums remain within your budget cause they will continue to rise and rise just like Medicare Part B premiums.  

Also know that the institution of Medicare can also discontinue plans as they determine feasible - they did it in 2010 and they did it again in 2020.  Course if the plan one is end is discontinued then those beneficiaries are grandfathered in but premiums would also rise in these discontinued plans because those that are left in the plan are getting older and possibly sicker and there is no young blood coming in to balance out the plan.  

Just thought I would offer a balanced perspective and can because I have neither - I have another type plan.  I just think the whole thing needs a new design and I could even point to other areas where a lot of work is needed.  

Off my Bandwagon now.

[CBtoo]

And when the advantage plan people have to actually USE much health care then they can't afford it because the out of pocket is far more than medigap premiums and the B deductible (if they have G for example). AND when you actually need to use your health insurance you may not pass medical underwriting to switch to a medigap to save money. Then you are really up a creek without a paddle unless you are solidly middle class and/or the system you are using doesn't fire you as a patient and then sue you when you are in collection for failure to pay.

I realize you love advantage plans, who knows maybe you even sell them. Agents get about twice as much to sell an advantage plan than a medigap which is one reason why those numbers are going up,

[GailL1]

@CBtoo wrote

And when the advantage plan people have to actually USE much health care then they can't afford it because the out of pocket is far more than medigap premiums and the B deductible (if they have G for example).

===============================

For a Medicare Advantage plan, you can look around and find one that has a lower maximum out of pocket.  In fact, there are some with a MOOP that is around $ 4000.  Yes, of course it is more expensive.

The ACOA recently did a comparison of the averages - Medigap premiums + any out of pocket averages about $ 7500 a year and a MAPD premiums + out of pocket = $ 9200 but that also includes the $ 2000 MOOP of the Prescription Drug Program. 

Of course it would be more if the beneficiary picks an enhanced plan on the prescription drug program.

[CBtoo]

In what universe does the medigap plus out of pocket average $7500? If people buy the worst supplement maybe, but if they buy G then that is incredibly far from the truth.

For both original medicare and advantage plans you have to pay for B anyway (I am ignoring the extra help program and dual eligible folks, only looking at those of us who pay full price so we compare). In this state even worst case a G supplement is thousands a year less than worst case with a supplement plan..

I have G+ extras from UHC, have had it for 6.5 years under the discounts go away in 10 years version rather than they go away in 15 years version and am paying $224.93/mo. Someone else I know who turned 65 in Nov is paying for G without the extras at $104 and loose change a month. Add to that the B deductible and we are good to go. If one were paying a $7500 out of pocket, divide that by 12 and it is $625/mo

The MAX G+ in this state when you have no discount at all is $293/mo and loose change. That isn't even close to $625/mo. That is a bunch of thousand LESS than $7500.

I have $0 premium Wellcare for my drugs as that is a good fit for me so no expense there for drug premiums. ALL of us now have the $2000 maximum out of pocket for drugs - advantage plans or not. 

Again, if you hit your max you will be paying far more in an advantage plan than with a supplement G, counting the premiums. It is FAR FAR FAR cheaper to have a supplement if you are hitting your max. 

[GailL1]

@CBtoo 

From the universe that considers all cost of a MAPD plan vs a Medigap.

NCOA.org 12/05/2024 What You'll Pay in Out-of-Pocket Medicare Costs in 2025 

When I gave the out of pocket cost for Medigap I was using Plan K.   Plan L would be lower and others even lower - if you have a more lucrative in benefits one - even lower to nothing but the Part B deductible but of course with lower out of pocket cost the premiums got higher.  

It is possible for people to pick a Medigap plan that is not so lucrative in benefits and save a REAL bundle on premiums now and into the future.

The average Medicare Advantage premium is projected to be $17 in 2025, while Medigap premiums may run anywhere from around $65 to $450 or more, depending on the typo of Medigap plan one chooses and their location.while the average monthly premium for Medicare Advantage plans is projected to be around $17 in 2025.  Yes, everybody pays the Part B premium or it is paid FOR them by their state.   Most everybody pay $185 for their Part B, I pay much more than that because of IRMAA so you see, there are many differences in what people pay for their Medicare.

ACOA.org12/02/2022 - What Is the Difference Between Medicare Advantage and Medigap? 

Yes, many beneficiaries that choose a Medigap plan initially may find that cost become too expensive after years of being on their Medigap plan.  This comes at a time when some have spent much of their retirement savings already and thus the escalating premiums of a Medigap may become too much for them.  Then they find that they cannot change plans because they have a preexisting condition and are refused other Medigap coverage because they cannot pass underwriting or the insurer updates them on the condition or disallows it for a specific amount of time. 

KFF.org 10/18/2024 - Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions 

Yes, everybody has to decide for themselves which is best for them - their healthcare and their pocket book.  I, like you, just want them to understand the differences in each of these health coverages and their cost - now and over time and the other things that make a big difference like being able to change plans as needs change.  

[CBtoo]

PS 

Premiums are only PART of the story. The maximum out of pocket and what you pay with each visit can add substantially to cost of an advantage plan that can total well above what someone pays in premiums with a supplement and their out of pocket. If you are healthy then you do save money. But when you are not you may not and you may have something wrong with you that you fail medical underwriting  so can't switch to a supplement.

Also networks matter. While they may not be an issue in a large city they may well be in somewhere smaller or in a rural area. If you can't afford to travel to be in network then your costs are substantially higher if you have to pay out of network. Some advantage plans don't cover out of network. With original medicare if someone accept medicare then they are "in network" and your supplement is required to pay if medicare pays. Also no need for a referral approval to see a specialist with original medicare.

I realize for you the sun rises and sets on advantage plans. You always post about them. Based on how you post about them I suspect you are an agent and agents get paid far more to sell an advantage plan than a supplement. I'd imagine that has a lot to do with the growth of advantage plan sales since 70% of people sign up through an agent. 

[TRL1111]

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@CBtoo wrote:

I realize for you the sun rises and sets on advantage plans. You always post about them. Based on how you post about them I suspect you are an agent 

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Who are you talking to/about?