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.  

[DavidM280677]

Hi Victoria,

I too have had a 41% increase in my premiums -- we're in OH.  Looks like yours is more like 43.58%.  This was across the board coupled with (depending on your age right now) 3% reduction starting at age 68, of the initial discount you received from UHC when you first signed up.

My wife an I are going to check rates again, but I'm afraid that we are going to be "stuck" paying these increases.  Sad to say. UHC may be the best priced again...

[CBtoo]

If people live in a state where you can change your medigap/supplement without medical underwriting the premiums are rising faster than in other states. This is because many use an advantage plan while they are healthy because it is cheaper. Then when they have more things wrong with them they switch to a supplement because the combined premium, medicare B deductible (only those old enough to have F don't pay that if and only if they choose F), and maximum out of pocket (ranging from nothing - F, only the B deductible - G, and it goes up from there for the other supplements) is cheaper than the maximum out of pocket on all advantage plans, You usually don't even have to hit the advantage plan max out of pocket for the supplements to be cheaper. Unfortunately it usually means the people who have supplements are "sicker" and so that drives prices up.

In states where you can't switch unless you pass medical underwriting the supplement group generally isn't "sicker" and so in those states the prices and increases are lower.

[TRL1111]

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@CBtoo wrote:

If people live in a state where you can change your medigap/supplement without medical underwriting the premiums are rising faster than in other states. This is because many use an advantage plan while they are healthy because it is cheaper. Then when they have more things wrong with them they switch to a supplement 

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I think you're talking about birthday rule states, because one of the knocks on the birthday rule is that it will lead to higher premium prices.

But it sounds like you're confused about how it works, because the birthday rule applies only to switching Medigap supplements--you have to already have a Medigap supplement to use the birthday rule to switch to another Medigap supplement without underwriting. It doesn't apply to Advantage members.  

There are a couple of states that have year-round guaranteed issue rights, but only a couple. I suppose you might be talking about those, but that should be made clear because they're definite outliers.

The bottom line is that in all but a couple of states, Advantage members who get sick and would prefer to have Original Medicare and Medigap supplement can't do so unless they can pass underwriting, whether they're in a birthday rule state or not.  

[CBtoo]

Supplements, not advantage plans, were what was being discussed and how the rates are going up. And no, I am not confused.

I am taking about more than birthday rule states (and the rules in those states aren't identical as states determine the rules for that) as there are an assortment of rules out there that vary between states that allow people to change their supplement once a year, and in some states switch from an advantage plan to a supplement without underwriting, the birthday rule is only one of them. 

In fact a new state law was passed in MN where people can change to a supplement or between supplements when they are between the ages of 65-70. After that they need to pass medical underwriting.

The rates are generally higher in states that allow people to change into supplements as the percentage of sick people migrate to supplements (from advantage plans) when their medical expenses start to rise when they are using more medical services (the out of pocket in advantage plans in my state range from $4800-14,200 and supps premium plus out of pocket is way lower).

Medical underwriting was instituted to prevent people using advantage plans when they hardly used medical services as then they would save a lot of money, and they'd switch to supps as those would be cheaper when they were much sicker. Medical underwriting prevents that if it is required, 

If there was no underwriting the percentage of "expensive" people in supplements would be higher, thus costs would go up to the insurance companies thus premiums would rise. Right now premiums are higher in states that allow people to switch to supplements (outside of their original sign up or the special, limited rules fro your first advantage plan sign up) because of that.

[TRL1111]

You're the one who brought up switching from Advantage to a Medigap supplement without underwriting, without noting that that's possible only in a couple of states. The vast majority of people can't switch from Advantage to a Medigap supplement without underwriting.

Furthermore, as far as I know the states that allow switching from an Advantage plan to a supplement without underwriting have community pricing on their supplements, so you can't really attribute higher premiums to the ability to switch because there's another variable.

[CBtoo]

Becker's (a credible source of information) mentioned this today so two more states although these are medigap to medigap. 

And there is solid research that, in fact, the rates do go up in Birthday and similar rates regardless of the reason,

"West Virginia and New Mexico are both launching Medigap “birthday rules” within the next year.

Federal law does not include ongoing protections for beneficiaries who want to switch Medicare supplement coverage beyond the established one-time, six-month window. However, these state laws permit a 60-day (or possibly longer, in New Mexico) Medigap open enrollment period that falls around the beneficiary’s birthday each year. Beneficiaries would not be subject to medical underwriting based on health status if they switched plans during this time.

“By expanding guaranteed issue opportunities, SB 21 would help level the playing field, promote more balanced risk pools, and support a more stable and competitive Medicare supplement market with increased coverage options for beneficiaries,” a February 2026 document from New Mexico Aging Services said. The law is expected to support over 70,000 people across the state.

In West Virginia, the guaranteed issue right applies only to those who have continuously held their Medicare supplement policy for at least 24 months, as of the replacement’s effective date. West Virginia beneficiaries can only switch to a plan from the same or an affiliated insurer, unless comparable coverage is unavailable. Beneficiaries also gain a guaranteed issue right after losing Medicaid eligibility. West Virginia’s state insurance commissioner will report on premium trends annually, as well.

West Virginia and New Mexico’s laws will go into effect June 11, 2026, and Jan. 1, 2027, respectively. "

Source:https://www.beckerspayer.com/policy-updates/west-virginia-new-mexico-to-roll-out-medigap-birthday-ru...

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And here is one article that documents prices do go up (although it is not the peer reviewed piece of reach I was talking about).

"What Is the Medicare Supplement (Medigap) Birthday Rule—and Why It May Hurt More Than Help?

The Medicare Supplement Birthday Rule, or Medigap Birthday Rule, is a state-level policy that allows Medicare beneficiaries to change their Medigap plan annually around their birthday without medical underwriting. While intended to help those with pre-existing conditions access new coverage, the rule often leads to unintended negative consequences, including increased premiums and reduced plan availability. These rules, now active in several states like California, Oregon, and Idaho, may seem consumer-friendly on the surface but are ultimately a regulatory misstep that disrupts pricing stability.

According to MedigapSeminars.org, the Birthday Rule backfires by forcing insurers to accept applicants without assessing health risk, which drives up costs for all enrollees. As premiums rise, some consumers are priced out of Medigap entirely and pushed into less suitable Medicare Advantage plans. Additionally, insurers are exiting states with birthday rules, and brokers are increasingly uncompensated—limiting consumer access to guidance. The article warns that well-meaning state legislation is inadvertently harming the very people it aims to protect and proposes a more targeted solution that better balances access with sustainability."

https://medigapseminars.org/medicare-supplement-birthday-rule/

[CBtoo]

These states, last I knew, allowed switching from an advantage plan to a supplement with no medical underwriting: CT, MA, NY, VT

And most community rated risk plans give younger people discounts. When they are much older they will pay less than age attained or age signed up

There is research that documents that premiums are higher when medical underwriting is not required to switch (not talking about at initial sign up nor the initial advantage sign up and then switch in the "special" time frame. The reason given is that people with more expensive health needs switch in no underwriting circumstances when it becomes cheaper to have a supplement OR when their special medical needs requires them to get care outside of their advantage plan network (for example MD Anderson Cancer Center).

[TRL1111]

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@CBtoo wrote:

These states, last I knew, allowed switching from an advantage plan to a supplement with no medical underwriting: CT, MA, NY, VT

And most community rated risk plans give younger people discounts.

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AARP/UHC is the only one I know of that does the discount thing.  The four states you mentioned have community pricing, and the premium is the same for a given plan regardless of whether the person is 65 or 95.  You can see for yourself by using the plan finder at Medicare.gov and entering various ages--the premium is always the same.

Also, Vermont does allow medical underwriting for Medigap supplements.  Last year a bunch of Advantage plans were discontinued, and people who had those plans had guaranteed-issue rights for a supplement, but that's the same as in every state.  If someone in Vermont is on an Advantage plan that is still being offered, they can't get a supplement without medical underwriting.

[MitchellB914806]

This is very close to the 40% premium increase they just notified me of.  The fact is that they increase premiums based on your age despite misleading claims on the Medicare.gov site.

[GailL1]

@VictoriaW166426 

Read your plan - it should describe any enrollment declining discount that you are getting and that is what they seem to be saying to you.’

When you 1st signed up for the UHC Medigap plan, they gave you what they call a declining enrollment discount.  It whole enrollment discount stays in effect for a few years, then the discount starts declining, so your premiums rise because of this as well as the normal increases for the overall plan. This is in addition to any premium increase due to risk loss, usage or medical inflation.  

Medigap insurance is really not health insurance.  The make NO health care decisions - their concept is simple, IF Mediare pays, they pay what you would have had to pay based on the lettered plan that you chose.  I believe you said plan G.  

Pure and simple, Medigap plans are financial protection insurance used with Original Medicare because OG Medicare has NO limit to it’s out of pocket cost.  A Medigap policy will protect you from any financially catastrophic medical event under OG Medicare. 

Medigap plan premiums rise with medical inflation, but moreso, they rise with usage and also from the risk loss that they have within a state who have loosened their laws of guaranteed issue rights without underwriting.  I do not know if you live in one of these states but if you do, that is also a factor of premium increases.  This means that a state will allow Medicare beneficiaries who have health conditions, sometimes extreme health conditions, to switch Medigap plans without underwriting.  So for this reason, premiums in these states are usually higher than in states that do not allow switching plans without underwriting.

Of course, you aren’t forced to have a Medigap plan and there are many insurers in most areas of the country and all the lettered plans have the exact same benefits since benefit design is governed by federal law.  If you can pass underwriting OR if you live in a state that allows some type of switching plans - insurers or plans - then you can pick a plan that is less in premiums - but premiums will rise there too - better or worse.

Baby boomers continue to retire - about 10,000 a day until about 2030 - they will most all be on Medicare and many will pick OG Medicare and a Medigap - probably plan G and they will begin to use it - some have stored up their health care until they get on Medicare and some will experience increase in use as they age - so cost will continue to rise with USAGE.  

[Skyhookt]

A 40% increase in premium for a type G supplement plan upon completing the first year of enrollment cannot be explained by the 3% per annum decline in the age-based discount. It can only be explained by a first-year-only 'new business' teaser rate expiring. Is anyone here aware of such a 'new business' discount? If it exists, where can I find it documented in any material provided before signing up?

[CBtoo]

From what you are saying it sounds like they haven't subtracted the discounted amount from that yet. As a result you should be paying less (presuming I am correct). 

If you use someone who accepts medicare and agrees to accept Medicare's reimbursement rate (as most providers do) then that shouldn't be an issue (eg the added amount).

[ElzbietaK386890]

 We live in Chicago and started on UHC Medigap plan G in 2023. The premiums, before discount, rose consistently: 2024-5%, 2025-13.50%, 2026-16.26% and 2027-35.01%.

This last increase is outrageous !

How the AARP, can in good faith recommend this plan to its members? UHC plans are Community types, so the increase should apply to all members equally. I thought that this will stop large increases, because so many people will be affected that AARP would advocate for us.    

 Do we have any better options?

[jo85336578]

I too am alarmed at the huge increase in my 2027 announced monthly preminums for AARP UHC Plan G. over 35% increase in North Carolina.I wonder how much AARP / UHC Plan N premiums will rise. I called the N.C. Commissioner of Insurance and asked if it was unusual for a monthly Medigap premium to rise by 35% in one year and their answer was "No." I was shocked. 

Have any of you found a website that shows 2027 Medigap premiums? Medicare.gov does a good job of showing current rates but not recently announced other insurance companies' 2027 Medigap premiums.

[CandaceS254392]

I am in Ohio,  and mine is community based not age attained, (plan G). My husband and I have a 41% increase starting in June of this year.  Ridiculous.  AARP should move on from United health care.  I will be looking around as well. 

[MitchellB914806]

My experience is the same and I plan to switch to a new provider suring the birthday open enrollment period.  I agree that AARP should dissociate themselves from UHC but frankly AARP seems to be primarily interested in making money from whoever will pay for their endorsement.  In the future I will treat an endorsement  by AARP as a reason to look more carefully for the hidden scam.

[GailL1]

You have a birthday rule in your state so you can switch to another insurer which has lower premiums.  Remember that AARP/UHC is community rated - but others in your state may not be - depends on your state.  A policy that is rated as attained age will also rise with age in addition to usage in the plan and medical inflation. 

But you can switch again next year, right.  I think IL stops the switching at a certain age - like 75.  But if you don’t have this restriction, you can switch every year - on and on - and who knows someday, you might end up with your original plan again.

[GailL1]

@ElzbietaK386890 

Here is your Illinois State book on Medicare for 2026 - many of the laws surrounding Medigap coverage is based on state law - not federal.

ILLINOIS.Dept of Aging.gov - 2026 MEDICARE MEDICARE CHOICES  

You should review all of it but specifically pages 10 forward where they are talking about Medigap plans and specifically the birthday rules that apply in Illinois on page 11.

Now are you gonna find the increases any better at any other company that sells the same plan in Illinois?  They may be somewhat cheaper - but what about their increases?  

Medigap plans are not health insurance, it is financial protection insurance for those on Original Medicare because there is NO limit to the beneficiary’s out of pocket cost on Original Medicare.  

Look at the rates compared to the different companies offering the same plan in your area.  Look at the rates and do the math of other plans that are in your area - some of the new favorites because of financial concerns are Plan N and Plan HD-G if offered in your area.

So look around to see if you can switch to another plan - all the federally regulated benefits within a specific plan are all the same - only the premiums differ.    Most all have the same claims process and use the cross-over method of claims just like AARP/UHC Medigap plans.

[MargaretS512549]

What i would like to know is why can't i simply change from AARP Plan G to AARP Plan N without underwriting. I am staying with the same insurer.

[GailL1]

@MargaretS512549 

Because where ever you go, you are carrying your “risk” with you and then you would be saddling the folks already in Plan N with higher usage and thus higher premiums all the way around.

Think about it - what if everybody did this - went from Plan G to Plan N just to save on premiums but without underwriting - 

Then next year when the premiums rise for the Plan N, they will all want to move to another plan with cheaper premiums. 

The reason there is underwriting is so that folks who are bringing some risk to the new plan can be assessed a premium surcharge to even out the risk they are bringing to the new plan.

Now if you live in a state that has expanded guaranteed issue rules so that people can switch plans or insurers depending on the way they have worded their law, then just by having the law in place they are paying higher premiums because of the risk that is built into each of the plans - this is for all insurers in the state.  

Some states have added that those who are less than 65 on Medicare can also do the same and this even produces higher premiums, again depending on the law, because these folks are the disabled and most likely higher medical care users.

Federal law made NO Medigap accommodations for those less that 65 - state law has to give it or not.  So we have an assortment of laws concerning the availability of Medigap plans to the disabled - some states have no provisions at all and thus these folks have to get a Medicare Advantage plan.  Other states restrict their choices to some of the less benefit plans like Plan A or Plan B, now we have many states moving to give them pretty much full access to Medigap plans - but some states are adding an assessment for this - Many states have higher premiums for those less than 65 to even out this inclusion,

Cast in point - Texas has passed a new law giving those with ALS or ESRD the options of getting Plan A or Plan B without any added premiums - but if these same less than 65 year old beneficiaries want a Plan G or Plan N - the insurers can charge them up to 200% MORE just because of the risk they are bringing to one of these Plans.

[MargaretS512549]

Also, logically speaking, if i am just switching, with same provider, from Plan G to Plan N, the carrier would have less risk because I would have copays and Part B overcharges that I would be responsible for.

[CBtoo]

Except the risk in each supplement depends on the make up of the supplement with respect to their heath risks and usage, Genearlly people who have fewer health problems problems chose something with lower premiums gambling they won't need to use health care much and, presuming they are in a state where you have to pass medical underwriting, they'd switch when premiums plus dedeuctable/copays are cheaper when they were using health are more. That would generally make that supplement have higher health care costs as those people, on average, would use the health care more as they were, on average, sicker.  

[GailL1]

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@CBtoo wrote:

Except the risk in each supplement depends on the make up of the supplement with respect to their heath risks and usage,

ME:  the luck of the draw when joining a plan - the more people in the plan, the better or worse the premiums depending on the health makeup of the plan.  But if it is a popular plan at the moment, like plan G when Plan F left the Medicap open market, then one can be relatively sure that a lot of new beneficiaries are joining the Plan G.  That’s not for sure but usually people entering at age 65 are relatively healthier than other older one and also since in  most (many)  state, Plan G is off limits to those less than 65. 

@CBtoo wrote:  . . . Genearlly people who have fewer health problems problems chose something with lower premiums gambling they won't need to use health care much

ME:  Not necessarily, especially this (AARP) group with their AARP/UHC choices.  They pick the plan that covers the MOST - It was at one time Plan J, 100% 1st dollar coverage + more benefits like some pharmacy benefits and home care, then when that bit the dust, Plan F with its 100% 1st dollar coverage and no out of pocket cost, then that bit the dust and now it is Plan G - perhaps in the future to be covered by Plan N.  

Few beneficiaries, up to now have considered taking a HD-G or a Plan K or Plan L.  If Medigap is for only financial protection insurance in case there is a financially catastrophic medical event - any of these will limit their out of pocket cost in Original Medicare.

But that is not what many beneficiaries seem to want - they want that 1st dollar, as much coverage as possible - so for that Want and Desire, one will pay a much higher premiums because their risk is relatively low and the insurers relatively high.

@CBtoo wrote . . . . and, presuming they are in a state where you have to pass medical underwriting, they'd switch when premiums plus dedeuctable/copays are cheaper when they were using health are more. That would generally make that supplement have higher health care costs as those people, on average, would use the health care more as they were, on average, sicker.  

ME:   Of course, it’s the “cake and eat it too” philosophy.  State politicians see this as helping the less fortunate on Original Medicare and either they and/or their constituents are dumb or they don’t realize how this risk thing works in the world of insurance.  So they pass these lenient guaranteed issue laws and all they are doing is making the switching of plans like a game of musical chairs and every year you switch plans or carriers.  Makes for a robust [Medigap] insurance marketplace.  If a beneficiary is only changing plans and not insurer, agents get no added benefits.  

This switching insurers also makes the MLR harder to calculate and thus some smaller carriers have a hard time keeping up.  Many of them have had to really increase their premiums because they are getting stuck with a lot of these higher risk switchers with no underwriting and their medical cost have soared.  There are reports of up to 50% increases from these smaller insurers who are trying to catch up to their pool of their Medigap beneficiaries.

Of course, people see this as good and nice to give the disabled more Medigap more choices or beneficiaries with high premiums a right to switch; politicians get a bump too - what isn’t good and nice about it - but then they complain about their premiums escalating.  If you want your cake and eat it too, somebody has to pay for the cake.  

Something ‘s gotta give - lots of plans out there to stop this race to the bottom - but there are problems with each of these for this person or another - this isn’t a place where “tax the rich” is gonna work cause beneficiaries are doing this to themselves. 

Yep, something ‘s gotta give

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[CBtoo]

My answers are based on research that people in health care administration have done. They have looked at the issues being discussed on this thread and done scientifically valid research. What you believe may or may not match that. In this case it does not.

Just as an FYI:  Within AARP/UHC plans more people are on advantage plans,  than who have supplements so arguing that more people have the AARP branded UHC plans choose the most coverage is false.  Advantage plans, with thier limited networks, ability to have referrals and care denied (there are no referrals for original Medicare and no approvals are needed if Medicare covers it, unlike advantage plans). In addition 68.76% of the plans sold by AARP/UHC are advantage plans. They had 9.9 million customers  with advantage plans and 4.5 million customers with supplements (2025 data). FAR MORE AARP/UHC customers bought advantage plans. This undermines you arguments above. 
 

[GailL1]

@CBtoo 

Where are your links to this research?  I would like to read them.  I have many of mine own also.  Like from the Urban Institute and the RJWF who say that putting a $ 5000 annual out of pocket on Original Medicare could end the need for a Medigap plan.  

Actually we already have a great example of how well it could work and that is how the new and improve Medicare Part D is working with its (2026) annual max out of pocke tof $ 2100.  Can’t afford to pay it all at one time - that’s fine, it can be financed for the current year.  Then start again for the next year.  Perhaps making some additional plans as to trying to pay more of it up front - but one is saving the cost of monthly Medigap premiums.  

Urban Institute.org - June 2022 - Adding an Out-of-Pocket Spending Limit to Traditional Medicare 

But guess where that all falls down in public opinion - it is when people forget about the money they are saving not paying that monthly Medigap plan.  Then they will just start gripping about having to pay money out of pocket for their Original Medicare.  

Wouldn’t that be great - no more paying for a Medigap plan with high premiums; no more trying to switch plans to save money - just take the money you are now spending on a Medigap plan and pay it to your health care providers until you reach the annual maximum out of pocket and then Medicare picks up the rest of the tab for the remainder part of the year.  WIN- WIN.

Guess what, I bet beneficiaries would then cut out the small stuff and concentrate on the major health concerns and preventive care.  Maybe they would even eat healthier if the dime is then coming directly out their pocket.  There is just something about that direct payment for some of our own health care expenses that make one a bit more conscious of where those dollars are spent. 

What I meant by what people pick more was that people that chose a Medigap plan especially of the AARP/UHC type was they choose the one that has the MOST benefits - that is why Plan G is currently the most popular plan purchased.  Beneficiaries just love that 1st dollar coverage - well now as close as they can get.  

I am pretty sure that we are going to see a down fall in the numbers of people selecting the MAPD plans because many did shut down this year because they could not meet the new rules on network adequacy and higher risk assessment.  Or the tighter control over the prior approvals.  Also the new rules on those special OTC benefits - now only applicable to those who are dual eligible in a Special Needs Plan.  Those ole money making schemes are over now that there is a new sheriff in town that is looking at the problems and doing something about them.  

It may turn out that the numbers are gonna get closer to 50/50 or perhaps a bit leaning towards Original Medicare.  So now we have to turn our attention to the problems on that side of the ledger, meaning Medigap plans and the increases in premium cost.  There I see many more people going the High Deductible Plan G route.  

I have been also researching how health plans in other industrialized nations work - most have “gatekeepers” - that too is something we need to pursue in Original Medicare - get a referral from your PCP to a specialist or pay a higher rate as your part of the cost.  Many other countries use this method of cost containment in their universal coverage.  We should try it. 

When care is denied whether under Original Medicare or MAPD plans, the beneficiary or their designate always has the ability to appeal - then it gets down to win some / lose some.  MAPD plans use the same criteria for service approval or denial that Traditional Medicare uses - the Medicare Local Coverage Determination guide and it is kept up to date.  

[MargaretS512549]

Why is Medicare Advantage subsidized but not Medigap?

[GailL1]

That’s not risk - that’s just a difference in the plans - Plan N only has (3) basic differences 

• the office visit copay of $ 20
• the ER visit (if not admitted) copay of $ 50
• and the no coverage of excess charges - of which there are not many and you can control that by visiting providers that accept Medicare assignment.

Look at the difference in Plan G and the High Deductible Plan G - the High Deductible Plan G deductible.  $ 2950 in 2026.  

Go see a SHIP agent in your state or a local Medicare Insurance brokers - maybe they can help you with any options you may have.  

OR work to change the system - but be careful that you don’t increase the cost of premiums any more than they already are - like how various states have “helped” their beneficiaries with added guaranteed issue rights - which have increased their premiums drastically.  

[GailL1]

OH @MargaretS512549 - really?

Since 2006, Medicare Advantage plans are A PART of Medicare - they are as much a part of Medicare as the Original Program - beneficiaries make the choice as to which way they want to get their benefits - Medicare Advantage plan (which usually includes the Prescription drug program) OR Original Medicare.  

CMS regulates ALL Medicare Advantage plans - They are managed care plans and use various cost saving measures approved by CMS to help keep medical cost in check.  Whereas in Original Medicare, they use only paying part of the cost with the beneficiary picking up some of the cost as a way to hold down medical cost.  It is the beneficiary’s CHOICE if they want to pay for some other way to cover their part of the cost of Original Medicare.

Remember CMS in past years has stopped some plans from being sold to hold down medical cost (1st dollar covereage).  Plan F and C were suspended from sales in 2020 and Plan E, H, I and J were suspended from sales in 2010.  They could do this with Plan G too come about 2030 - what happens then, as what has happened in those who held onto these old obsolete plans, is the pool of members keep getting older and older and using more and more medical care and without any new [younger and healthier] blood coming into the plan, premiums for these old plans keep getting higher and higher and higher.  I knew one such beneficiary who was very old who had an $ 800 a month premium for her Part F.  My mother who died in 2012 had a Plan J and at the time of her death (89)  her premiums were already approaching $ 400 a month and that plan had only been closed for new sales for 2-years.

A surefire way of holding down premium cost in a Medigap plan is for the beneficiary to pick up more of the risk (or their cost).  That’s why the High Ded Plan G is so much less expensive in premium cost than the regular Plan G because the beneficiary is picking up that High Ded Plan G deductible ($2950 in 2026).  It is rapidly becoming the Medigap plan of choice for many new beneficiaries - Plan N is rising in premiums pretty rapidly because that is where beneficiaries are going when they switch from a Plan G in a state where they can.  This is only gonna be a momentary reprieve cause Plan N premiums will rise from the risk those switching (without underwriting) are bringing with them.

Medigap plans are an option to use with Original Medicare - a personal choice - not required.  

Medicare Advantage plans were devised in part just because some people could not afford a Medigap plan to go with Original Medicare and had no other way to cover their part of the cost - 

Many other type plans can cover Original Medicare’s part of the cost IF YOU QUALIFY for one of them - like Medicaid, some types of employer coverage, CHAMPVA, TRIcare for Life, etc. or some folks just pay out of pocket (risky for some).

Federal law ONLY establish the various plans and what has to be covered within them - and certain guaranteed rights like when you lose access to a Medicare Advantage plan and a few others - past that, states take on the responsibility of overseeing Medigap plans. 

Like I said before, even though people on SSDI (those less than 65 years old) can get Medicare after being declared disabled for 29 months, they are severely restricted in getting a Medigap plan depending on what state they live within.  They do get another initial enrollment period when they hit the age qualification of age 65 - a do-over so to speak.

A Medigap plan like I have explained before is NOT health insurance - it is GAP insurance - a financial protection insurance product OF CHOICE that protects the beneficiary with Original Medicare from a financially catastrophic medical event since Original Medicare has NO cap on out of pocket cost as a Medicare Advantage plan does.  

A beneficiary over the age of 65 can CHOOSE any Medigap plan that is available where they live and from any insurer that is licensed in their state to sell such.  

Maybe you need to work with a SHIP agent in your state or a local Medicare insurance broker to give you any options you may have in your state - if any.

This is just a byproduct of high medical cost and 70 MILLION beneficiaries being on the Medicare program - the Original and Medicare Advantage plans.  

There are ways that Original Medicare could control cost more just as other countries control their universal care cost but for some reason beneficiaries seem reluctant to accept any changes.  So higher premiums is where this is all headed.  

[MargaretS512549]

All the background you shared is accurate, but it doesn’t answer the question. MA plans receive federal subsidies through capitated payments and risk adjustment. Medigap plans do not. That’s the structural difference I was asking about, and it’s why Medigap premiums behave the way they do.

[GailL1]

@MargaretS512549 

Same answer - MA and MAPD plans are PART of Medicare they are financed just like Original Medicare base on their enrollment.

A beneficiary choses how they want to get their benefit - Original Medicare or a MA / MAPD plan.

That’s what make up the program of Medicare.

Medigap plans are outside of this realm - they are NOT part of the program of Medicare - they are extra - they are a choice to have or NOT have.

Medigap plans add nothing or give nothing to the program of Medicare.

MA and MAPD plans have out of pocket cost which those who receive this coverage have to pay and so does Original Medicare.  

Medigap plans are just a way to pay for these out of pocket cost in Original Medicare - whereas in MA or MAPD plans the beneficiary has to pay it out of pocket and gets a lower premiums because of this choice of plans.  

Course some people do pick up an indemnity plan to help cover their cost in either but that is also an extra expense on the beneficiary no matter how they get their benefits.

I don’t know how else to say it - Medigap is NOT part of the program of Medicare except that federal law does describe each of the plans as to what benefits are covered and how - the plan design.