Recent premium increase for United Healthcare coverages

---

@ElzbietaK386890 wrote:

 Do we have any better options?

---

If you can pass underwriting, switch supplements today.

If you can't pass underwriting and are 65-75 years old, Illinois has a birthday rule that allows you to switch to another plan from the same company, as long as the new plan has equal or lesser benefits than your current plan.  That might allow you to switch from Plan G to Plan N and save a little money.  AARP/UHC doesn't offer a high-deductible Plan G.

And one thing to consider is that if you pass underwriting and get a Plan G with another company, see if that company also offers a high-deductible Plan G.  You might not want it now, but if the premiums become intolerable in the future, you at least would have to option to use the birthday rule to switch to the high-deductible Plan G from that company.  Of course if you need to use the birthday rule because you can't pass underwriting, then it's possible your claims are high enough that the high-deductible plan will cost you more than the Plan G premiums, but it's something to keep in mind.

Or maybe you DO want the high-deductible Plan G now.  The premiums are a LOT lower, because you pay a bigger portion of your medical bills.  But you won't be able to later use the birthday rule to go from a high-deductible Plan G to either regular Plan G or Plan N because they offer more benefits than the high-deductible Plan G.

I would suggest that you talk to a SHIP counselor about what moves you can make.

---

@ElzbietaK386890 wrote:

UHC plans are Community types, so the increase should apply to all members equally. 

---

I'm not really following what you're saying.  I've always thought the community pricing on these plans is bogus and intentionally confusing.  As far as I know, the underlying premium going up by some amount does apply to all members equally.  People get discounts off that underlying premium of varying amounts, based on their age, in accordance with the plan documents.

And finally, most supplement premiums are going up.  Some by a lot.  It just depends on the claims history--if they pay out more in claims, they're entitled to charge higher premiums to cover those claims.  

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).

@BruceW844572 

If you are talking about UHC - you do understand that the CEO is over ALL parts of their business 

Employer Coverage, Individual coverage (if they do that IDK), Medicare Advantage coverage, Medigap coverage and more . . . . 

Increases in Medicare plans over the last several years has also been due to legislative changes in the Rx program by the Inflation Reduction Act.

Medigap premium increases are approved at the state level - they are figured on plan usage, medical inflation and risk assessment.  

Many health policies have a specific % (75 % - 85%) that have to be paid out in claims and how much has to be set aside as a reserve in case there is some huge influx of claims and what remains pays for Administration and any profit.  

It is all determined by actuarial data and thus they don’t just pull numbers out of the air.  

Also the more RISK you are willing to take for your own care, the lower your premiums will be for this higher risk policy. 

Like compare a Medigap Plan G and a High Deductible Plan G - one is several hundreds of dollars a month, the other is less than $ 100 in some states less than $ 50

If you are talking about advantage plans that will be different than if you have a supplement (eg medigap).

By law supplements pay if medicare pays. So the only time you'd have a problem is if medicare refused to pay. 

Advantage plans have their own rules. They have to cover everything that medicare A and B covers however each company deals with pre-approvals by their own set of rules. That effects denials.

@zooeyhall 

Seems like you have covered it all and am very glad that you have the plan that you want and it is within your price point (for now).

The only thing you didn’t cover was why MA plans exist in the 1st place - Because some beneficiaries cannot afford or do not want a Medigap plan and having Original Medicare without some type of supplemental coverage could create a financially catastrophic condition since OG Medicare does not have a maximum out of pocket cost - not annually and not lifetime.  

For many, having a MA plan is not that much different than the plans they have had under their employers with group coverage - network, copays, deductibles, prior authorizations for medical procedures or drugs, step therapy, quantity limits, - all were used in some way under different plans during their working years.

Then there are the Special Needs Plans that are also MA plans - for the disabled, for those who have many chronic conditions, they give extra benefits to help out these beneficiaries who may lack access to things that can and do help their healthiness - giving benefits like transportation to and from appointments, a card to get OTC needed items, even an allotment to help pay their energy bill and getting access to healthy foods.

Yes, not all states make it easy to switch a Medigap plan to one that is less expensive - but when that is available, premiums rise because it add to the risk of the insurer since it bypasses the underwriting.   So do as you might and switch plans to something more reasonably priced, just having the availability of doing it is making the rates go higher.  

Medicare Advantage plans have a place in Medicare, a purpose.  Just like Medigap plans have a purpose.  

However all MA plans are not the same - an HMO is much more restricted than a PPO plan.  Problem is, people don’t chose with scrutiny - sometimes they just look for “cheap” or extra benefits and forget about the actual purpose of the plans - healthcare.  

CMS now seems to be doing a good job in tightening the rules on MA plans - making it easier to get prior authorizations for medical procedures and drugs.  Setting rules on the risk adjustment criteria that MA plans get if their beneficiary is sicker than most - now they have to have the added conditions in their medical file - and audits are done to validate this.

Beneficiaries should pick what is the best plan for themselves - their health and their pocketbook - MA plans give this option.  

@Wagz2023 

What state do you live in because it is your state that governs the rules of when a person can switch plans or insurers or how those under 65 (SSDI) are covered.

It is also YOUR state that approves of the rate increase that Medigap insurers compute that they need based on their Medical Loss Ratio.

@jo85336578 

1st are you on Medicare because of your age (over 65) or a disability (under 65)?  That makes a difference in what you can and cannot do in some states.

Next:  what state are you within ?  That is the place to start to find out what the rules for switching plans are in your home state.  Are you going to have to go thru underwriting or is there a “birthday rule” or in a few states continuous enrollment.

You can talk to a SHIP agent in your state - (State Health Insurance Programs Assistance)  Here is the locator for your state.

SHIPHelp,org  

OR you can talk to a long time, respected, independent Medicare Insurance broker in your area and sit down with them and let them do the info gathering for you - it cost you nothing.  They only get paid if you select a plan with their representation.  Ask friend and relatives who they might use.  OR as the agent that you buy your other insurance products from like homeowners or auto - they too may have a recommendation of a local, independent Medicare Plan in your area,  

It is sometimes difficult to to compare rating history of a particular insurer unless your state legislates that they all do it the same way - either community rated, issue age related or attained age related.  You would need to know this for any new insurer that you are considering - I believe ALL AARP/UHC Medicare Supplemental plans are community rated and are considered a group plan but maybe more than one specific group depending on which subsidiary might have done the underwriting of your policy.

I have always found that this publication from Medicare is a good overall description of Medigap plans even though at the national level the only thing they do is establish the individual plan descriptions on which plans stay open and which ones they are restricting from any further sales like in 2020 when they stopped the sale of Plan F and Plan C to stop first dollar coverage.  In 2010, they stopped any more sales of Plan H, I, J and I think E for the reason that they no longer were applicable with the changes to Medicare in early 2000’s with the advent of Medicare Part D. 

It is just a general knowledge publication but it helps to understand the actual coverage of a Medigap plan.  A Medigap plan is NOT part of the program of Medicare.  It is private insurance that is purchased in combination with Original Medicare - it is medical financial protection insurance to help a beneficiary out if they are struck with some cost catastrophic medical event since OG Medicare does not have a limit on out of pocket cost.  

Whoops forgot the link - here it is:

Medicare.gov - Medicare Supplemental Insurance 

 I will be happy to look up any state info for you on Medigap laws - if you need any help - it is usually found on your state’s dept of insurance website or related government agency site - like some times it is the dept of finance. Just let me know here if I can assist you in at least getting you started with your options.

---

@rr1026788 wrote:

My plan increased 23% and I do not think this is justified. 

---

Premiums are based on the amount of claims that the plan has to cover.  How much did claims go up for your plan last year?

Be sure when you do this is look at what the premiums will be when you are old across any of the companies you are looking at and the one you are moving from. If they are far steeper the older you get in one or more companies avoid them since you can't predict what will happen with passing medical underwriting in the future.

Also some people fail it due to mistakes in their medical records. Before you apply look very carefully with respect to what is recorded in there. Then if there are errors you need the doctor to fix them, then it needs resubmitted to medicare (and earlier insurances if you have had medicare for less than 5 years as most things have a 2-3-5 year look back) to fix "mistakes". Only after that has gone through apply. If you can get your hands on the actual questions that should reduce the number of errors you need to fix if mistakes in there aren't included in what they check for.

Of course having an accurate medical record is a good thing anyway, but it is easier to correct just your medical record than having to correct insurance as the databases they look in record diagnoses and they use that, not what you say. If you fail and want to argue you will need to provide them (and that is not free and can't be mailed by you or be from what you can see in your medical records online) full medical records for however many years the look back is for the condition or medication. That will cost big bucks and you will have to pay for it.

I have the same problem. They are lying that it is "FREE extras". Nope when the one without all the "extras" costs significantly less these extras aren't even remotely close to free. 

You can switch though if you pass medical underwriting (if you don't live in one of the states where you can switch without doing that once a  year).

The told me a different subsidiary runs the no "extras" version thus you have to pass medical underwriting to switch into it because it is a different company. It's part of the same **** (fill in your favorite swear words) company so corporate doesn't have to have those rules. They are choosing to do so because well over half of the people with those "extras" never use them so that is a big money maker for them.