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.  

[MargaretS512549]

I hear you on the structural differences. My question is only about why MA receives federal payments while Medigap does not.

The fact that Medigap is ‘not part of Medicare’ explains the legal category, but it doesn’t answer the policy question about subsidizing one private product and not the other.

[GailL1]

@MargaretS512549 

MA or MAPD are NOT private products even though they are administrated by private insurers - MA or MAPD plans are part of the PROGRAM of MEDICARE - they are built into the Social Security Law.

SSA.gov - Medicare Program Description and Legislative History 

from the link - lots more at the link if you want to read it.

A third part of Medicare, sometimes known as Part C, is the Medicare Advantage program, which was established as the Medicare+Choice program by the Balanced Budget Act of 1997 (Public Law 105-33) and subsequently renamed and modified by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173). The Medicare Advantage program expands beneficiaries' options for participation in private-sector health care plans.

[MargaretS512549]

Whether MA is administered within the Medicare statute isn’t the point — the financing difference remains: MA plans receive federal payments to private insurers, while Medigap plans do not. If the purpose was to hold down costs, and MA receives more per participant than OM, it doesn't sound very cost effective to me.

[CBtoo]

The belief was that if more was spent on wellness (to prevent illnesses or other health issues, to catch things earlier where they are easier and cheaper to treat) - what that extra money was supposed to make it possible to do, then the saving would come because then far less would be spent on medical care for illnesses, etc. because with wellness spending things would be caught earlier and thus be cheaper to treat. The savings would come that way.

Except that is not how it worked out in the end. Medicare advantage plans ended up being more expensive to the government. And to the patient if they needed a lot of medical care (due to the much higher max out of pocket)

[GailL1]

@MargaretS512549 

MA or Medicare Advantage plans are NOT private plans they are MEDICARE PART C - they are only administered thru private insurers.

A MEDIGAP plan is a PRIVATE product sold to only supplement Original Medicare -

A Medigap plan has NOTHING to do with providing health services, or providers or whether something is even covered.  

A Medigap plan has nothing to do with holding down cost - they just pay their part of the cost that the beneficiary has chosen in their Medigap plan.

ALL a Medigap does is supplement - the Medigap insurer makes NO decision on anything to do with Medicare - it only pays what Medicare does not based on the plan chosen.   THIS is their purpose - has nothing to do with holding down Medicare cost - that is what a MA or MAPD plans does under the rules make by CMS because they are governed by the Social Security Medicare law - Medicare Part C as established by President Bill Clinton.   

@MargaretS512549 - I cannot help you further if you do not understand what the purpose of a Medigap plan is and how it is NOT part of Medicare at all but a way for your out of pocket cost to be covered by some private plan.

[MargaretS512549]

On average, Medicare Advantage costs the federal government about 20–22% more per beneficiary — roughly $2.5k extra per person per year — compared with Original Medicare.  Either end the MA subsidies or give us the same subsidy to cover our costs. Seems only fair.

[GailL1]

@MargaretS512549 

and from what year is this research?  Got a link?  There is now a new CMS Sheriff in town and he is setting news procedures so that some of these past shenanigans by some MAPD providers are now things of the past.  

There are NO subsides to MAPD or MA plans, they are part of the program of Medicare and they are paid to do their job based on what Original Medicare spends on care - that is the basis of the payment to them.

If a beneficiary is a higher user of health care, they are paid more but now that has to be documented in their providers medical file  - so no more, doing it on their own.  CMS is auditing for this.  

They are paid more for those who are dual eligible and have many chronic conditions in the Special Needs plans that are set up for them.

Why should a Medigap plan be subsidized by Medicare - they don’t do anything for Medicare - it is your choice to have one and it is your choice as to which one you have - You can always go tthru underwriting - that is why it is there - for you to switch plans or switch insurers.  It is not like you have no choice in the matter.  

Go thru underwriting and just pick a lesser benefit plan.  

[MargaretS512549]

It’s in the March 2024 MedPAC Report to Congress, Chapter 12. MedPAC is the congressional advisory commission that audits Medicare spending. None of the changes by "new CMS Sheriff in town" eliminate the overpayment..

[GailL1]

No they didn’t eliminate the prior overpayments but you know what - neither did the court cases that were brought by the previous administration - 

How the story goes . . 

KFF Health News 01/30/2023 - Government Lets Health Plans That Ripped Off Medicare Keep the Money 

KFF Health News - 11/12/2024 - KFF Health News Sues To Force Disclosure of Medicare Advantage Audit ... 

These audits were years and years behind - then the new CMS sherriff came along - of course, they had to do some catch up and review of the problem then take some action.

CMS.gov 05/21/2025 - CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage ... 

Committee for a Responsible Federal Budget 10/09/2025 - Court Blocks CMS Ability to Recover Overpaym... 

KFF Health News - 01/29/2026 - Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Pl... 

We did get this as a result of the NEW Sheriff - from the above [last] link:

Earlier this month, the Justice Department announced a record $556 million settlement with the nonprofit health system Kaiser Permanente over allegations the company added about half a million diagnoses to its Advantage patients’ charts from 2009 to 2018, generating about $1 billion in improper payments.

…. ., In a news release, CMS Administrator Mehmet Oz said curbing this practice would ensure more accurate payments to the plans while “protecting taxpayers from unnecessary spending that is not oriented towards addressing real health needs.”

“These proposed payment policies are about making sure Medicare Advantage works better for the people it serves,” Oz said.

In late 2025 KFF.org did an analysis and did find that both United Health care and some others were doing chart reviews earlier but that Kaiser Permanente and Humana were not - Humana is still fighting in court for any repayment.  

KFF.org - 11/20/2025 - Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enr... 

Then in March 2026, CMS began catching up on these RAVD audits back to 2018 

CMS.gov -03/04/2025-Medicare Advantage Risk Adjustment Data Validation Program About the Program 

CMS.gov - RADV Announcements March 2026  

They are continuing this audit program until they find something else that may work better.  The new rules is that any condition that is mentioned and treated in a person medical chart can be used to increase their MA risk adjustment - as it should have been all along.

We may never get anything back from most of the big ones because as I see it, we cannot prove it but it does seem that the CMS head is continuing to crack down on a lot of MAPD shenanigans and thus they are having to play more by the rules - we just have to make sure they are checked - not left to their own ways as the previous administration did. 

[MargaretS512549]

I never said the purpose of Medigap was to hold down costs.  I understand what the purpose of a Medigap plan is and that it is NOT part of Medicare at all but a way for your out of pocket cost to be covered by some private plan.  I said if the purpose of creating and subsidizing MA was to hold down costs, it's not working. MA costs the government (us) more. Quit subsidizing something that doesn't work. Or subsidize the rest of us equally.    

[CBtoo]

Correct. It is Medicare Advantage plans that were designed to hold down costs to medicare it's self (eg the government).

Medigap plans were to help those who buy them to protect them from the unlimited out of pocket you'd have if you only and Medicare A and B. So buying does hold down costs - eg out of your wallet, but they do not hold down costs for the government.

[GailL1]

@CBtoo wrote .. . . . but they do not hold down costs for the government.

Nothing does - but at least those shenanigans by some of the MAPD insurers are now being corrected by the current CMS administration.  CMS is putting tighter rules in placed to stop them from over rating a beneficiaries risk assessment - now it has to be documented in the person’s medical history kept by their PCP.  

So I think we will see a more efficient use of Medicare money with new CMS audit procedures in place - these audits were supposed to be already in place but they were YEARS behind.  

[CBtoo]

Medicare Advantage Plans (MA) include B and most of the time D. Both of those are subsidized for everyone regardless of whether you are in an MA plan or original medicare (OM) or not -  unless your income is so high you pay full price on the premiums.

The government was hoping that by giving MA plans more money they could put an emphasis on wellness that OM doesn't do, thus reduce health care costs overall for everyone in those plans more than the cost of th subsidies. They also gave MA plans the right to reject treatment, referrals, etc.. With OM that doesn't happen (exceot for a few things where everyone has to get pre-approval) and the supplements have to pay if medicare pays. They don't have a choice. MA plans doesn't have to pay and you have to appeal if they don't. 

Of course the entire concept has headed down the tubes because the insurance companies make more money off of MA plans, has more control over what is paid for, networks, etc. which also rewards denying care, an issue supplements don't have. As a result insurance companies do what they are rewarded for which creates denying care which is an unintended consequence of how MA was set up.

There is more to it than this but this is some of it.

[GailL1]

WHAT ??!!

The current CMS administration is cracking down on MA plans and the way they have been running away with the farm so to speak.  That’s why many of the plans were cancelled in 2026 because under the new rules of adequate networks and no more Valued Benefit Insurance Design started by the Medicare Innovation program (began as part of the PPACA) and how a beneficiary is risk rated - 

Plans left areas and opened up a [Medigap] guaranteed issue period for these beneficiaries having to go back to Original Medicare. 

CMS has a fair way of establishing what is paid to MAPD plans for the care of those who enroll - it is based on what Original Medicare pays for the same services.

CMS also has to approve the cost saving measures that managed care can use to hold down medical cost.  The current CMS administration is also redoing the rules concerning prior approvals - for both MAPD plans an Original Medicare - they are going to be defining when prior medical approval is needed, and how it is done and setting a time limit on getting it done.  They are placing work routines on both insurers and providers to get it done in the most expedient method.  

Course some people don’t think that prior approvals are needed at all - Oh lord, Katie bar the door if that ever takes off.  Cost would skyrocket.  

If Original Medicare covers a service, MAPD plans do too - just in a different way.  Yes, appeals are there to help protect the beneficiary but that is applicable to whatever way a beneficiary get their benefits.  

If a MAPD plan is what a person wants, and plenty do, then more power to them in their choices.

BTW, did you know for those who have dual eligibility, live in an areas where there is limited resources, have multiple chronic conditions, then it is Medicare Advantage plans that control, monitor and issue the special help that they are given under Medicare and Medicaid.  CMS has a hard time overseeing such special programs but special MAPD plans can do it easily.

[TRL1111]

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@ElzbietaK386890 wrote:

 Do we have any better options?

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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.

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@ElzbietaK386890 wrote:

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

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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.  

[JamesH377174]

 I just received my Plan G Increase today. It is 20.41%. Totally out of control and this is every year. I could understand maybe 10% but 20% is insane. I live in Florida so you are stuck if you have any preexisting conditions because you cannot change to another Medigap plan. I am going to contact the insurance commissioner because the state has to approve the increases. 

 Does AARP do anything for us because when I signed up through them they acted like it was so   fantastic to do it through them. They have done absolutely nothing for us since I got this policy as it continues to go up double digits each year. 

[TRL1111]

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@JamesH377174 wrote:

I could understand maybe 10% but 20% is insane.

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Why is 10% okay but 20% insane?  Did you examine the numbers UHC submitted to the insurance commissioner that led it to approve the 20% increase?  

[zooeyhall]

Reading all of these, is why I am glad I stuck with traditional Medicare.

Too many seniors listened to all those TV ads from celebrities pushing Medicare Advantage plans.  Yeah---it sounded great!  Lower premiums, a smattering of dental/vision care.  Free health club memberships!  Just turn your old-age health care over to the private sector!

And now---surprise!  The other shoe has just dropped!

When I saw all the conservative groups pushing for Medicare Advantage, I knew immediately it was just a push for backdoor privatization of Medicare.  A dearly cherished goal for groups like The Heritage Foundation, and the "Better Medicare Alliance", (a major advocacy group founded by insurance companies, including UnitedHealth Group, Humana, and Aetna--- that lobbies for higher rates and defends MA against cuts), I knew this would happen.

[GailL1]

@zooeyhall 

This thread isn’t about MA plans - it is about the increases in MEDIGAP plan premiums -  mostly Plan G or for those that still have them Plan F.

Thank goodness for good MA plans - PPO type with a good star rating - for those beneficiaries who cannot afford a Medigap plan OR for those who are less than 65 and on Medicare because of a disability and either do not have any access to a Medigap plan or only one of the lesser benefit ones at an astronomical monthly premium - the later do get a new choice when they reach age 65.

If your state is one that is extending guaranteed issue rights to change plans in some way - then you too will experience some hefty price increases as usage increases due to the shear number of beneficiaries in your plan and/or hefty medical inflation.  

It seems that among the newest Medicare enrollees, Plan N and Plan HD-G are getting closer looks because many of them realize what is coming.

[TRL1111]

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@zooeyhall wrote:

Reading all of these, is why I am glad I stuck with traditional Medicare.

I don't think you're following the discussion.  It's about the huge increases in Medigap supplement premiums.

I'm not a fan of how Medicare works, but I think it's a good thing Advantage plans are there for those who can't afford a supplement, because that's the only way they can avoid being on the hook for 20% coinsurance with a maximum of infinity dollars every year. 

[jphorenci]

And the raping of America's elderly continues. Just got my notice of another 20%+ increase for the 2026-2027 policy year. United Healthcare are thieves. How they can continually raise rates over 20%+ year after year should be investigated by the Justice Department. And how AARP can claim they have retired peoples best interest at heart is laughable. The sales commissions paid to AARP for these policies is outrageous. Both the AARP and especially United Healthcare should be ashamed of themselves. For those still participating in the AARP/United Healthcare RX policies, STOP. Investigate the Wellcare Rx plans recommended on the Medicare site. My RX plan with them has better coverage and zero monthly premium. I will also now begin my research to change supplement plans, 

[SeanmraganR601889]

I switched to Anthem Blue Cross because they were less expensive but six months later they increased the premium to be the same as UHC.

[kasyy]

yes - agreed - I got rid of it year half ago when they priced me almost 30% more - luckily I was able to get a guaranteed policy with my union - and you are so so correct - wellcare'rx plan is awesome - and AARP sending people to buy an overpriced drug plan - shameful

[melkis]

My UHC Supplement is going up 20.45%, AARP should be ashamed of themselves, not one program they recommend, not health, car, life, dental, NONE are saving Seniors any money.  They should take some of the 9 Million in kickbacks paid to them from UHC and give it to their members.

[pf75974628]

Last year in March I received my new premium notice.  It rose by 25%.  I called to find out why and was told it was because the medical facilities in my area charged some of the highest costs in the country.  This year my new notice says the premiums will rise by 18%.  I have a G plan that now includes a deductible.  I used to have an F plan but the premiums were even higher.  It appears that everyone gets a low premium for a while since they are generally younger and healthier but once you start using your insurance, the premiums rise rapidly.  I need to do some research on how local facilities charge versus other states.  Maybe UHC is pulling a 'Trump.'

[TRL1111]

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@pf75974628 wrote:

It appears that everyone gets a low premium for a while since they are generally younger and healthier but once you start using your insurance, the premiums rise rapidly. 

Just to be clear, supplement premiums have nothing to do with an individual's utilization.  It's not like car liability insurance, where your premium can/will go up if you file a claim.  

[CBtoo]

Actually what happens is that one a year, you lose some of your age related discount off of the maximum premium and once a year they increase the maximum premium. For people who got their supplement on the same month that the premium goes up you have a once a year bigger jump as both the across the board increase and the declining age related discount are combined into one month. Once (after 10 or 15 years depending on when you started getting UHC) you have used up all your age related declining discounts and aged out of that then your premiums will go up only once a year and will only reflect the across the board increase.

And yes your premium for HG depends on where you live and does vary across states and areas. Typically it is higher in states where you don't have to undergo medical underwriting to change what you have as sicker people tend to gravitate towards supplements as advantage plans will cost them more as they use health insurance more. If you live in a state where you have to pass medical underwriting to change then premiums tend to be lower as sicker people can't switch out of their advantage plan to a supplement.

G always had the Medicare B deductible as G's deductible. It was only F where that was paid for and there was no deductible at all. 

[sktn77a]

A bit late to this party but it's not just UHC supplements that are increasing uncontrollably.  I'm 73 and have an Aetna/CVS Plan G supplement.  Started out at just over $120 a month 3 years ago.  After one year, it went up to $150.  This year it went up again to $180 - 50% in three years - WAY greater than any inflation measure you can come up with.  Before that I had an Old Surety Plan F which was skyrocketing before I switched.  Unfortunately, 2 years ago I had a minor heart issue requiring the implantation of a pacemaker so I'm basically stuck with my current supplement ad infinitum.  I think these companies tease seniors with low starting rate (eg the "30% discount" with UHC) and then sneak in annual increases to make up for this.  I wish State insurance commissioners would take a harder line with these insurance companies!

[NealV490712]

Congratulations, that's much less than my increase with United Healthcare!

[GailL1]

@sktn77a wrote . . . . . I wish State insurance commissioners would take a harder line with these insurance companies!

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How do you know they don’t?   From the guidance that I have seen on their Loss Ratios and the amount they have to have in reserve in some states - it seems that beneficiaries are all using their plans - and not just AARP/UHC as you pointed out.  And their plans are usually the ones where it protects their pocketbook the most - now, Plan G, so there is more on the insurer to pay.

It is EASY money for the insurer - they don’t have to manage any care or make any decisions about what or who to pay - If Medicare pays, they pay whatever is their portion or IF Medicare does NOT pay, they don’t get any flack because they didn’t pay, that is all on Medicare to do the determination of coverage and the amount of the payment.  

I have heard that some of the smaller insurers are considering their options of leaving this coverage market - Allstate & National General were the ones  I heard about leaving this Medigap marketplace recently.

Utah just changed their Medigap law to allow for the “Birthday Rule” so premiums will be going up there in a few years just because of this.  

Are you sure your state does not have any extended guaranteed issue right periods where you can switch again without underwriting?  There are getting to be more and more states that are adding some resemblance of the Birthday Rule and of course there are a few states where you can change or pick up anytime because they have continuous enrollment - NY, MA, CT and ME (but ME is a little weird so I would have to read their rules again for the detail).

We all have known that cost rise with years - me, I don’t have to worry about a Medigap plan premium because I have other coverage but I am having to put on my 2nd roof on my home and it is a lot more than I paid the last time - 24 years ago.