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.  

[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]

---

@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

---

[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. 

[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]

---

@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.