Recent premium increase for United Healthcare coverages

[jphorenci]

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

[CBtoo]

To add to your answer - one of the problems people are having now is how errors in Electronic Records spread like wildfire across doctors and are incredible time consuming to fix. 

To give you an example: I had kidney stones where things got blocked on one side and urine started backing up. As a result a kidney function test showed acute kidney injury (which is usually temporary, which it was in my case was). But, because the doctor who admitted me to the hospital had listed that particular kidney function and no one wrote in the medical record that it converted to normal after the stones passed I am STILL having to get that removed from doctor notes.

Copy/paste is a bad thing (well and it got put into the list of medical conditions behind a fire all we can't see in EPIC/mychart). I thought I had finally gotten that cleaned up and then my last doctor visit for something else it was back. And listed in a way it got coded for in that doctor's visit. Sigh.

It's like playing wack-a-mole. I can't pass medical underwriting until that is fixed. I'd be stuck in tier two prices which defeats the purpose of switching from the G with the extras (that they call free) to the G without them. Since the G without them is far cheaper these benefits are not free. (this is the AARP/UHC supplement). 

By the way - it is not enough just to get your medical records changed. You have to get the facility to resubmit the bill explaining it was an error. If they don't do that the information the insurance companies have access to will still show the error.

the "look back" is 2-5 years depending on the condition depending on the company and state. Many cancers are 3-5 years, with blood cancers being 5 years. And there are some things where you will fail (which includes taking some meds). Also you won't pass if you have certain tests or surgeries scheduled you have done yet. You have to wait until after the tests until the results are known or being hospitalized in the last 90 days...  And of course there are conditions where you automatically fail - like being on dialysis, being in active cancer treatment...

The list is pretty long and company criteria varies. It takes major work to get the companies to admit to everything on the list and most of the time that list is hidden behind insurance agent fire walls. Also if you fail it may take multiple calls (the agent can't do this for you although if you were on a call and on speaker phone then they can listen in and with your permission comment) to even get told why you failed, which visit dates have the problematic information, It took me 5 calls, each time getting fixed what they told me only to fail because they didn't tell me everything. I finally decided to wait out the 2 years for one thing for it to age out, only to discover there was a new mistake in there (the kidney stone issue mentioned above).

The entire thing is a giant PITA and how electronic medical records can be dangerous with wrong information in there that is so hard to get out of there permanently. For example, I am using one drug off label and people make an assumption that is wrong and without even asking me. Then they put in my records that I have that condition. Now I know to bring it up each and every time) 

In states you have to pass medical underwriting to change from an advantage plan into a supplement (Yes I know this goes beyond what was asked) keeps expensive patients from switching in once they need more medical care as that drives up the costs up since there are a higher percentage of expensive patients in supplements.

Being allowed to switch from one supplement to another one within the same company is a different situation. Most people want to switch "up" (eg lower deductible when they are sick as usually that saves money) and so again you have a higher concentration of more expensive people in some plans which drives those costs up, thus the premium. Then the people who can pass medical underwriting bail to switch to a company that has cheaper premiums, which increases the percent of expensive patients in that plan, rinse and repeat. As a result most companies just have an across the board rule about medical underwriting, 

There is way more to this than what I am posting here and I am not an agent. I had to pry this information out of AARP/UHC over multiple phone calls. And I taught business prior to being retired so I understand finance, etc, and how this kind of stuff works on the financial side of things.

[GailL1]

@CBtoo 

I noticed you said “usually” when you said “As a result a kidney function test showed acute kidney injury (which is usually temporary, which it was in my case was)”  

Time cures any medical records misdiagnosis - they aren’t thinking that this person may want to switch their Medigap plan - that’s not health care.  Your medical records should show everything, for the next provider that may look at it for any added problems.  

Plus insurers have the MIB to check with your permission.  You can always add a statement to it, I believe - but it is kind of like your permanent record - who reads it all?  

CFPB.gov - MIB, Inc. 

Ever looked at your Lexus Nexus report?  Basically the same thing but it shows your driving record and other personal auto info like who else can drive your car in your household or outside of it.

[CBtoo]

Time does not age out things that are wrong that are repeated each year and billed that way each year. You have to take active steps to remove that information. 

For example. I have an incurable but indolent blood cancer. Until I corrected it, even though I was in remission they'd code it as active disease as that mistake kept being carried over. I had to take active steps to correct that so that that wrong billing code from the wrong diagnosis code wasn't included every year. No amount of passing years would have fixed that.

At least with UHC if you challenge what they determined, even if you can prove that is wrong they still want 5 years of your entire medical record at your expense and you can not give them the visit notes you have access to, They need to be the notes that appear in the side of, in this case epic/mychart that patients can't access. Not only that this includes all notes from all doctors you have seen in that 5 year period, all tests, etc. EVERYTHING. This can cost hundreds and hundreds of dollars. 

[GailL1]

@CBtoo 

Not necessarily - your medical record is updated every year.  So if something is not occuring or reoccuring as a result of your health, it is not given much power on the MIB.

Yes, if something like a cancer has the ability to reoccur then it never goes away because of that recurrence propensity.

Challenge all you want but they do have the final word regardless of what you argue.  - Cause they make the rules and get no federal money for this Medigap coverage.

[CBtoo]

And if they update it with mistakes that aren't fixed then the mistakes are still there.There are tons of mistakes in electronic medical records that get carried over from year to year. So if it is a mistake it can carry over each year with updated records until you are dead of old age. And it is a real pain in the butt to get that kind of stuff fixed.

With supplements they are required to pay if medicare pays so challenging UHC is irrelevant. Your wrong medical records are only relevant to the extent you need to pass medical underwriting to get something like long term care insurance, change supplements, whatever.

Mistakes in your medical records are only relevant with advantage plans (which I don't have one of those). And in many cases you can win if you are denied as they often cave when they are challenged. Over half the time people win challenges with advantage plans.Sometimes they have lost in court over certain things they had denied, 

[GailL1]

@CBtoo 

You miss the point - if you do not have any mention of a health conditions that may have been cured (that can be cured) or wrong as the case may be then 5 - 7 - 10 years from now, that condition is not gonna get much power in medical underwriting - it is always what you have been diagnosed with or if it is a possible recurrent disease that it is given power to get you turnded down - but that still does not mean that they cannot uprate your premiums.  

I commend you for trying to get your med records right - I do that every time I go to the doc - I just look over what he put on the treatment sheet and the diagnosis that were listed.  I know what they are - unless a new one pops up - then we have to have all the test results to validate the new diagnosis.  

Medical history is only important when picking a MAPD every year to see if you are one of the beneficiaries that will need extra care and thus you are labeled as higher risk - CMS now says that this has to be documented in the providers files and they are auditing MAPD plans to make sure that they have this documentation for these higher risk beneficiaries. 

[CBtoo]

You are missing the point.

As long as that condition isn't IN your medical record as a current condition it won't be a problem (as you say) BUT WHAT I AM SAYING - and this has personally happened to me when trying to pass medical underwriting WHEN WHAT IS IN YOUR CURRENT RECORD OR IN BILLING CODES FOR CONDITIONS IS WRONG (as there are various databases they check) THEN YOU HAVE A PROBLEM that needs fixed to pass medical underwriting. It doesn't matter what your PCP says if the billing codes for medical conditions are listed by any doctor - not just your PCP is wrong,.

[CBtoo]

And that is how it works in some states. Unfortunately premiums for suppliments is then usually higher a sicker patients switch to them so they don't have network issues and their total cost (premiums and out of pocket) then generally ends up cheaper than being on an advantage plan due to how sky high the maximum out of pocket is on advantage plans.

[TRL1111]

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@CBtoo wrote:

Unfortunately premiums for suppliments is then usually higher a sicker patients switch to them so they don't have network issues and their total cost (premiums and out of pocket) then generally ends up cheaper than being on an advantage plan due to how sky high the maximum out of pocket is on advantage plans.

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If you're responding to @MargaretS512549 , she's not talking about people moving from Advantage to Original Medicare plus a Medigap supplement.  She's talking about switching from one supplement to another, specifically from Plan G to Plan N.  It's unlikely that even in that scenario, sicker people are going to want to do that because of the copays they incur under Plan N.

[MargaretS512549]

"She's talking about switching from one supplement to another, specifically from Plan G to Plan N. It's unlikely that even in that scenario, sicker people are going to want to do that because of the copays they incur under Plan N."                       Which is exactly why i don't understand why a person would have to go through underwriting to switch from Plan G to Plan N with the same insurer. It's not logical.

[GailL1]

@MargaretS512549  @TRL1111 

Of course they would entertain this type of change especially if there is a big enough spread between the premiums since all they are looking at is $ 20 office visit copays and a $ 50 ER visit (if they are not admitted - it is waived if admitted to hospital).  The excess charges are rare, in fact in some states they have even outlawed them by providers.  But even otherwise, people can check to see if the doc accepts assignment because it is only the “non-participating” docs that even charge them.  Beneficiaries can look up the status of the docs they see on the Medicare site to see if they accept assignment.  But even at that the excess charges are only 15% of the Medicare rate - 

So it all goes back to how much they are saving in premium cost - that is where the biggest difference will be - and that is a month.

So say their Plan G new premiums is $378 a month but the Plan N is only $ 208 a month - that’s a savings of $ 170 A MONTH or $ 2040 a year - that’s a pretty good savings even considering the copays and perhaps even a few excess charges. 

A better value for people that can is the HD-G plan - even with the added $ 2950 deductible - it just depends on the premium spread between what they have now and what it will be changing to on the new plan.  

A same [exampled] Plan G that is $ 378 a month could have a much bigger savings with a Plan HD-G 

$ 378 X 12 = $ 4536 a year + $ 283 Part B deductible = $ 4819

Plan HD-G premiums of $ 70 a month X 12 = $ 840 a year and you don’t have to add in the Part B deductible cause that is covered within the high deductible of $ 2950 in 2026.

So $840  + $ 2950 = $ 3790 less $ 4819 = a savings of $ 1029 going from a Plan G to a HD-G.

Plus since many on HD-G are healthier any premium increases are going to be on the low side since many of the beneficiaries are lower risk - so if even if you have higher risk, you still get the benefits of being in a group with healthier folks. 

[TRL1111]

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@GailL1 wrote:

So say their Plan G new premiums is $378 a month but the Plan N is only $ 208 a month - that’s a savings of $ 170 A MONTH or $ 2040 a year - that’s a pretty good savings even considering the copays and perhaps even a few excess charges. 

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What zip code are you using that has such a huge difference between Plan G and Plan N?  Maybe Texas is an anomaly, but in my zip code, a 69-year-old woman with AARP/UHC's Plan G has a premium of $175 a month while the Plan N is $150.  That's only $25 less, nowhere near $170.

Those premiums are going up in July, to $217 and $186, respectively.  Both plans are going up 24%, and I remember people predicting that Plan N would have lower increases than Plan G because healthier people would be the ones choosing to be in Plan N over Plan G.  Obviously that didn't work out in my zip code, and maybe it won't work out for the high-deductible plans, too, because people will flock to them when they first sign up for Medicare, and flock to them when downgrading their plan with guaranteed-issue rights under birthday rules (not applicable in Texas), affecting that risk pool, too.  

[GailL1]

I am just giving an example - no specific place.  

But here is AZ - notice the Male HIGH price comparison in Plan G, Plan N and Plan HD-G

AZ SHIP   

Yea, every state is different and depending state laws, state regulators, usage, risk and medical inflation and on the health status of their Medigap population.  

You maybe right - it may just be the luck of the draw on which plans rise the most in premiums but I just think that the HD-G, if nothing else will attract beneficiaries that will think twice a bit more since it is more their out of pocket cost that is 1st having to be covered.  Now of course, this would be for those normal medical things - just the ole regular Part B office visits with just those smaller complaints.  

Something serious and they will spend that $ 2950 without question and begin their regular Part G coverage.  

This does make a difference in usage.  That is why CMS has gotten rid of selling 1st dollar coverage plans now.  

Will “G” be next come about 2030 when the baby boomers are finishing up their enrollment in Medicare????

[TRL1111]

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@GailL1 wrote:

I am just giving an example - no specific place.  

But here is AZ - notice the Male HIGH price comparison in Plan G, Plan N and Plan HD-G

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With all due respect, why not compare the highest price Plan G to the lowest price Plan N? It would make your case more compelling, and no less accurate.

Margaret is wondering why she can't change from G to N with her current insurer, and I assume she has an AARP/UHC plan. I have no idea where she is, but using your Phoenix example, for a 65-year-old man, there's a $60 difference between Plan G and Plan N, and when the premiums go up on June 1, it will be an $80 difference. So...not the $170 you made up, but also not the $25 that applies to me in particular. And his Plan G with AARP/UHC is $204, nowhere near the $526 highest premium possible in the chart you posted.

I found these premiums on the AARP/UHC website. What's really interesting is that for man turning 65 getting a supplement starting May 1, these are the premiums (his premium will be guaranteed for six months):

Plan G $204
Plan G with wellness extras $209
Plan N $142
Plan N with wellness extras $169

But look what happens if he starts on June 1, when the 2026 price increase hits:

Plan G $265
Plan G with wellness extras $230
Plan N $185
Plan N with wellness extras $186

For both Plan G and Plan N, the increase is $30%. But for the versions of Plan G and Plan N that include wellness extras, the increase is 10%.  

The increases are the same for Plan G and Plan N, even though everybody was expecting Plan N to go have lower increases because of the presumably healthier risk pool.  So that makes two states where the anticipated lower increases for Plan N didn't actually happen.

That's the same thinking with High-Deductible Plan G. It will be interesting to see if it actually pans out.

Adding to the intrigue, notice that increases for the plans with wellness extras are far lower than for those without; as I said, it's 10% for plans with wellness extras and 30% for plans without them. In fact, in June, for our 65-year-old man, the Plan G with wellness extras will be $35 cheaper than the Plan G without them, and the Plan N will be the same premium whether it's the N with wellness extras or the N without them.  That certainly isn't what one would expect.

So it's probably futile to try to predict anything when it comes to supplement premiums, except that they'll go up.  But it matters if they go up by 1% or 30%, and that's what's impossible to predict.

[CBtoo]

They might switch from G to N because they have no clue about the make up of the risk pool. They may be thinking about premiums only, using a system that won't cut off care and sue you if you don't pay (we have a big system here that won't do that and many people use them for that reason). Maybe they think they will end up paing less as they are not thinking through the math. People do all sorts of things for reasons that aren't rational, logical or make financial sense.

[CBtoo]

I was explaining why premiums are usually higher in states where you can avoid medical underwriting to switch. She was also not happy with the high premium costs. I wasn't addressing the G-->N. My answer was for more than just her since others are reading the threads and may not know that.

[jphorenci]

We know how it works Gail. Are you a shill for UHC? The increases are unreasonable and feed overpaid executive compensation plans, exorbitant AARP commissions, and excessive company profits at the expense of average elderly Americans. Many of those elderly don't have the time, energy or skill set to shop for better prices, foolishly depend on AARP to look out for their best interest, and fear change will leave them penniless and homeless. The process is so convoluted and complicated they simply comply and UHC expect they will, so it has no motivation do do better. I've spent hours on my laptop taking care of my personal business but very many of my generation do not have the capability of doing the same. 

[PatriciaT879467]

I agree. That is why we need a real nationalized health care plan like every other modern and civilized country in the world. I enrolled in planG 2 years ago at $120 a month and now it’s $200 a month. (an increase of over 50%in 2 yrs).

[GailL1]

@PatriciaT879467 wrote . . . . That is why we need a real nationalized health care plan like every other modern and civilized country in the world

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

WOW - well that should cost a bundle in taxes and you do know that they still sell private insurance in many of those other countries that covers what their national plan does not.

Instead of that, why not just change plans or insurer if you can - A High Deductible Plan G in most states is very cheap - like $ 50 - $ 75 a month, but of course, you take on some of the risk in the annual high deductible amount that you pay before the Plan G kicks in - 

[PatriciaT879467]

Sorry sweetie if only life were that simple. You have to go through an entire underwriting process just to switch supplemental plans and I did pick the cheapest plan 2 years ago but they just jack up the rates after that. i pay over $200 a month for medicare plus $200 a month for planG.  That’s $400 a month and for a senior a big part of my income not to mention the deductible. They almost force you into an advantage plan.  That sucks.  

[GailL1]

@PatriciaT879467 

Ever considered taking on some of the risk yourself - you would probably like another plan like the High Deductible Plan G rather than having a MAPD plan as your only option price wise.  I would take on more risk rather than go on a MAPD plan even if I had to attempt to go thru underwriting. 

We all pay at least $ 200 for Medicare Part B - that is what funds Part B + the 75% that the government throws in.  Some people even pay a whole lots more for Part B if they have to pay the IRMAA (Income Related Monthly Adjusted Amount) which is based on your income.  That’s just for their Part B.

SSA.gov-Premiums: Rules for Higher-Income Beneficiaries  

Underwriting is not required in all states. Do you know the rules in your state on when you can switch plans or insurers for your Supplemental plan?  

And YOUR state is the entity that approves all the premium increases on a Medicare Supplemental plan - Maybe check with your Dept of Ins to find out the reason why they approved the increase on your plan - USAGE, RISK and INFLATION are the usual culprits.  Federal law does not govern Supplemental plans - that the state’s responsibility.  The Feds limit is describing the benefit limits on each of the plans and defining any special enrollment conditions and of course, keeping them open for further membership or shutting them down for no further purchases of a specific plan.   Those that are disabled (under 65)  and on Medicare do not have any rights to a supplemental plan from the Feds - all their rights come from the state.  

Did you know that in some states, people are paying upwards of $ 400 a month or more for a Plan F or Plan G.  Did you know that some people that are less than 65 (disabled) pay over a $1000 a month for their Plan G and even close to that for one of the lesser plans like Plan A which is the go to for many states to put those who are disabled.

[somarco]

I have HDF . . . had it for 10 years. My premium has never increased during that time and is still $56/month. Every year (until now) I have saved $$$ vs a traditional F or G. Cataract surgery cost $5k this year (including $4200 for lenses not covered by Medicare). During that 10 years I have saved at least $20k in premiums.

My health has been good during that time. If I had something major, or chronic + expensive the numbers may not have worked in my favor.

Many who choose traditional F or G and then regret it because the premium is going up do not fully appreciate the value of original Medicare + Medigap. When they decide to leave they do so because MAPD is often $0 per month and completely ignore how intrusive MAPD is and how much it actually costs once you factor in the unpredictable cost of care.

I could have picked a MAPD but I did not want to let an insurance carrier override my doctor with regard to my care. Also, the MAPD plans in my state have a MOOP of $5k - $10k.

If you have chronic conditions going in, with frequent office visits and lab work, regular G might be a good choice . . . certainly better than MAPD (in my opinion).

[LuisaC963531]

I am canceling my aarp. I thought it was there to help cost down for seniors now uh has gone to almost 300 a month

[GailL1]

@LuisaC963531 

I think you have been under the wrong impression of the purpose of the AARP - benefits are only just offered.  You pick the ones you want and leave the rest.  I have never heard that AARP is there to hold down Medigap cost - they have nothing to do with price setting of a Medigap plan - says so everywhere on this site and the world wide web.

Probably is even mentioned in your plan itself - 

AARP.org - AARP® MEDICARE SUPPLEMENT FROM UNITEDHEALTHCARE® 

Read the disclosure.  

[GailL1]

@jphorenci 

BTW, I am not a shill for any Medicare plan - I just want beneficiaries to know their options for their best interest.

I am a senior - actually a very old senior - I am now closer to 90 than 65 and I have been doing this on this site since 2008.  Perhaps it is time that I stopped. 

[SereneSeagull]

@GailL1  I sure hope you don’t stop.

 I think many times these conversations get so emotional because it can be frustrating.  I think taking the emotional side out of it and listening can be beneficial.  I’ve learned a lot, as have others, I’d hope, with your detailed and thoughtfully researched answers.  Sometimes people lash out at the frustration of it all.    Thank you.😊 

[SereneSeagull]

@jphorenci I believe @GailL1 to be a person who cares here, your comments are out of line.  

[jphorenci]

And I will continue to call out anyone who defends these out outrageous increases. The very dismissive just change plans attitude is not someone who cares and is out of line as far as I'm concerned. 

[GailL1]

@jphorenci 

Are you kiddin’ me?  Changing plans is the option that is available - even if they change to a Medicare Advantage plan.

They need to know about their options.  They can go to their state’s SHIP office and get one-on-one counseling on what action options they have within their state.  

So they don’t have to learn it on their own to make a decision, they can learn where to get help from their state.  In fact, they even have a website to locate the office in their state.  

Edited to add the link:  State Health Insurance Assistance Programs - State locator

If they can’t figure out how to get some direction, they may need to appoint a person who can act for them in this respect - maybe even in other respects too.

[GailL1]

@jphorenci 

Then go to your state and ask them why they approved the increases.  They will tell you pretty much what I have told you - the increases are justified (for all companies) based on -

• USAGE
• RISK
• INFLATION
• and the chosen or legislated rating method used by their insurers 

I am sorry that so many seniors have a hard time understanding Medicare (all of it) and making decisions for themselves and need help in determining their best course of action.  Perhaps that is why EVERY state has a SHIP office to help them - (State Health Insurance Assistance Program)  - Counselors are there to advise them.  But of course, the other solution is a Medicare Advantage plan.