AARP/UHC Medicare Supplemental Inflation Increases 21.88% for me!

[Buckeye]

Looks like maybe I could save a little. UHC has paid about $48k last 12 months. Happy I have it!

Your 20% coinsurance was $48,000? Wow! That's $240,000 in approved Medicare charges, i.e. the amount after the $500 bill the doctor submitted is turned into a $100 Medicare approved charge of which you (or your supplement policy) owes $20. That's a stunning amount. I hope all is well with you.

 

[Pluperfect]

I know someone who had cancer and will have to have immunotherapy infusions for the rest of his life. The Medicare-approved amount is $30,000 per treatment, and he gets it every six weeks. That's 8 or 9 per year, for a total of about $250,000. Plus whatever other doctoring he gets, which I'm sure is minor in comparison, unless he gets cancer again and has to have chemotherapy.

 

[Dranoel]

Your 20% coinsurance was $48,000? Wow! That's $240,000 in approved Medicare charges, i.e. the amount after the $500 bill the doctor submitted is turned into a $100 Medicare approved charge of which you (or your supplement policy) owes $20. That's a stunning amount. I hope all is well with you.

Yup, get a serious disease like cancer and this is not at all unusual. Thankfully, my immunotherapy has worked very well.

 

[finnski1]

My Anthem Blue Cross Supplemental Plan G went up 12.6%. Just changed in May, my birthday month. DW's (same plan) went up 7.2%. She is 3 years older than me.

 

[Midpack]

Just sharing our history both from 65 yo on, so others might know what they are in for - although your experience will be (completely) different depending on your chosen provider and unique medical history. MoO insists I am not in a closed book pool, I don't believe them. I had treatment for prostate cancer in 2024-25 so I can't switch providers until 2030 if then (probably not)...

 

[wmc1000]

Your 20% coinsurance was $48,000? Wow! That's $240,000 in approved Medicare charges, i.e. the amount after the $500 bill the doctor submitted is turned into a $100 Medicare approved charge of which you (or your supplement policy) owes $20. That's a stunning amount. I hope all is well with you.

Medicare approved amount is the gross charge before applying the Medicare negotiated amount that is actually paid. As an example DW had a $55K surgery, which Medicare approved but Medicare's actual payment was $15k less 20% and the supplement provider paid the $3k balance. So in this case the $15K was the full amount the provider agreed to accept for a $55k full charge surgery.

 

[Pluperfect]

Medicare approved amount is the gross charge before applying the Medicare negotiated amount that is actually paid. As an example DW had a $55K surgery, which Medicare approved but Medicare's actual payment was $15k less 20% and the supplement provider paid the $3k balance. So in this case the $15K was the full amount the provider agreed to accept for a $55k full charge surgery.

You seem to be saying Medicare negotiates with individual providers, like insurance companies do, but my understanding is that there's a set amount Medicare approves for a given procedure code regardless of who the provider is. Medicare pays 80% of that amount and the beneficiary or his supplement pays the other 20%.
In which case the Medicare-approved amount isn't the gross charge, and it's like with other health insurance--it has nothing to do with what either the insurance company or the insured will pay.

 

[Koolau]

You seem to be saying Medicare negotiates with individual providers, like insurance companies do, but my understanding is that there's a set amount Medicare approves for a given procedure code regardless of who the provider is. Medicare pays 80% of that amount and the beneficiary or his supplement pays the other 20%.
In which case the Medicare-approved amount isn't the gross charge, and it's like with other health insurance--it has nothing to do with what either the insurance company or the insured will pay.

I just know, looking at my EOB reports that Medicare only allows a small amount of the "full charge" and then usually only pays a large fraction (80%??) of that.

So the bill might say $1877.59. Medicare approved $214 and then (maybe) MC paid $187 or whatever. (Made up numbers to make a point). I'm surprised providers don't squawk loudly about this. Maybe they just make it up on non-MC payers (and people without insurance).

 

[PatrickA5]

Here's my stats so far this year.

Billed to Medicare: $32,050

Paid by Part B: $3,616

Paid by Part G: $401

Paid by me: $283

There was one item (Colonoscopy) that Medicare didn't send on to Part G.

Obvious from above is that you have to have a LOT of medical expenses to break even on Part G premiums. But, that's why we have it.

 

[sengsational]

MoO insists I am not in a closed book pool, I don't believe them.

You should be able to shop for a plan as a generic person of your age and living in your geography and see your exact plan for the exact price you are paying. At least that's what I did to make sure that the price I was paying wasn't higher than it should have been. Matched to the penny.

That doesn't mean the plan is actually getting new members, of course, which is what you want.

After a long argument with ChatGPT, while it gave me all kinds of crap that I didn't ask about, or that I knew already, it finally spit out something that probably rings true to you:

The formal closure may not be the cause of the sick-duck pool. The sick-duck pool may already exist, and formal closure is merely the paperwork acknowledgement that the company has no intention of writing meaningful new business into that block anymore.

I couldn't get it to tell me that regulators force them to close books. It did say the regulators might start asking harder questions when they show up with another subsidiary and a fresh offering. And it said customers and brokers might get freaked out by too many offerings of the same policy by "the same company" at wildly different prices.

 

[Midpack]

I couldn't get it to tell me that regulators force them to close books. It did say the regulators might start asking harder questions when they show up with another subsidiary and a fresh offering. And it said customers and brokers might get freaked out by too many offerings of the same policy by "the same company" at wildly different prices.

Well put. I’ve wondered why (state) regulators allow that, as stated in your last sentence. OTOH it’s pretty routine to offer the same policy at different prices in home and auto insurance depending on region/weather for home and region/claim history for auto.

 

[sengsational]

Another thing these companies are driven to do, in their constant sneaky increments, is to offer a slightly different product to have an excuse for regulators. "But our customers want a policy that includes an annual eye exam" they say with mock innocence. The regulators are then forced to call BS on them, or let it slide. Oh, when the comment was made about the eye exam, it was with a pack of vicious lawyers that looked like rabid wolves in the background. Regulator: "Nah, I'll go home early and smell my daughter's head after her bath."

 

[Sunset]

Here's my stats so far this year.

Billed to Medicare: $32,050

Paid by Part B: $3,616

Paid by Part G: $401

Paid by me: $283

There was one item (Colonoscopy) that Medicare didn't send on to Part G.

Obvious from above is that you have to have a LOT of medical expenses to break even on Part G premiums. But, that's why we have it.

I hope to not break even on my Part G premiums.... as that would generally mean I don't need too many extreme health treatments.

It is insurance after all, something I pay for and hope to not use

 

[Pluperfect]

So the bill might say $1877.59. Medicare approved $214 and then (maybe) MC paid $187 or whatever. (Made up numbers to make a point). I'm surprised providers don't squawk loudly about this. Maybe they just make it up on non-MC payers (and people without insurance).

And in your example, $214 is the Medicare-approved charge. The OP would say the $1877.59 would be the "Medicare approved amount." But that doesn't make sense because Medicare has nothing to do with that amount--same as how regular health insurance EOBs show a huge charge that is reduced to whatever the insurance company negotiated.

Medicare pays 80% of the Medicare approved charge--in this case, it would pay $171.20 to the provider. The beneficiary (or his supplement) pays the remaining 20% to the provider.

Providers do squawk loudly about it. That's why some quit taking Medicare at all, or more commonly will accept Medicare only if the beneficiary is already a patient. There are lots of stories about people having trouble finding a doctor who accepts new Medicare patients.

 

[MBSC]

Mutual of Omaha has opened new books in Delaware and Kansas. The old books are "closed to new members" but still processing claims for current members.

Within the industry, "closed book" means the insurer, or their third-party administrator (TPA), also stops processing claims for current members. They receive a letter outlining their Medigap guaranteed-issue rights to certain plans at the preferred rate without underwriting. The state DOI frowns upon this and typically prohibits the parent company from selling Medigap plans for 'x' years. There can also be tighter scrutiny of non-Medigap business.

The public uses closed book in a more generic sense for simplicity.

Effective June 12, 2026, Medicare supplement new business rates will go into effect in Delaware and Kansas. Delaware Med supp plans will now be underwritten by Mutual of Omaha Insurance Company and Kansas Medicare supplement plans will be underwritten by United World Life Insurance Company.

Source: Express » Blog Archive » Important Update for Delaware and Kansas

 

[PaunchyPirate]

Resurrecting this post a bit. I'm 9 months away from filing for Medicare, but I'm starting the detailed research now since I'm helping my best friend figure out his plan for a September sign up this year. He doesn't deal well with numbers and details of stuff like plan pricing.

I've skimmed thru this thread and don't see this situation specifically mentioned. Sorry if I missed it.

We both live in Pennsylvania. UHC/AARP rate increases for 2026 went into effect on June or July 1st. I can't tell for sure. As mentioned above in some posts, in PA, we see plans from both UHIC and UHICA. UHIC includes the Wellness Extras. UHICA does NOT include the Wellness Extras.

However, the monthly price of Plan G WITH the Wellness Extras (UHIC) is $14 LESS than the plan without them (UHICA). It actually saves money to add in the Fitness/Vision/Hearing/Dental add-on. Very weird.

I also have been using the SERFF filing database for Pennsylvania' rate increase process. Across the board, UHICA's average increase this year was 30% and UHIC was only 12.5%. It seems to me that UHC definitely wants customers to not choose UHICA and instead go with the UHIC plan.

For today's rates for a 65 year old, male, non-smoker, with no household discount, but an autopay discount:
Plan G with Wellness Extras = $209.67
Plan G (no wellness) = $224.25

Oh, for Plan N, this situation is not the same:
Plan N with Wellness Extras = $178.71
Plan N (no wellness) = $148.64

Weird.

 

[big-papa]

Resurrecting this post a bit. I'm 9 months away from filing for Medicare, but I'm starting the detailed research now since I'm helping my best friend figure out his plan for a September sign up this year. He doesn't deal well with numbers and details of stuff like plan pricing.

I've skimmed thru this thread and don't see this situation specifically mentioned. Sorry if I missed it.

We both live in Pennsylvania. UHC/AARP rate increases for 2026 went into effect on June or July 1st. I can't tell for sure. As mentioned above in some posts, in PA, we see plans from both UHIC and UHICA. UHIC includes the Wellness Extras. UHICA does NOT include the Wellness Extras.

However, the monthly price of Plan G WITH the Wellness Extras (UHIC) is $14 LESS than the plan without them (UHICA). It actually saves money to add in the Fitness/Vision/Hearing/Dental add-on. Very weird.

I also have been using the SERFF filing database for Pennsylvania' rate increase process. Across the board, UHICA's average increase this year was 30% and UHIC was only 12.5%. It seems to me that UHC definitely wants customers to not choose UHICA and instead go with the UHIC plan.

For today's rates for a 65 year old, male, non-smoker, with no household discount, but an autopay discount:
Plan G with Wellness Extras = $209.67
Plan G (no wellness) = $224.25

Oh, for Plan N, this situation is not the same:
Plan N with Wellness Extras = $178.71
Plan N (no wellness) = $148.64

Weird.

Here in TX they deadpooled/closed the books on their Plan G without extras late last year. Basically that means they take no new enrollees. Then people (like my wife) who can easily pass underwriting "escape" the plan and move into the one "with extras". Over time, the remaining pool gets riskier and riskier with people who can't pass underwriting and rates then increase/spiral. By the time I signed up to start last month, it was no longer available and I went straight to the one "with extras".

Cheers.

 

[BubbaChris]

For today's rates for a 65 year old, male, non-smoker, with no household discount, but an autopay discount:
Plan G with Wellness Extras = $209.67
Plan G (no wellness) = $224.25

The Plan G with extras looks similar to mine. Here in Utah I'm paying $171.88 with the spouse discount for AARP Plan G. My coverage started in April.

Kind regards,
Chris

 

[audreyh1]

Mine will go up 15%. DH’s would have gone up 18% except that somehow his household discount was increased from 7% to 10% so the overall rate increase was 12%.