Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
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Common concerns in shopping for funds and for health insurance
Double whammy given all health plans' substantial default rise next year due to the administration's awful attitude toward ACA
Honestly, I didn't think that bad attitude was that much of a factor. But it turns out that this attitude (in the form of "we won't extend enhanced subsidies") by itself added 4% to premiums. Not to mention the cost of losing those subsidies.
This 4% extra increase is the result of healthier people who previously had enhanced subsidies losing them and deciding to go without insurance. The remaining pool of insured people are on average sicker and more costly to cover.
This is also what some people in government were hoping for when they dropped the penalty for not having insurance down to $0.
The amount insurers charge for ACA Marketplace premiums is rising for several reasons, including but not limited to increasing hospital costs, the rising popularity of expensive GLP-1 drugs like Ozempic, and the threat of tariffs. These factors are similarly cited by insurers selling employer coverage. However, an additional factor driving up the amount insurers charge for ACA Marketplace premiums (that is not affecting employer premiums) is the expected expiration of the enhanced premium tax credit. In their 2026 filings to state regulators describing their requested premium increases, ACA Marketplace insurers said they would charge about 4 percentage points more, on average, than they otherwise would have because they expected healthier people to drop Marketplace coverage if enhanced premiums tax credit expire.
You can go back to Original Medicare + Medigap w/o underwriting if 1) You move to another county or a state that doesn't offer your Advantage. 1) Your Advantage is cancelled.
Medigap Guaranteed Issue When you move, you can enroll in a new Medicare Advantage plan in your new zip code or choose to return to Original Medicare and apply for a Medigap policy. Moving out of your Medicare Advantage plan’s service area opens up a Guaranteed Issue window for Medigap plans, meaning you could apply for a Medigap plan without having to answer health questions.
As mentioned above, moving out of your Medicare Advantage plan’s service area opens up a Guaranteed Issue window for enrolling in a new Medigap plan without underwriting. This GI window starts 60 days before your existing coverage ends and ends 63 days after your coverage ends.
If your current Medicare Advantage plan is leaving Medicare or stops being offered in your area, you may also have a guaranteed issue right to buy a Medicare supplement policy (Medigap) without going through medical underwriting.
@msf: This 4% extra increase is the result of healthier people who previously had enhanced subsidies losing them and deciding to go without insurance. The remaining pool of insured people are on average sicker and more costly to cover.
I dream of a 4% annual increase. Currently, without my CGs included, I'm estimating the cost for my Anthem health plan (same features as this year) will be 50-60% higher. I'm a fairly healthy and active person (not yet Medicare age) and I don't really complain much, but it's hard to justify that increase simply for an annual checkup, shots, and bloodwork. Anyway, I will diligently pay up since the Wheel of Fate tends to favor more visits to the doc as we age. Place your bets!
I agree with you that the risk of something bad happening is just too great to go without coverage. I'm not the type of person who bets double or triple leveraged funds.
There are at least four different sources of increases in what you pay. Two are factors that raise premiums and so affect "gross" cost. Two are factors that reduce subsidies, affecting the "net" cost that you pay.
Premiums are going up 22% due to a variety of general health reasons including covering expensive weight loss drugs.
Premiums are going up an additional 4% due to government policies encouraging healthy people to drop coverage.
Subsidies are going down generally because the government is letting enhanced subsidies expire.
Your income related subsidies are going down because your income on paper is going up.
It sounds like you're talking about a combination of the first three - a 26% increase in premiums coupled with a loss of subsidy support. If that's the case, then as absurd as it sounds, consider yourself lucky. The KFF paper reports that the average increase is 114% (i.e. net premiums more than double).
Comparing pricing on medicare.gov for Plan-G Medigap. We will not be signing up until late 2026 at earliest.
If all Plan-G cover exactly the same by law (I am told), why would anyone choose other than the cheapest plan? (Attained age and community pricing held constant.)
I see plans from ~$140/mo all the way to $600+ per month. What is the practical difference?
some plans are from insurers that I have never heard of, that does make me uneasy.
@msf: It sounds like you're talking about a combination of the first three - a 26% increase in premiums coupled with a loss of subsidy support. If that's the case, then as absurd as it sounds, consider yourself lucky. The KFF paper reports that the average increase is 114% (i.e. net premiums more than double).
Oh, I'm so lucky! (/sarcasm)
I feel our post-tax healthcare costs (or HCSP pre-tax) are inching toward the cost/tax of Canadian social medicine (Universal Health Care) - about $6K/personyear. I'll have to compare costs with my relatives in Toronto next year.
Comparing pricing on medicare.gov for Plan-G Medigap. We will not be signing up until late 2026 at earliest.
If all Plan-G cover exactly the same by law (I am told), why would anyone choose other than the cheapest plan? (Attained age and community pricing held constant.)
I see plans from ~$140/mo all the way to $600+ per month. What is the practical difference?
some plans are from insurers that I have never heard of, that does make me uneasy.
@DrVenture Medigap Plan G is the Cadillac. The only thing that it does not cover is the Part B deductible, which in 2025 is $240. Once you pay that, Plan G covers the rest of your approved Medicare costs for the year.
Medicare Plan N is good. Again, you pay the $240 Part B deductible. Plan N has what is called Part B Excess Charges (providers can bill excess charges (up to 15%), though in practice, most don’t. Over 95% of U.S. doctors who see Medicare patients accept assignment). Some states do not allow Excess Charges. I know someone who resides in a state that does allow Excess Charges and in 10 years, she has never been billed for these charges. Also with Plan N, you are responsible for a $20 doctor visit and up to $50 for an ER visit if you are not admitted (25% - 30% less than G?).
High-deductible G has the same benefits as G, but you must first pay an annual deductible before the plan begins paying. For 2025, that deductible is $2,800. The monthly premium for HD-G is considerably less than G (65% Less?).
Yes, by law, each companies G must provide the same benefits. Same with N, HD-G and so on. My opinion is to stay with a name brand company. You want one that has good customer service, has a good reputation for processing claims, is financially strong, etc. You will find a name brand company that will be very competitive. Ask your doctors/hospitals which insurance companies they like best (the ones that pay claims promptly!). What you don’t want to happen is to end up with a “bad” company, you have a bad year medically, and you have to go through underwriting to change carriers. You may be stuck with the bad company.
Post and/or read some threads on the Bogleheads forum. Very knowledgeable people regarding Medicare and these three different plans.
Plan G Medigap plans have different prices because although the benefits are standardized by the government, the premiums are set by private insurance companies. These companies use various factors to determine costs, including your age, location, gender, and tobacco use, and they have their own pricing methods, such as attained-age, issue-age, or community-based ratings. Other factors like company expenses, health underwriting, and discounts also cause price variations.
Some Medigap insurers can stop offering coverage in your state. If that happens, you can switch to another Plan G policy without medical underwriting. When I researched this years ago, most agents advised choosing a reliable, financially strong company that: * Has offered Medigap for decades and is likely to stay in your state long-term. * Has a larger policyholder pool, which often leads to smaller annual rate increases. * Offers coverage in multiple states, so your policy travels with you if you move.
I couldn’t find any reliable resource that tracks the historical rate increases for Medigap policies over the years.
Comments below on Medigap are from what I remember from helping someone a couple of years ago. Little time to check all of the details now, so not everything may be spot on:
IMHO what is most important is type of pricing, attained age, issue age or community pricing. It's hard to control for age because you don't know how quickly attained age policies will increase rates for each extra year of age. OTOH if you ever switch policies, I think you reset your issue age with the new policy.
As I recall, plans get around community rating by offering discounts based on age. Sort of like saying: here's the price of a gallon of gas, but we'll give you a discount if you pay cash. So you really have to dig into the pricing details.
Regarding excess charges, terms of art to know are "participating", "nonparticipating", and "opt out". Providers who "opt out" have opted out of Medicare and cannot provide service. While that sounds the same as "nonparticipating", nonparticipating means that they are allowed to impose excess charges. In all but 8(?) states nonparticipating providers can charge, as Mona wrote, 15% extra. Some of those eight forbid any excess charges, while others allow a smaller amount. For example, NYS allows 5%.
While Medigap policies are standardized, for the past several years they have been allowed to offer extra benefits similar to Medicare Advantage plans. Gym memberships, vision care, etc. All Medigap Plan Gs are equal; some are more equal than others.
Since I've no experience with using Medigap plans, I'll phrase this as a question. What difference does the quality of the insurer make to you? Some insurers are particularly slow and that can put a burden on the provider waiting for payment - that affects the provider, not you. True it can even be annoying to have to wait months for the EOBs to arrive. Other than that, what difference does the quality of the Medigap insurer make? They don't determine whether a service is covered. Medicare does that. They just fill in the gaps.
My interest in this subject is limited, because our health insurance is provided through the City of San Francisco contract with Blue Cross of California.
But it seems to me that this subject is so important, and also so complex, that all of the posting work shown here is so important that if possible MFO should retain it for future reference in a separate permanent category.
I note that two categories are no longer in actual use- "The Bullpen", and "The OT Bullpen". I wonder if it's possible to rename one of those, discard all of the existing content, and transfer this thread there as a "starter". I believe that it would add significant value to MFO as an information resource, and might be relatively easy for Chip to handle.
I will attempt to ask David if he thinks that this would be possible.
@msf Over the past few years, I have tried to track the pricing of community rated, issue age rated, and attained age rated Medigap Plan N policies, but I haven’t found any pattern I can understand. It seems nearly impossible to determine definitive reasons for the differences in pricing.
For example, I have a friend on Medigap Plan N who is 70 years old. For most of 2025, she paid $116 per month. Recently, Aetna announced a new premium of $142, a 22.5% increase. After going through underwriting, she was able to switch to Cigna for $114 per month.
You wrote:
"True it can even be annoying to have to wait months for the EOBs to arrive. Other than that, what difference does the quality of the Medigap insurer make? They don't determine whether a service is covered. Medicare does that. They just fill in the gaps."
For someone who is 70, 80, 90, or 100, especially if their health isn’t great, receiving calls and bills from the hospital, even though they are not legally responsible for payment, can be confusing, frustrating, and stressful.
Let's say that you choose a financially unstable insurer that offers a low premium for a Medigap Plan N policy to attract business. A year later, on your birthday, the insurer sharply increases premiums, perhaps by 50%, to cover losses, well above what a highly rated, stable insurer charges. If you’ve had high medical usage or are in poor health, you may not be able to pass underwriting with another insurer for a Medigap Plan N. What options do you have then?
Of course, this isn’t to suggest it couldn’t happen with a financially stable insurer (as my Aetna Plan N example shows), but it is likely less common.
For someone who is 70, 80, 90, or 100, especially if their health isn’t great, receiving calls and bills from the hospital, even though they are not legally responsible for payment, can be confusing, frustrating, and stressful.
True enough. Sometimes knowing some magic words can help. A few years ago I helped someone who was billed an extra $1/2M by a standby surgeon. I suggested that they ask the surgeon's office for papers where the patient signed off on the potential charges. Otherwise the patient would file a balance billing complaint. That seemed to do the trick - the surgeon's office went silent.
Nevertheless it still creates a lot of stress for the person who thinks they are on the hook or is getting hounded for something they know they don't owe.
Let's say that you choose a financially unstable insurer that offers a low premium for a Medigap Plan N policy to attract business. A year later, on your birthday, the insurer sharply increases premiums, perhaps by 50%, to cover losses, well above what a highly rated, stable insurer charges.
This is a good example of where I see similarities between selecting investments and selecting insurers. Either way, you can pay up a bit for peace of mind: higher premiums to established insurer for more stable rates; lower return asset class for less volatility.
In some states, there are state regulators that watch out for rate manipulation and protect residents. Georgia does not seem to be among them.
State insurance departments review and approve all Medigap rate increase requests, but approval standards vary dramatically between states. California requires extensive justification for increases above 10%, while states like Florida approve most reasonable requests without extensive review. Some states like New York prohibit age-based increases entirely, while others allow companies to implement both inflation and age-related adjustments simultaneously. These regulatory differences explain why identical Medigap plans from the same company can have completely different rate increase patterns based on your location.
our health insurance is provided through the City of San Francisco contract with Blue Cross of California.
I sort of guessed that from your description of SF insurance company changes. For additional "fun", take a look at how NYC has been trying to change its retirees coverage for years. If you're not experiencing the plan yourself, it's hard to understand the current plan let alone the replacement plan. ISTM that both sides (city and retirees, with unions in the middle) are hyperventilating, exaggerating the problems with the other side. For the moment the status is: no change.
If not mentioned above, several companies such as Aetna offers discounts on their medigap plans if 2 household members or both spouses are insured by them. We were able to swing a 12% discount on each of our (wife and I) plans with Aetna. You would have to confirm this availability in your location though and when they apply in your situation.
I do not know anything about MGH PPO. My experience with the Harvard Hospitals was in medical school ( 1978) but I have kept touch with several good friends on the faculty.
As I understand it Harvard Pilgrim is pretty good, at least one of my doctor friends is satisfied.
While MGH has always had a stellar reputation (Mankind's Greatest Hospital etc) their tactics recently trying to lock PCPs out, Union busting and playing hard ball would give me serious pause to have anything to do with them. One of our family sees a specialist there and they have been told "No more telehealth" and it is enforced
My contacts are all at the BI which was always friendly and excellent. They have been forced into a series of mergers which may or not work.
Comments
Honestly, I didn't think that bad attitude was that much of a factor. But it turns out that this attitude (in the form of "we won't extend enhanced subsidies") by itself added 4% to premiums. Not to mention the cost of losing those subsidies.
This 4% extra increase is the result of healthier people who previously had enhanced subsidies losing them and deciding to go without insurance. The remaining pool of insured people are on average sicker and more costly to cover.
This is also what some people in government were hoping for when they dropped the penalty for not having insurance down to $0. https://www.kff.org/quick-take/aca-insurers-are-raising-premiums-by-an-estimated-26-but-most-enrollees-could-see-sharper-increases-in-what-they-pay/
1) You move to another county or a state that doesn't offer your Advantage.
1) Your Advantage is cancelled.
See https://boomerbenefits.com/what-to-do-when-moving-to-another-state-with-medicare/
Medigap Guaranteed Issue
When you move, you can enroll in a new Medicare Advantage plan in your new zip code or choose to return to Original Medicare and apply for a Medigap policy. Moving out of your Medicare Advantage plan’s service area opens up a Guaranteed Issue window for Medigap plans, meaning you could apply for a Medigap plan without having to answer health questions.
As mentioned above, moving out of your Medicare Advantage plan’s service area opens up a Guaranteed Issue window for enrolling in a new Medigap plan without underwriting. This GI window starts 60 days before your existing coverage ends and ends 63 days after your coverage ends.
Advantage cancelled; see (link).
If your current Medicare Advantage plan is leaving Medicare or stops being offered in your area, you may also have a guaranteed issue right to buy a Medicare supplement policy (Medigap) without going through medical underwriting.
I dream of a 4% annual increase. Currently, without my CGs included, I'm estimating the cost for my Anthem health plan (same features as this year) will be 50-60% higher. I'm a fairly healthy and active person (not yet Medicare age) and I don't really complain much, but it's hard to justify that increase simply for an annual checkup, shots, and bloodwork. Anyway, I will diligently pay up since the Wheel of Fate tends to favor more visits to the doc as we age. Place your bets!
I appreciate your thoughts and info. Thx.
There are at least four different sources of increases in what you pay. Two are factors that raise premiums and so affect "gross" cost. Two are factors that reduce subsidies, affecting the "net" cost that you pay.
- Premiums are going up 22% due to a variety of general health reasons including covering expensive weight loss drugs.
- Premiums are going up an additional 4% due to government policies encouraging healthy people to drop coverage.
- Subsidies are going down generally because the government is letting enhanced subsidies expire.
- Your income related subsidies are going down because your income on paper is going up.
It sounds like you're talking about a combination of the first three - a 26% increase in premiums coupled with a loss of subsidy support. If that's the case, then as absurd as it sounds, consider yourself lucky. The KFF paper reports that the average increase is 114% (i.e. net premiums more than double).If all Plan-G cover exactly the same by law (I am told), why would anyone choose other than the cheapest plan? (Attained age and community pricing held constant.)
I see plans from ~$140/mo all the way to $600+ per month. What is the practical difference?
some plans are from insurers that I have never heard of, that does make me uneasy.
Oh, I'm so lucky! (/sarcasm)
I feel our post-tax healthcare costs (or HCSP pre-tax) are inching toward the cost/tax of Canadian social medicine (Universal Health Care) - about $6K/personyear. I'll have to compare costs with my relatives in Toronto next year.
Medicare Plan N is good. Again, you pay the $240 Part B deductible. Plan N has what is called Part B Excess Charges (providers can bill excess charges (up to 15%), though in practice, most don’t. Over 95% of U.S. doctors who see Medicare patients accept assignment). Some states do not allow Excess Charges. I know someone who resides in a state that does allow Excess Charges and in 10 years, she has never been billed for these charges. Also with Plan N, you are responsible for a $20 doctor visit and up to $50 for an ER visit if you are not admitted (25% - 30% less than G?).
High-deductible G has the same benefits as G, but you must first pay an annual deductible before the plan begins paying. For 2025, that deductible is $2,800. The monthly premium for HD-G is considerably less than G (65% Less?).
Yes, by law, each companies G must provide the same benefits. Same with N, HD-G and so on. My opinion is to stay with a name brand company. You want one that has good customer service, has a good reputation for processing claims, is financially strong, etc. You will find a name brand company that will be very competitive. Ask your doctors/hospitals which insurance companies they like best (the ones that pay claims promptly!). What you don’t want to happen is to end up with a “bad” company, you have a bad year medically, and you have to go through underwriting to change carriers. You may be stuck with the bad company.
Post and/or read some threads on the Bogleheads forum. Very knowledgeable people regarding Medicare and these three different plans.
Some Medigap insurers can stop offering coverage in your state. If that happens, you can switch to another Plan G policy without medical underwriting.
When I researched this years ago, most agents advised choosing a reliable, financially strong company that:
* Has offered Medigap for decades and is likely to stay in your state long-term.
* Has a larger policyholder pool, which often leads to smaller annual rate increases.
* Offers coverage in multiple states, so your policy travels with you if you move.
I couldn’t find any reliable resource that tracks the historical rate increases for Medigap policies over the years.
IMHO what is most important is type of pricing, attained age, issue age or community pricing. It's hard to control for age because you don't know how quickly attained age policies will increase rates for each extra year of age. OTOH if you ever switch policies, I think you reset your issue age with the new policy.
As I recall, plans get around community rating by offering discounts based on age. Sort of like saying: here's the price of a gallon of gas, but we'll give you a discount if you pay cash. So you really have to dig into the pricing details.
Regarding excess charges, terms of art to know are "participating", "nonparticipating", and "opt out". Providers who "opt out" have opted out of Medicare and cannot provide service. While that sounds the same as "nonparticipating", nonparticipating means that they are allowed to impose excess charges. In all but 8(?) states nonparticipating providers can charge, as Mona wrote, 15% extra. Some of those eight forbid any excess charges, while others allow a smaller amount. For example, NYS allows 5%.
https://nyassembly.gov/write/upload/req/physician_charges.pdf?v=1726590590
While Medigap policies are standardized, for the past several years they have been allowed to offer extra benefits similar to Medicare Advantage plans. Gym memberships, vision care, etc. All Medigap Plan Gs are equal; some are more equal than others.
See, e.g. https://www.commonwealthfund.org/blog/2021/small-share-medicare-supplement-plans-offer-access-dental-vision-and-other-benefits-not
https://www.goodrx.com/insurance/health-insurance/medigap-gym-membership
Since I've no experience with using Medigap plans, I'll phrase this as a question. What difference does the quality of the insurer make to you? Some insurers are particularly slow and that can put a burden on the provider waiting for payment - that affects the provider, not you. True it can even be annoying to have to wait months for the EOBs to arrive. Other than that, what difference does the quality of the Medigap insurer make? They don't determine whether a service is covered. Medicare does that. They just fill in the gaps.
But it seems to me that this subject is so important, and also so complex, that all of the posting work shown here is so important that if possible MFO should retain it for future reference in a separate permanent category.
I note that two categories are no longer in actual use- "The Bullpen", and "The OT Bullpen". I wonder if it's possible to rename one of those, discard all of the existing content, and transfer this thread there as a "starter". I believe that it would add significant value to MFO as an information resource, and might be relatively easy for Chip to handle.
I will attempt to ask David if he thinks that this would be possible.
For example, I have a friend on Medigap Plan N who is 70 years old. For most of 2025, she paid $116 per month. Recently, Aetna announced a new premium of $142, a 22.5% increase. After going through underwriting, she was able to switch to Cigna for $114 per month.
You wrote:
"True it can even be annoying to have to wait months for the EOBs to arrive. Other than that, what difference does the quality of the Medigap insurer make? They don't determine whether a service is covered. Medicare does that. They just fill in the gaps."
For someone who is 70, 80, 90, or 100, especially if their health isn’t great, receiving calls and bills from the hospital, even though they are not legally responsible for payment, can be confusing, frustrating, and stressful.
Let's say that you choose a financially unstable insurer that offers a low premium for a Medigap Plan N policy to attract business. A year later, on your birthday, the insurer sharply increases premiums, perhaps by 50%, to cover losses, well above what a highly rated, stable insurer charges. If you’ve had high medical usage or are in poor health, you may not be able to pass underwriting with another insurer for a Medigap Plan N. What options do you have then?
Of course, this isn’t to suggest it couldn’t happen with a financially stable insurer (as my Aetna Plan N example shows), but it is likely less common.
True enough. Sometimes knowing some magic words can help. A few years ago I helped someone who was billed an extra $1/2M by a standby surgeon. I suggested that they ask the surgeon's office for papers where the patient signed off on the potential charges. Otherwise the patient would file a balance billing complaint. That seemed to do the trick - the surgeon's office went silent.
Nevertheless it still creates a lot of stress for the person who thinks they are on the hook or is getting hounded for something they know they don't owe.
Let's say that you choose a financially unstable insurer that offers a low premium for a Medigap Plan N policy to attract business. A year later, on your birthday, the insurer sharply increases premiums, perhaps by 50%, to cover losses, well above what a highly rated, stable insurer charges.
This is a good example of where I see similarities between selecting investments and selecting insurers. Either way, you can pay up a bit for peace of mind: higher premiums to established insurer for more stable rates; lower return asset class for less volatility.
In some states, there are state regulators that watch out for rate manipulation and protect residents. Georgia does not seem to be among them. https://davesilverinsurance.com/how-to-compare-medigap-insurance-rate-increases/
I sort of guessed that from your description of SF insurance company changes. For additional "fun", take a look at how NYC has been trying to change its retirees coverage for years. If you're not experiencing the plan yourself, it's hard to understand the current plan let alone the replacement plan. ISTM that both sides (city and retirees, with unions in the middle) are hyperventilating, exaggerating the problems with the other side. For the moment the status is: no change.
https://www.thecity.nyc/2025/06/20/medicare-advantage-unions-eric-adams/
I do not know anything about MGH PPO. My experience with the Harvard Hospitals was in medical school ( 1978) but I have kept touch with several good friends on the faculty.
As I understand it Harvard Pilgrim is pretty good, at least one of my doctor friends is satisfied.
While MGH has always had a stellar reputation (Mankind's Greatest Hospital etc) their tactics recently trying to lock PCPs out, Union busting and playing hard ball would give me serious pause to have anything to do with them. One of our family sees a specialist there and they have been told "No more telehealth" and it is enforced
My contacts are all at the BI which was always friendly and excellent. They have been forced into a series of mergers which may or not work.