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Predictions are the trend to enroll in Medicare Advantage plans will slow and MA plans will be forced to trim benefits. A recent article on MarketWatch provides more analysis.
Many seniors still like MA plans for their extra benefits and generally lower premium costs, but they don’t like limited networks, required referrals, deductibles and co-pays in some cases.
But that is not the problem.
According to the (10/4/25) article, “The market (for insurers) remains lucrative as the government pays 22% more per Medicare Advantage enrollee, or about $83 billion a year more, than if that person had been enrolled in traditional Medicare, according to the Medicare Payment Advisory Commission, the independent federal agency that advises the U.S. Congress on issues affecting the Medicare program.”
MA plans were supposed to save Medicare money. Why the reverse was allowed to happen is questionable. Probably poor management, but no doubt politics as well.
In any case, sooner or later MA beneficiaries will pay more, receive fewer benefits or in some cases their plan will disappear.
Received my Kaiser MA “Annual Notice Of Change For 2026” the other day. The Monthly Plan Premium is going up by 41%, many of the copays are going up by 50% and the benefits have been reduced. This is for the Silver HMO plan.
Kaiser is very efficient and I’m sticking with them.
Unfortunately, regular Medicare is increasingly going to be subject to all the pre-approval nonsense of MA plans. Medicare is pushing Accountable Care Organizations which seek to reduce the cost of Medicare to the government. See:
https://www.cms.gov/priorities/innovation/key-concepts/accountable-care-and-accountable-care-organizations
The only advantage which regular Medicare users have over MA plans is that insurance companies are not involved in ACO operations as these are directly between providers and Medicare.
No, not that advantage, regular Medicare does not use networks, you are free to go anywhere in the country and you do not need any referrals.
Pre-approval is not nonsense. It is a valid cost containment measure and if done right a benefit to patients. There is some concern that Medicare if providing financial incentives to review organization.
There are easy pickings for savings if Medicare paid MA plans no more than the cost of basic Medicare.
Not all health care is necessary (about 25% is not according to doctor’s estimates) or effective.
I often wonder what people would think of cost management procedures if they were actually paying the bill as opposed to a third party – government or insurers or most often their employers.
Every system in the world employs some technique to control costs.
I will be looking for any changes to my mom’s MA plan. She is all about the $0 monthly payment besides the Medicare Part B amount. She also gets $$ quarterly for HSA type stuff, but the amount has gone down every year. She has to pay deductibles and copays. I am not sure she saves any money unless she doesn’t go to the dr much that year. I am not the financial person for her. Chris
Beginning Jan 1, 2026, Medicare Plan G will begin a pre-approval pilot program for 17 services in 6 states (Arizona, NJ, Ohio, Oklahoma, Texas and Washington). It will be interesting to see how the number of Medigap denials of these services compares with the denials by MA plans.
Nothing to do with Plan G it’s basic Medicare in those states for services that have long shown potential abuse or questionable medical value. Medigap pays on what Medicare approves. Medigap does not deny or require separate approvals.
The Medigap plan a person has, has no bearing on pre-approval processes.
Nevertheless, Medicare is implementing a new pre-approval plan that will require health care practicioners to jump through new hoops. Procedures include
Beginning January 1, 2026, certain medical procedures under Traditional Medicare will require prior authorization in six U.S. states. This means your healthcare provider must obtain approval from Medicare before performing specific services—otherwise, coverage may be denied.
This update also affects individuals with Medigap plans such as Plan G or Plan N, if they’re using Traditional Medicare coverage.
The change is part of a pilot initiative called WISeR (Wasteful and Inappropriate Services Reduction), which is designed to curb medical overuse and detect potential fraud.
https://www.resourcemedicare.com/post/new-medicare-changes-in-2026-prior-approval-required-for-these-17-services#:~:text=Beginning%20January%201%2C%202026%2C%20certain,overuse%20and%20detect%20potential%20fraud.
I thought this misinformation was addressed already in this forum back in July 2025 with the article titled “A major Medicare benefit just vanished.”
If anyone is interested in the truth, go to CMS official website, which clearly states the program is a six-year pilot and voluntary
What I stated is correct. All of it.
The article is misleading.
If a Medicare Advantage plan disappears, the members have the opportunity to switch to Medicare and Medigap without underwriting…
True, but the risk is that if that happens and MA beneficiaries have higher cost factors as MA plans claim, such transfers will drive up costs for Medigap plans.
Claims are claims, they always go somewhere. No underwriting simply means that members of the group of insured accepting those folks are at greater financial risk.
Agree, and we wonder how things will look in 5 years for MA plans. To add, premiums for 2026 Medigap plans in my state have a healthy increase.
In NH two Medicare Advantage insurers are leaving the state. Part of the reason is The Center for Medicare and Medicaid Services are onto these insurers coding their insureds as sicker then they actually are to get higher subsidies.
It’s ironic that over the past several years there were rumors the government was going to force traditional Medicare insureds to change to Medicare Advantage plans. Seems like pretty soon there will be little to no insurers in states.
All going up considerably, plus our Part D quadrupled for 2026.
NYS increases are out of control.
My Part D has gone up, but by much less than that. i’m waiting for the data to show up on the Medicare web site in mid-October to compare plans. Thanks to medical underwriting I can’t change my Medigap plan.
Speaking of increases, I was hoping for your perspective, @RDQ:
https://humbledollar.com/forum/unhealthy-inflation-expectations/
Inflation has long trended higher for health care. Even when I was working we used an 8% annual trend rate, but that is just one factor in premium increases. Utilization by any group is the biggest driver. Those costs are driven by the price of services and the intensity of the care meaning high use of high tech procedures and in-patient care and volume of care.
Profit by insurers is not a big factor in the premium. Their total profit is driven by volume of contracts, not individual contract premium margins. And, when you see the profits of some major carriers, much of the total profit is driven by other lines of business.