Some carriers are leaning more heavily into HMO networks in certain markets, meaning no out of network benefits. Most don’t require referrals (handled on the back end), but you still need to see an in-network provider.

Why are PPO options shrinking in some areas? In addition to recent Part D legislation, medical utilization and treatment costs have significantly increased, and some carriers are making HMO options more attractive to control cost by keeping members in network. Our local Blue Cross contact told us less than 2% of their claims are out of network. National brands like Aetna and Humana are national HMOs, meaning members can see in-network providers in other states.

It’s more important than ever that we have your updated prescription and provider lists, as networks and formularies are expected to change. Medical deductibles are becoming more common, prescription deductibles even more so. With hospital copays now close to or exceeding $400 per day, it’s worth discussing hospital indemnity plans, designed to help pay these unexpected costs for a reasonable monthly premium.

For Our Clients with Medicare Supplement and   Part D Plans

Medicare Supplement increases are getting higher by the day, recent actuarial data puts the average around 16% for Plan G and 15% for Plan N. In our region, Humana is raising rates on 11/1/26 by about $50 for Plan G and $20 for Plan N. Plan N has generally run more stable across carriers.

The difference between Plan G and Plan N: after the Part B deductible ($283 for 2026, projected to rise to $292 for 2027), Plan N caps doctor copays at $20 (can be less if the doctor doesn’t charge it) and $50 for the ER, but doesn’t cover Part B excess charges. That’s illegal in PA and a handful of states, legal everywhere else. Plan G covers the excess, though fewer than 2% of doctors nationwide charge it, capped at about 15% of Part B expenses, doctor and outpatient only, not the higher costing Part A services like hospital room and board.

For those concerned with rising premiums, Plan N is worth considering, and we’re happy to provide quotes.

Reminder: AEP does not affect Medicare Supplements. They can’t be freely changed in most states, only after medical underwriting, meaning acceptance and price aren’t guaranteed. This can be done any time of year, not just during open enrollment.

If you currently have Plan F or G, we recommend considering Plan N. Savings vary, but for someone saving around $700 a year, that’s roughly the equivalent of 35 maximum $20 office visit copays or 14 maximum $50 ER copays, keep in mind your actual copays could be lower.

Why are these plans increasing so much recently? A few factors stand out:

1. People are living longer, which is great, but it also means these insurance pools age and see more claims over time
2. Rising medical utilization and claims experience across the industry
3. Legislation like the IRA and the growing birthday rule trend add pressure industry wide, the same way a disaster in one state can raise insurance costs everywhere

The birthday rule lets a senior with a Medicare Supplement switch companies or downgrade plans each year within a specified window of their birthday, no underwriting required. Roughly 17 states have some version of this, and a few more, including New York, don’t underwrite (ask health questions) at all. Fewer companies offer this coverage in those states, and pricing runs noticeably higher, a 65 year old female in PA might pay around $130 for Plan N versus $300 or more in NY. Some in the industry expect notably steeper increases in states adopting these rules, roughly 40%. PA has not adopted the birthday rule for 2027.

Most Supplement companies are national brands, and losses in birthday rule states can contribute to higher costs for everyone they insure, even in states that want to stay competitive. Many clients are getting priced out into Advantage plans. If you’d like to discuss alternative Supplement options, or are entertaining switching to Advantage, we’re here to help!

For Our Clients with Standalone Part D Prescription Drug Plans

Since Medicare Supplements haven’t been permitted to offer prescription coverage since Part D began in 2006, most Supplement clients also need a standalone Part D plan. If you opt out, Medicare tracks the months without creditable prescription drug coverage and enforces a penalty when you later enroll in a drug plan.

For example, someone who went 120 full months without creditable coverage could face a penalty of 120 (months) x $41.33 (2027 national base premium) x 1%, or about $49.60 a month, added to whatever drug plan they enroll in for as long as they have Medicare drug coverage.

The maximum Part D deductible for 2027, both Advantage and standalone, is $700, and without the government subsidy, many plans are expected to change or be discontinued. Double check your drug coverage.

To check your drug coverage, watch our video walkthrough on how to input your medications and compare Part D plans, or use Medicare’s own tool at Medicare.gov, or call 1-800-MEDICARE directly. Whatever you decide, feel free to consult with us before finalizing anything so we can make sure you’re in the right plan

If you are entertaining Advantage plans, please reach out, as there are many nuances, such as which plans your providers currently accept.