2026-04-22 05:00:12 EDT / 哥伦比亚广播公司新闻 / KFF健康新闻
从事保险销售数十年以来，伊利诺伊州的经纪人约翰·贾吉从未见过这样的情况。
去年8月，他名下80多位投保丘博保险公司同款医疗保险附加险的客户，保费直接上涨了45%。
“我做经纪人这49年来，从未见过保费涨幅直接全员生效，而不是等到保单周年日才执行，”贾吉说道。他的经纪公司正忙着为客户寻找更实惠的替代方案。这类保险用于支付传统医疗保险未覆盖的免赔额和其他费用，如果没有这类附加险，消费者每年需要自付的医疗费用将没有上限。
虽然45%的涨幅异乎寻常地高，但贾吉和其他经纪人表示，医疗保险附加险（又称Medigap）保费出现两位数上涨已经成为常态。
丘博保险公司的发言人未回应置评请求，未就此次保费上涨发表看法。
超过1200万人——约占传统医疗保险参保人数的43%——购买了医疗保险附加险。其他人则依靠退休后雇主提供的保险或其他后备保障。据KFF数据，约13%的传统医疗保险参保者没有补充保险，这意味着如果患上重病，他们可能面临巨额医疗费用支出。
在补充保险市场，继去年的大幅上涨之后，费率似乎再次攀升。内布拉斯加州咨询公司Telos Actuarial的数据显示，2026年第一季度，安泰、蓝十字蓝盾、信诺、哈门那、奥马哈相互保险公司以及联合健康集团等机构向各州保险专员提交的备案文件显示，最常见的G计划附加险保费涨幅从略高于12%到超过26%不等。
“虽然这一数据集仅覆盖了部分州的少数保险公司，但这表明，鉴于理赔经验面临上行压力，保险公司正试图调整保费费率，”Telos公司的咨询精算师布雷特·穆谢特说道。
保费持续攀升
保费费率因所选保障类型、参保者居住地和年龄而异。据KFF数据，2023年G计划参保者的月均保费为164美元，这一数字此后可能有所上涨。
“在俄亥俄州等一些州，医疗保险附加险多年来的年度涨幅一直维持在3%至5%，现在则达到了10%至15%，”阿曼达·布鲁顿说道。她是医保解决方案公司Medicare Answers Now的所有者，该公司的客户为销售代理人。
据保险代理人帕特里夏·麦克向KFF健康新闻提供的费率表显示，阿拉斯加的普雷梅拉蓝十字公司今年将其G计划保单的保费提高了近12%，她还表示另一家保险公司的涨幅接近13%。
位于瓦西拉的阿拉斯加保险福利公司所有者麦克举例说，去年每月需支付172美元G计划保费的65岁女性，现在每月保费将达到192美元。
普雷梅拉发言人考特尼·华莱士在电子邮件中表示，医疗保险每年都会调整免赔额和共付费率，这会影响覆盖这些上涨费用的补充保险计划。
华莱士还提到，该公司的会员医疗服务使用率有所上升，“这进一步推高了理赔成本，最终影响了保费”。
经纪人和保险政策专家将保费上涨归咎于一系列因素：参保者医疗服务使用量增加、人口老龄化、劳动力和医疗成本上升、部分州针对医疗保险附加险的监管规定，以及人们加入或退出私人医疗保险优势计划。
“五年前，保险公司保费涨幅超过10%的情况极为罕见。现在，涨幅低于10%的情况反倒少见，涨幅超过20%则并不稀奇，”位于达拉斯的人寿和健康保险公司Integrity的政府事务副总裁查伦·杰克逊说道。
伊利诺伊州福赛斯市Jaggi Petry保险与投资公司的联合所有者贾吉表示，他最终为80多位遭遇大幅涨价的客户找到了其他方案，而涨价的这家保险公司此前曾是成本最低的选择。但这并非易事——而且预计保费还会持续上涨。
“这些涨幅令人难以置信，”贾吉说道，他表示今年多家保险公司的保费涨幅都超过了15%。
保险政策专家提出了一些可能的解决方案，包括国会为医疗保险参保者的自付费用设置上限，或补贴医疗保险附加险的购买费用。
“传统医疗保险是唯一没有自付费用上限的联邦健康保险项目，”参议员罗恩·怀登（俄勒冈州民主党）在电子邮件中写道，并补充说，该项目“需要更新和加强，以保护美国老年人的医保保障权益”。
但在当前的立法环境下，需要国会批准的医保改革举措不太可能通过，尤其是增设自付费用上限会增加联邦预算开支。
后续影响
人们通常在65岁时有资格参加医疗保险。参保者在首次加入传统按服务收费医保项目后的六个月内，可以按标准费率购买医疗保险附加险，无需回答健康相关问题。
此后，参保者申请或更换医疗保险附加险将受到严格规定限制，可选方案大幅减少，且通常都需要权衡取舍或做出艰难选择。
至少有16个州实施了所谓的“生日规则”，要求保险公司每年允许已参保医疗保险附加险的人更换其他补充保险计划——通常在其生日前后——且无需进行健康核保。这些规定可以帮助包括有健康状况的消费者在内的人群更换保险。
另有四个州——康涅狄格州、马萨诸塞州、缅因州和纽约州——要求保险公司全年或在年度注册期内为所有申请人提供至少一种医疗保险附加险政策，具体取决于各州规定。无论参保者健康状况如何，都允许更换保险。
面临高额医疗保险附加险费用的另一个选择是退出传统医疗保险，加入私人医疗保险优势计划，这类计划设有自付费用上限。但加入该计划意味着参保者通常只能使用指定网络内的医生和医院。如果参保者改变主意，想要转回传统医疗保险，他们只有12个月的窗口期，可以在无需通过健康问题审核的情况下购买医疗保险附加险。超过这个时间后，难度会更大。
“很多人不知道，如果参加了一年的医疗保险优势计划，他们可能会被医疗保险附加险计划拒保，或因既往病史被收取高额保费，这实际上让许多人被困在医保优势计划中，”自由派智库美国进步中心的研究助理布莱恩·凯泽说道，他也是近期一份相关报告的合著者。
也有一些例外情况。例如，如果医疗保险优势计划退出某个市场或离开医保项目，其参保者可以有资格购买补充保险，无需回答健康问题或因既往病史被收取更高保费。
据KFF数据，仅今年一年，就有约260万人因保险公司退出所在市场而失去了医疗保险优势计划的保障，另有超过100万人将在2025年失去保障。明尼阿波利斯市专注于老年人保险的市场研究机构Deft Research的总裁乔治·迪佩尔表示，许多人转而选择了其他医保优势计划，但“约44万人转向了医疗保险附加险政策”，有时是因为他们所在地区没有其他医保优势计划。Deft Research是达拉斯的Integrity公司的子公司。
一些医保专家指出，无论何时保险公司在不考虑参保者健康状况的情况下为其办理参保手续——无论是因为生日规则，还是因为参保者的医保优势计划退出市场，使其符合免健康核保的豁免条件——都可能使保险公司面临更高的医疗服务使用率和成本，进而更有可能全面提高保费以抵消可能的财务损失。
经纪人提到的另一种降低成本的选择是考虑两种带免赔额的医疗保险附加险，目前年度免赔额略低于3000美元。与覆盖更大比例年度自付费用的附加险相比，这类计划的月保费要低得多。
不过，“很多人无法接受3000美元的免赔额，”麦克说道。
KFF健康新闻是一家致力于健康议题深度报道的全国性新闻编辑部，也是独立健康政策研究、民调与新闻机构KFF的核心运营项目之一。
Medigap premiums leap, and consumers have few alternatives
2026-04-22 05:00:12 EDT / CBS News / KFF Health News
After decades of selling insurance, Illinois-based broker John Jaggi had never seen anything like it.
More than 80 of his customers who were enrolled in the same Medicare supplemental plan from the insurer Chubb got hit last August with a 45% increase.
“In my 49 years of doing biz as a broker, I’ve never seen a premium increase be effective immediately on everyone, instead of on their policy anniversary,” said Jaggi, whose brokerage scrambled to find more affordable options for clients. The policies pick up deductibles and other costs not covered in traditional Medicare, and without one there is no upper limit on how much a consumer might owe each year.
While 45% was an unusually big jump, Jaggi and other brokers say double-digit premium increases for Medicare supplemental, or Medigap, policies are becoming the norm.
A Chubb spokesperson did not respond to requests for comment on the increase.
More than 12 million people — about 43% of those in traditional Medicare — buy a Medigap policy. Others rely on some sort of retiree employer coverage or a different backup. About 13% of people in traditional Medicare don’t have supplemental coverage, according to KFF, meaning they could be vulnerable to large costs if they have a serious illness.
In the supplemental market, following big increases last year, rates appear to be rising again. In early 2026 filings with state insurance commissioners from Aetna, Blue Cross Blue Shield, Cigna, Humana, Mutual of Omaha, and UnitedHealthcare, rate increases for Plan G policies — the most commonly purchased supplement type — ranged from just over 12% to more than 26% in the first quarter, according to Nebraska-based consulting firm Telos Actuarial.
“While this is a small dataset across a select number of states, it’s an indication that carriers are looking to correct their premium rates in light of upward pressure on their claims experience,” said Brett Mushett, a consulting actuary with Telos.
Climbing numbers
Premium rates vary based on the type of coverage chosen, where a beneficiary lives, and their age. For Plan G coverage, beneficiaries paid an average monthly premium of $164 in 2023, according to KFF. That amount has likely risen since.
“In some states, like Ohio, Medicare supplements for years would have a 3% to 5% year-over-year increase. Now it’s 10% to 15%” said Amanda Brewton, owner of Medicare Answers Now, a marketing organization whose clients are sales agents.
In Alaska, Premera Blue Cross raised the premiums on its Plan G policies by nearly 12% for this year, according to rate sheets provided to KFF Health News by insurance agent Patricia Mack, who said another insurer raised rates by nearly 13%.
For example, a 65-year-old woman who last year would have been charged $172 a month for a Plan G policy would now face a monthly rate of $192, said Mack, who owns Alaska Insurance Benefits in Wasilla.
Premera spokesperson Courtney Wallace said in an email that Medicare makes changes to deductible and copayment rates each year, which affects supplemental plans that cover those increasing amounts.
Wallace also noted that the insurer saw higher medical service use among its members, “which further drove claims costs and ultimately impacted premiums.”
Agents and policy experts blame a range of factors for rising premiums: an increase in use of medical services by beneficiaries; aging of the population; increases in labor and medical costs; rules in some states governing Medigap plans; and people’s enrolling in — or getting out of — private Medicare Advantage plans.
“Five years ago, it was exceedingly uncommon to have a carrier with a rate increase of more than 10%. Now it’s very uncommon to see a rate increase below 10%, and it’s not uncommon to see it over 20%,” said Chalen Jackson, vice president for government affairs at Integrity, a Dallas-based company that sells life and health insurance.
Jaggi, who co-owns Jaggi Petry Insurance & Investments in Forsyth, Illinois, said he eventually found other options for many of those 80-plus clients with the large increase, which came from an insurer that had previously been the lowest-cost option. But it wasn’t easy — and continuing increases are expected.
“These are unbelievable increases,” said Jaggi, who said he is seeing premium hikes exceeding 15% this year across a range of insurers.
Policy experts have outlined possible solutions, including for Congress to cap out-of-pocket costs for Medicare beneficiaries or subsidize the purchase of Medigap coverage.
“Traditional Medicare is the only federal health insurance program without an out-of-pocket cap,” Sen. Ron Wyden (D-Ore.) wrote in an email, adding that the program “needs to be updated and strengthened to protect the Medicare guarantee for American seniors.”
But making changes to Medicare that require congressional approval is unlikely in the current legislative environment, especially because adding an out-of-pocket cap would add costs to the federal budget.
How this plays out
People generally qualify for Medicare when they turn 65. Beneficiaries have six months after they initially enroll in the traditional fee-for-service program to purchase a Medigap plan at standard rates without having to answer health-related questions.
Strict rules then kick in around when beneficiaries can enroll in or switch Medigap coverage and options become much more limited, with each one generally involving trade-offs or tough choices.
At least 16 states have what’s known as a “birthday rule,” which requires insurers once a year to allow people enrolled in a Medigap plan to change to different supplemental coverage — usually around their birthdays — without being medically underwritten. Those rules can help consumers, including those with health conditions, to switch.
An additional four states — Connecticut, Massachusetts, Maine, and New York — require insurers to offer at least one Medigap policy to all applicants either year-round or during an annual enrollment period, depending on the state. Changes are allowed no matter the person’s health.
Another option for those facing high Medigap costs is to leave traditional Medicare and enroll in a private-sector Medicare Advantage plan, which have out-of-pocket caps. But joining one means beneficiaries must generally rely on a set of in-network doctors and hospitals. And if they change their mind and want to go back to traditional Medicare, they have only a 12-month window in which to purchase a Medigap plan without passing health questions. After that, it can be more difficult.
“A lot of people don’t know that if they are in Medicare Advantage for a year, they can get turned down by a Medigap plan or charged really high premiums because of a preexisting condition, which for many people effectively traps them in MA plans,” said Brian Keyser, a research associate at the liberal Center for American Progress and co-author of a recent report on the issue.
There are some exceptions. For example, if a Medicare Advantage plan withdraws from a market or leaves the Medicare program, its enrollees can qualify for a supplemental plan without being asked health questions or charged more for having preexisting conditions.
For this year alone, about 2.6 million people lost Medicare Advantage coverage when their insurer pulled out of their markets, according to KFF, and more than a million lost coverage for 2025. Many switched to other MA plans, but “somewhere around 440,000 of those people did go to a Medicare supplement policy,” sometimes because there was no other MA plan in their area, said George Dippel, president of Deft Research, a Minneapolis-based market research organization focused on insurance for older people. Deft is part of Integrity, the Dallas company.
Some Medicare experts note that anytime insurers enroll people whose health status they can’t consider — whether because of birthday rules or because their Medicare Advantage plan left the market and thus qualified them for an exemption from medical underwriting — it potentially exposes them to more health care utilization and higher costs, making them more likely to increase premiums across the board to offset the possible financial hit.
Another option mentioned by brokers for people looking to lower their costs is to consider one of the two types of Medigap plans that come with a deductible, which is currently just under $3,000 for a year. Those plans charge far lower monthly premiums than Medigap plans that pick up a much larger portion of annual amounts people must pay toward their Medicare services.
Still, “a lot of people are not comfortable with a $3,000 deductible,” Mack said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.