Still on Plan F? Here's Why Your Premium Keeps Going Up

The letter shows up around the same time every year. You open it, you find the new premium, and it is higher than last year. Nothing about your health changed. You did not file more claims. You did not move. You did not do anything differently at all.

And yet the number went up again.

If you are on Medicare Supplement Plan F, there is a specific reason for that, and it has almost nothing to do with you personally. It has to do with the other people in your plan.

This is the explanation nobody gives you at the kitchen table. It takes about ten minutes to read, and by the end you will understand exactly why your premium behaves the way it does and what your realistic options are.

Plan F is closed. That is the whole story.

In 2015, Congress passed a law called MACRA — the Medicare Access and CHIP Reauthorization Act. Buried inside it was a provision stating that beginning January 1, 2020, a Medicare Supplement policy that pays the Part B deductible could no longer be sold to anyone newly eligible for Medicare.

Plan F pays the Part B deductible. So does Plan C. That made both of them off-limits to anyone who aged into Medicare on or after that date.

If you already had Plan F, nothing was taken from you. You kept it. You can keep it for the rest of your life if you want to, and the coverage works exactly as it always has. Millions of people did exactly that and are still on it today.

But here is the part that matters: no new people can come in.

What happens to a pool when nobody new gets in

Think about the group of people who share your Plan F rate. Insurance companies call this a rate class or a block of business. Everyone in it was 65 or older before 2020. Which means every single one of them is now at least in their early seventies. Many are well past that.

Insurance pricing runs on averages. The company looks at what the whole group costs to insure, divides by the number of people in it, adds administrative expense and margin, and that is roughly your premium.

Now age that group by one year and take nobody in. Claims go up, because older people use more healthcare. That is not a moral judgment, it is just what bodies do. Meanwhile no 65-year-old walks through the door to average things down, because legally none can.

So the average claim per person rises. The premium follows.

Then it happens again the next year. And the next.

The industry calls this a closed block. When the effect compounds hard enough, people call it a rate spiral. Whatever you call it, the mechanism is the same, and the important thing to understand is that it does not level off on its own. An open block reaches a kind of equilibrium — new healthy people entering roughly offset the aging of the people already there. A closed block has no such mechanism. It only ages.

Why it compounds instead of leveling out

There is a second effect layered on top, and it is the one that makes closed blocks behave worse than simple aging would predict.

As the premium climbs, some people leave. Who leaves? Overwhelmingly, the healthy ones — because they are the people who can pass medical underwriting somewhere else. Someone managing several chronic conditions generally cannot move, so they stay.

The block does not just get older. It gets sicker, relative to where it started. Which pushes the average claim up faster, which pushes the premium up faster, which prompts the next round of healthy people to leave.

Actuaries have understood this dynamic for decades. It is not a scandal and it is not anyone cheating you. It is the predictable behavior of a pool that cannot replenish itself.

But it does mean something practical for you: the longer you stay, the more the composition of the group works against you.

How Medicare Supplements are actually priced in Tennessee

This is worth understanding, because it determines how much the closed-block effect shows up in your particular bill. Companies use one of three approaches.

Attained-age rating. Your premium is based on your current age and goes up as you get older, on top of any across-the-board rate increases. Most Medicare Supplements sold in Tennessee are priced this way. It starts out looking cheapest at 65 and climbs steadily.

Issue-age rating. Your premium is based on your age when you bought the policy. It does not increase simply because you had another birthday, though the company can still raise rates for the whole class.

Community rating. Everyone with that plan pays the same, regardless of age.

Here is why this matters to you. If you are on an attained-age policy inside a closed block, you are getting hit from two directions at once — your own age increase and the class-wide increase from a pool that keeps aging. Those stack.

If you do not know which type you have, that is a normal thing not to know. It is one of the first things we look up.

To be clear: your coverage is excellent

This is worth saying plainly, because people hear “your plan is closed” and assume they were sold something bad.

You were not. Plan F is the most complete Medicare Supplement ever offered in this country. It covers the Part A deductible, the Part B deductible, coinsurance and copays, excess charges, skilled nursing facility coinsurance, and foreign travel emergency care. You hand over a card at the doctor’s office and you generally do not get a bill afterward.

That is a genuinely good product, and there is a reason it was the most popular Medicare Supplement in the country for years running.

The problem is not the coverage. The problem is the math underneath the price.

“But I’ve been with them twelve years and never had a problem”

We hear this constantly, and we understand it. You have paid faithfully, they have paid their share, nobody has given you any grief. That feels like a relationship worth protecting.

Here is the uncomfortable truth: your loyalty is not what sets your rate. The block does. The company is not raising your premium because they stopped valuing you — they are raising it because the actuarial math of a closed pool says they have to. Staying another five years out of loyalty does not earn you anything, because there is no mechanism by which it could.

That is not a reason to be angry at the carrier. It is a reason to stop treating tenure as a factor in a decision where it genuinely isn’t one.

So what can you actually do about it?

Here is where we have to be honest with you, because a lot of what you hear on the radio skips this part entirely.

In Tennessee, you do not have an automatic right to switch.

Some states have what is called a birthday rule. In those states, for a window each year around your birthday, you can move to a different Medicare Supplement without answering any health questions at all. It is a guaranteed door, and it opens every year.

Tennessee does not have that rule. Neither do most states.

What that means for you is straightforward: outside of a few specific guaranteed-issue situations, moving from your current plan to a different one requires medical underwriting. The new company reviews your health history and decides whether to accept you, and at what rate.

That is not a reason to give up. It is a reason to find out where you stand before anybody fills out an application.

What underwriting actually looks at

People imagine this is more mysterious and more invasive than it is. In practice, most Medicare Supplement underwriting comes down to a fairly short list.

Your prescriptions. This is the big one. Companies run your medication history, and certain drugs signal conditions that affect the decision. This is also why the medication list is the first thing we ask for — it tells us more, faster, than almost anything else.

Recent hospitalizations. Generally the last two years, sometimes further back.

Anything scheduled or recommended but not yet done. A surgery on the calendar, a test your doctor ordered, a specialist referral you have not acted on yet. Pending is often treated more cautiously than resolved.

Specific conditions. Some are usually declines outright at most companies — end-stage renal disease, active cancer treatment, oxygen dependence, certain heart conditions. Others are reviewable depending on severity, control, and how long it has been stable: diabetes, COPD, atrial fibrillation, a past cardiac event.

Height and weight. Most companies publish a build chart with acceptance ranges.

Tobacco use. Affects rate, and at some companies affects acceptance.

Two things worth knowing. First, this varies significantly between companies. A condition that stops you cold at one carrier is routinely accepted at another. That variation is the entire reason a pre-qualification is worth doing — the answer is not “yes or no,” it is “yes at these companies and no at those.” Second, control matters more than diagnosis. Well-managed diabetes on a stable medication regimen reads very differently than a recent diagnosis with medications still being adjusted.

Start with a health pre-qualification, not an application

This is the step people skip, and skipping it is how you end up with a declined application in your file.

Here is what actually happens.

We ask questions, about fifteen minutes’ worth. Current medications and doses. Health events in the last few years. Anything scheduled. Height, weight, tobacco. Nothing invasive, no physical exam, no blood work.

We check your answers against current carrier guidelines. Every company publishes its own underwriting rules and they change. We look at which ones would likely accept you as you are today.

We pull current rates for your age and county. Tennessee rates vary by where you live, so a Knox County figure is not the same as a Blount or Loudon County figure.

We tell you what we found — including if the answer is unfavorable. If nothing available is meaningfully better, we say that.

No cost. No obligation. No application submitted, so nothing goes on any record anywhere. If you decide to do nothing, you have lost fifteen minutes and gained an accurate picture of your own situation.

If you did move, what would you move to?

Usually Plan G, and the difference is smaller than most people expect.

Plan G covers everything Plan F covers with exactly one exception: it does not pay the annual Part B deductible. You pay that yourself, once a year.

So the real question is arithmetic. If the annual premium savings exceed that one deductible, you come out ahead — and because Plan G is still open to new enrollees, it does not carry the closed-block problem your current plan does. That is the structural part, and it usually matters more over time than the first-year savings.

There is also High-Deductible Plan G, which carries a much lower premium in exchange for a substantial annual out-of-pocket amount before coverage begins. It fits some people well and is a poor fit for others. It depends on your cash position and how you feel about a large potential bill in a bad year.

We would walk through both with your actual numbers rather than in the abstract.

Questions worth asking before you move anywhere

If you do decide to look, these are the questions that separate a good move from a move you regret.

How long has this company sold Medicare Supplements in Tennessee? New entrants sometimes price low to build a block, then raise rates once they have one.

What has their rate increase history looked like? Past increases are not a guarantee, but a company with a decade of moderate increases is telling you something a brand-new one cannot.

Is this block open or closed? Moving from one closed block into another closed block accomplishes very little.

Is the plan standardized? All Plan G policies cover identical benefits by federal law. If someone is selling you on richer benefits within the same letter plan, something is off.

What is the household discount? Many companies discount if a spouse or another Medicare-eligible adult in the home is also covered. It is frequently missed.

A good agent brings these up before you ask. If nobody is mentioning rate history, that is worth noticing.

The one mistake that genuinely hurts people

Never cancel your existing policy until the new one is approved and in force.

Not when you apply. Not when you feel good about the phone call. Not when someone tells you it looks fine. When you have written confirmation that the new policy is active.

The gap is where the damage happens. If you cancel first and the new application is declined, you may not be able to get back what you had — the plan you left is closed, and you would be reapplying to something else with the same health that just caused a decline.

Overlapping by a few weeks and paying two premiums for one month is not wasted money. It is the cheapest insurance you will ever buy.

And sometimes the answer is: stay right where you are

We want to be straightforward about this, because it is how we have run this business since we opened in 2021.

Sometimes we run a pre-qualification and the honest recommendation is to do nothing. Maybe a recent health event means you would not clear underwriting anywhere worth going. Maybe the difference is not large enough to justify leaving a plan you have held for a decade. Maybe you are on the older end and stability is worth more to you than the savings.

When that is the case, we say so, and we tell you why.

What we will not do is let you go another five years paying into a closed block without ever finding out whether you had options. That is not service. That is neglect, and neglect is the thing we actually compete against.

Who should be looking at this right now

If you are somewhere between 72 and 80, still on Plan F or an older Plan G, and in reasonable health, you are precisely the person this applies to. You are far enough past 65 that the closed-block effect has been compounding for years, and often still healthy enough to have real choices about it.

Those choices do not stay open indefinitely. Health changes, and it usually changes in one direction. Every year you wait is a year underwriting gets harder — which means the best time to find out where you stand is always earlier than you think.

Common questions

Will checking hurt my current coverage?
No. A pre-qualification is a conversation. Nothing is submitted, nothing is reported, and your existing policy is untouched.

Can my company drop me because I’m expensive?
No. Medicare Supplements are guaranteed renewable. As long as you pay the premium, they cannot cancel you for health reasons or claims history. They can raise rates for your whole class, which is exactly what you are seeing.

Does the new company have to cover my existing conditions?
Once a policy is issued, yes — standardized benefits are standardized. Underwriting happens at the application stage, not afterward. Some policies apply a pre-existing condition waiting period in limited situations, which we would flag before you applied.

Is Plan G going to end up closed like Plan F did?
There is no current law closing Plan G. Its situation is different — it remains open to everyone newly eligible, so new people keep entering the pool. That is the structural advantage.

I’m 84 and on Plan F. Is it too late?
Not automatically, but be realistic. Underwriting gets stricter with age and health history accumulates. It is still worth fifteen minutes to find out rather than assuming.

Do I have to change agents?
No. We are glad to look at your situation regardless of who wrote the policy or who services it. Some people move their business to us afterward, plenty don’t.

Let’s find out where you stand

A pre-qualification is free, takes about fifteen minutes, and you get a straight answer either way.

Call (877) 809-1755 or text (866) 580-1776
Email [email protected]

Tri Star Insurance Management Group
10805 Kingston Pike, Suite 210, Knoxville, TN 37934
Monday–Friday, 9:00 AM–5:00 PM

Ryan Hall, RSSA®, is the principal of Tri Star IMG in Knoxville. He and partner Adam W. Sursa bring more than 60 years of combined experience in senior insurance products to East Tennessee families.

This article is for educational purposes only and is not medical, legal, or tax advice. Tri Star IMG is a licensed independent insurance agency. We are not affiliated with, endorsed by, or connected to Medicare or any government agency. Plan availability, pricing, underwriting requirements, and carrier guidelines vary by company and are subject to change. Individual results depend on your specific circumstances.