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Following the articles with the Premium & Lives results, Business Performance, and Underwriting results, here is an overview with highlights of the Claims results from the Gen Re Medicare Supplement Market Survey. The survey looked at insurer’s 2025 results, with 46 questionnaires completed, representing 96 companies with Med Supp business.
Some of the most valuable leading indicators in the Medicare Supplement market are found in the claims themselves. Claims organizations sit at the front lines of an evolving healthcare landscape, watching in real time how medical advances, changing utilization patterns, rising treatment complexity, and shifting morbidity trends are influencing outcomes and costs.
For claims executives, these signals can provide an early view of emerging risks, operational challenges, and opportunities to implement appropriate and adaptive claims strategy that challenge conventional thinking to assist with both risk management and portfolio performance.
Beyond claim costs and utilization patterns, the Med Supp Market Survey report (Claims Section) also examines the growing importance of fraud prevention, detection, and mitigation strategies as schemes become more sophisticated and healthcare spending continues to rise.
Overall, 91% of the Med Supp claims received in 2025 were paid, with 2% pending and 7% denied.
Among companies with only closed blocks of business, 94% of claims were paid and just 6% remained unresolved or declined.
Half of the participating companies project overall claims experience to increase in 2026 versus 2025, and all 16 of these companies maintain open blocks of business.
In contrast, among the nine companies with only closed blocks, seven anticipate a decline in claims experience.
Twenty-three companies (68%) rely on in-house automated systems or tools to detect, prevent and mitigate fraud.
Overall, six companies reported using external systems for fraud detection, with Healthcare Fraud Shield being the only solution specifically cited.
Among the seven companies that do not currently utilize internal or external fraud detection systems, three with open blocks indicated plans to implement such capabilities within the next year.
Most companies (72%) reported an increase in detected claims fraud, particularly among those with open blocks. Specifically, 11 companies with open blocks and six companies with only closed blocks indicated that fraudulent claims rose by more than 25% in 2025 compared to 2024. No companies reported a decrease in claims fraud.
Nearly all companies (97%) reported identifying DME-related fraud in 2025, with 25 of 31 (81%) noting an increase when compared to 2024. Fraud related to wound care was identified by 26 companies (81%), of which 24 (92%) reported an increase. In contrast, only three companies reported a decline in certain types of fraud, including one for wound care and two for laboratory services.
Reach out if you’d like more info, including if you want to see the survey’s participating companies.
We’ll have one more article with highlights from the survey’s Distribution Results section.
Read the other articles released in this series.
