Insurers that offer Medicare Advantage (MA) healthcare plans have been scaling back plans or eliminating them altogether, leaving millions of retirees in the lurch.
Indeed, many of the people who pick a Medicare Advantage plan during open enrollment that runs from Oct. 15 to Dec. 7 may only be in that plan for a year or two before it, too, goes away.
If you are one of the more than 35 million seniors enrolled in Medicare Advantage, here's what you need to know if your coverage suddenly changes or disappears.
How is Medicare Advantage different?
Unlike traditional Medicare, which is accepted by almost all doctors and hospitals, Medicare Advantage operates much like employer-provided insurance. You pay lower costs if you stay within a network of doctors and providers, and pay higher out-of-network charges if you seek care elsewhere.
The lure for many Medicare Advantage plans is you pay no monthly premium, though you still must pay your monthly Medicare premium to the Social Security Administration. By contrast, if you use traditional Medicare and supplemental, or Medigap, insurance, you will pay a private insurance premium in addition to your Medicare premium.
Medicare Advantage can save you money if you stay well. But if you get sick, you often have to pay substantial deductibles and copays, which can make MA more expensive than traditional Medicare plus supplemental insurance. You also may need to get prior authorizations from your insurer before beginning a new treatment or undergoing a recommended procedure.
Why are plan terminations happening?
In 2026, 2.6 million seniors saw their Medicare Advantage plans terminated, representing 13% of enrollees in MA plans with drug coverage, according to a KFF analysis. That was more than double the percentage from the year before. The percentage excludes seniors enrolled in MA special needs plans, plans without prescription drug coverage and those with employer coverage.
This year has seen similar moves from larger insurers like Humana, UnitedHealthcare and Molina Healthcare along with smaller plan providers such as Clear Spring Health and Presbyterian Health.
Insurers say costs for offering these plans continue to increase. Seniors are seeking healthcare services at higher rates and certain drug prices keep rising.
At the same time, federal payments for offering these plans are increasing at a slower pace, squeezing insurers' profit margins. And now, due to a federal rule change, insurers are footing a larger portion of prescription drug costs after enrollees exceed their out-of-pocket spending limit.
"Insurance companies are now deciding, 'We don't want to just lose our shirts all day long. Let's take our ball and go home,'" said Melinda Caughill, co-founder of 65 Incorporated, which provides Medicare consulting services.
What can MA seniors do?
If your insurer is getting rid of your plan, it must send you a notice. Right now -- with Medicare open enrollment season heating up -- it may be easy to miss it.
"People are going to be absolutely inundated with advertisements [and] mailings to try to persuade people to enroll in plans," said David Lipschutz, co-director of law and policy for the Center for Medicare Advocacy. "So sometimes the official notifications from someone's actual plan can get lost in the shuffle."
If you do nothing after getting the notice, you will be enrolled in a replacement plan. But you can also select a new Medicare Advantage plan that fits you best. The key is to make sure your preferred physicians and provider networks along with your prescription medicines are covered by any new MA plan you sign up for.
Another option is switching to traditional Medicare. That has its own issues, such as pricey or even denied Medigap plans, the supplemental policies that cover the 20% of medical costs that traditional Medicare doesn't pay.
If your current MA plan is ceasing altogether or your insurer is pulling out of your area, you should get a right to purchase a Medigap plan without undergoing any underwriting, according to Lipschutz. That means you can't get denied or charged more because of a health condition.
But if your MA plan is merging into another plan in the same area by the same insurer, that doesn't necessarily trigger the right to purchase a Medigap plan without underwriting, Lipschutz said, unless you live in the four states -- Connecticut, Massachusetts, Maine and New York -- that require guaranteed Medigap issue rights.
The notice you receive should spell out if you get that Medigap purchase right.
Using the nuclear option
What happens if you don't qualify for a Medigap purchase right, but the remaining MA plans don't cover your specific doctors, hospitals or treatments -- especially if you are sick? You might want to consider going nuclear.
That means moving completely out of your Medicare Advantage insurer's network -- oftentimes to another state, Caughill said. The move allows you to get a guaranteed right to get a Medigap policy without underwriting.
"That's why we call it the nuclear option," she said, "because you have to move."
Caughhill helped four clients this year execute this strategy after the Mayo Clinic, which provides many cancer treatments, stopped taking Medicare Advantage plans.
"For some people it's a matter of life and death," she said.
Where to get help
If your current plan is eliminated or merged, the task of finding a new plan may feel insurmountable, especially given the number of options to compare.
There are places that can help beyond the private Medicare consultants. Lipschutz recommends that seniors contact their state health insurance assistance program, also known as SHIP. You can also reach Medicare's customer support by calling 1-800-MEDICARE.
"Many more people use agents and brokers, some of whom are aboveboard," Lipschutz said. "But some are chasing commissions and steer people towards products that are best for the agent rather than the beneficiary."
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