Tens of Thousands of Vermonters to Lose Medicare Advantage Option in 2026

Nearly all Vermonters enrolled in Medicare Advantage plans are expected to lose their current coverage come 2026. New information from the Centers for Medicare and Medicaid Services indicates that every provider in the state, except one, will cease to offer these plans for that year.

Neither UnitedHealth nor Vermont Blue Advantage has updated their Medicare Advantage offerings for 2026. According to CMS data, these plans currently cover around 51,600 individuals, with Vermont Blue Advantage alone serving approximately 26,000 residents.

Humana, however, will continue to provide Medicare Advantage plans in several counties, including Bennington, Caledonia, Essex, Orange, and Windsor. Yet, no other county plans were indicated in the CMS data for next year.

Commissioner of the Department of Financial Regulation, Kaj Samsom, remarked, “It’s undoubtedly disruptive for seniors to have limited choices in these plans.”

It’s important to note that these changes affect only individual Medicare Advantage plans. Large companies can still offer their retirees Medicare Advantage coverage. In September, the State Accounting Bureau announced that a health plan for retired teachers would transition from Vermont Blue Advantage to Health Spring. Vermont Blue Advantage is a joint venture of Vermont Blue Cross and Blue Shield and its Michigan-based parent company.

The Medicare Advantage plan serves those eligible for Medicare, which includes individuals aged 65 and older, as well as some younger people with specific disabilities. Although the plans are managed by private companies, they receive funding from the federal government. They often provide wider coverage options, including prescription drug coverage, and typically have an annual out-of-pocket expense limit, in contrast to standard Medicare, which generally covers only 80% of health-related costs.

Last year, Vermont saw two Medicare Advantage plans withdraw, leaving Humana, Blue Advantage, and United Health as the remaining choices for residents. At that time, there were just 50 individuals enrolled in Humana Plans.

This week, UnitedHealth, which is the largest provider of Medicare Advantage plans in the U.S., announced that it would terminate coverage for approximately 600,000 patients nationwide in 2026.

Across the country, Medicare Advantage providers are scaling back their coverage due to diminishing profits. A recent quote from industry analysts pointed to a shift in federal regulations as a key factor, revealing that private insurers are now receiving less funding from the government while more patients are shouldering care costs themselves.

Current plans will remain in effect until the end of this year. The Medicare annual enrollment period is set for October 15th to December 7th, during which patients can select their plans for the upcoming year.

Individuals affected by the loss of Medicare Advantage coverage are assured eligibility to enroll in the Vermont Medicare Supplements Market plan within 63 days after their current coverage ends. The Department of Financial Regulation recommends keeping any notifications received from insurance companies as proof to ensure access to the supplemental plan.

“This is indeed a challenging situation, but there’s no need to panic. You still have time and options, along with resources available to help navigate this change,” Samsom advised.

Residents are encouraged to connect with the Vermont State Health Insurance Program for assistance, as well as consult the Medicare Handbook for guidance on managing coverage.

Without the Medicare Advantage Plan, individuals have the choice between traditional Medicare and private supplemental plans, commonly known as Medigap. Many people with traditional Medicare often need to purchase a prescription drug plan, or Part D, to cover costs not included in standard Medicare.

However, Vermont’s Medigap plans can be quite pricey. State healthcare advocate Mike Fisher pointed out that this shift could potentially push more individuals to enroll in Medicare without any additional supplementary coverage.

It’s also noteworthy that the Medicare Advantage Plan has faced criticism over the years. Fisher mentioned, “We often receive feedback from individuals who feel they’re sold plans that don’t meet their needs.” He added that there are indeed many satisfied users of the Medicare Advantage plans in Vermont.

This story will be updated.