Reduction of Medicare Advantage Plans in Maine
In Maine, at least four companies providing Medicare Advantage plans are cutting back on their offerings due to regional downsizing and federal budget cuts to Medicare. Anthem and Aetna have both confirmed they’re reducing their presence in the state. Martins Point Health is ceasing its plans entirely, and UnitedHealthcare has also announced its plans will be discontinued, according to a letter to members obtained by a local newspaper.
The extent of the impact on Maine residents remains uncertain. It’s unclear how many companies overall are scaling back operations in the area and if certain counties, like those in New Hampshire and Vermont, will see greater effects than others.
Medicare Advantage plans are provided by private insurers that the federal government approves, offering the same basic services as traditional Medicare, but with added benefits like vision, dental, and prescription drug coverage, often through specific networks of providers.
Due to rising costs, many insurance companies are making even deeper cuts to their plans in northern New England and across the nation. This has forced some beneficiaries to revert to traditional Medicare.
Bob Carey, the director of the Maine Department of Insurance, mentioned that officials are currently investigating which insurers are leaving the market and where those changes will take effect. He pointed out that there is no centralized system to track how much business these companies conduct in Maine because they are federally regulated. The office is aware that some plans will be exiting specific counties.
Last year, over 212,000 residents in Maine were enrolled in private Medicare Advantage plans, according to health policy researchers. Nationally, about half of those eligible for Medicare—typically people who are 65 and older or younger individuals with certain disabilities—opt for Advantage plans.
Anthem Blue Cross and Blue Shield is set to reduce some of its plans in Maine by 2026, as indicated on its website. They did not provide information regarding how many Mainers will be affected. Additionally, the company plans to exit New Hampshire entirely next year.
A spokesperson for Aetna stated that around 1,400 individuals in Maine will be affected by the coverage changes. However, some southern and central counties will continue to have generic Medicare plans and other options tailored for low-income seniors.
UnitedHealthcare is also exiting Vermont and will discontinue its plans in Maine next year, which will impact about 100 residents who will need to switch to a different UnitedHealthcare plan that offers similar coverage.
A spokesperson for UnitedHealthcare noted that the company is making strategic adjustments to its Medicare Advantage offerings through 2026 to maintain affordability and stability. Earlier this month, the firm reported that it had stopped offering plans in 109 counties across the U.S. due to Medicare cuts, rising expenses, and increased program utilization.
Additionally, Martins Points Generations Advantage will discontinue at least one plan, though no explanation for this change was provided in their communication, while several other plans are still listed for availability next year in Maine.
Although Advantage plans tout the benefits of being more affordable and offering additional services, they can actually be cumbersome for healthcare providers to manage. This difficulty sometimes leads providers to stop working with those plans, according to Jeff Austin, who serves as vice president for government communications and public affairs with the Maine Hospital Association.
The association is advocating for greater federal oversight of these plans, as Austin pointed out that they tend to offer reimbursement rates 20% lower than traditional Medicare’s 10%. He also mentioned that the program often aggressively denies long-term care certifications, complicating the reimbursement process.
Carey, the director of the state Department of Insurance, highlighted the importance for residents affected by these plan discontinuations to keep the notices they receive from their insurance providers. This notice will enable them to select alternative plans without undergoing the medical underwriting process.
Beneficiaries can switch to another Advantage plan or consider enrolling in a Medicare Supplement (Medigap) plan instead. However, it’s important to note that supplement plans do not include the additional benefits provided by Advantage plans, and members would need to purchase a separate prescription drug plan. The new arrangements would allow individuals to see which providers accept Medicare, independent of network restrictions.
Other insurance companies and consumer advocacy groups in Maine did not respond to inquiries for additional information. Questions directed to the Department of Health and Human Services were referred to the Department of Health.
