Impact of Medicare Advantage Plan Withdrawals in New Hampshire

Richard Godek, an 81-year-old resident of Winchester, has been relying on Anthem’s Medicare Advantage plan for his prescription medications, which are crucial for reducing his risk of heart attacks and strokes. However, on October 2nd, he received a letter from Anthem announcing that the Medicare plan would no longer be available in 2026.

Godek’s situation isn’t unique; many seniors in the area have received similar notifications. Several private insurers, including Martin’s Point, UnitedHealth, WelSense, and Anthem, plan to exit the Medicare Advantage market in New Hampshire due to diminishing federal funding and escalating healthcare costs. This leaves only Humana’s Medicare Advantage plan available in Cheshire County, a choice not accepted by Cheshire Medical Center and other sites within the Dartmouth Health System, placing local seniors in a difficult position.

For those affected, options for in-network care are limited. They can choose to travel to Brattleboro Memorial Hospital, about a 30-minute drive from Keene, or Monadnock Community Hospital in Peterborough, which is approximately 40 minutes away.

Residents like Godek are now forced to search for new insurance plans as they prepare to lose their coverage. Without sufficient insurance, he estimates his out-of-pocket cost for prescriptions could soar to $427 a month. Although he’s considering other options, he fears he’ll still be left with hefty expenses.

Feeling abandoned, Godek remarked, “Anthem dropped me like a hot potato.” Other seniors share his concerns; many worry that increasing healthcare costs will compel them to sacrifice basic needs like food and clothing.

The Decline of Medicare Advantage Plans

Medicare Advantage plans serve as a privatized alternative to traditional Medicare, which is the public insurance program for individuals aged 65 and older, as well as for those with disabilities. While these plans generally come with lower premiums than standard Medicare, they also offer less extensive coverage and often require more prior authorizations. A report indicates that around 35 percent of the 344,813 Medicare beneficiaries in New Hampshire will be enrolled in a Medicare Advantage plan by 2024.

The recent trend, however, has shifted. In October 2024, the New Hampshire Department of Insurance alerted that 44,000 seniors would face coverage loss due to major insurers like Harvard Pilgrim and WellCare withdrawing their plans from the state. Aetna has also scaled back its Medicare Advantage offerings.

The state health department attributed these changes to rising healthcare expenses and a reduction in Medicare funding. Following that, an announcement in October indicated that 77,000 residents statewide would be impacted by the upcoming discontinuation of additional Medicare Advantage plans in 2026.

The specific consequences of these withdrawals will vary by county. While some counties, like Hillsborough, will see new options from Humana, Cheshire County will be significantly impacted as all Medicare Advantage plans except for Humana’s will be eliminated.

This situation reflects a broader national trend within the Medicare Advantage market, where reduced government payments, rising healthcare costs, and heightened usage of plans are squeezing profits for insurance companies managing these plans. Notably, New Hampshire is set to see the largest reduction in Medicare Advantage plans across the country in 2026.

An Anthem spokesperson explained that this strategic withdrawal allows the company to focus more on Medicare services that deliver significant value, including Medicare Supplement Plans, which will still be available in New Hampshire. They pledge to assist affected members in transitioning smoothly to new insurance options.

Hospital Network Changes

With most plans leaving Cheshire County, seniors will face reduced access to Cheshire Medical Center. If a member of a Humana Medicare Advantage plan needs hospital admission, prior approval from Humana would be required, as they would be accessing an out-of-network facility.

A contractual dispute between Humana and Dartmouth Health is the reason behind this lack of access. Cheshire Medical Center’s CEO noted that this is beyond the health system’s control, adding, “This is Humana’s unilateral decision not to renew contracts.” Negotiations had been attempted but appear unlikely to produce results before the 2026 deadline.

While Monadnock Community Hospital does accept Humana’s plans, an influx of new patients might burden the hospital. Financial losses are already being felt, with hospitals around the area losing significant funds annually under Medicare Advantage due to complications with administration and denial rates from insurance providers.

This complicated situation has led local seniors like Donna McOwen to feel increasingly agitated about losing their coverage after many years. McOwen expressed her frustration, “Everything makes you unstable. I don’t particularly want to use an out-of-network plan. What options do I have?”

As local organizations step up to assist residents in navigating insurance changes, the deadline for all types of Medicare enrollment is approaching on December 7th, with the Medicare Advantage enrollment period running from January to March. Communities are pulling together to guide seniors through these transitions.

Many seniors are considering reverting to traditional Medicare with supplemental coverage, a choice that often comes with higher costs. Keene resident Joanne Allen articulated a sentiment common among many, expressing frustration over the system: “We’ve worked hard all our lives and paid for Medicare, but in the end it’s ridiculous.”

As Godek weighs his options—which include joining Humana’s plan, going back to traditional Medicare, or seeking another route—he reflects on the swift exit of private insurers from the Medicare Advantage market. He can’t help but feel that the situation reveals deeper issues within the health insurance landscape, stating, “I think it’s terrible that our laws allow insurance companies to do this. No one seems to care.”

The continuing changes in Medicare Advantage plans and their implications for local seniors will be monitored closely as the community navigates this challenging landscape.