Deadline approaches for choosing a new plan as Medicare terminations are near.

Medicare Advantage Plans Facing Changes in Rochester

ROCHESTER, N.Y. — Time is running out for those enrolled in Medicare Advantage plans, with some set to terminate in 2026 in the Rochester-Finger Lakes area.

“Everyone has until December 7 to pick a new plan,” mentioned David Kirst, who manages insurance sales and operations for AAA in Western & Central New York.

If beneficiaries miss this deadline, they will still have Medicare Parts A and B, but their Medicare Advantage coverage will no longer be available.

Kirst clarified, “This means they would revert to standard Medicare coverage, not the traditional Medicare Advantage plans.”

This shift could significantly influence prescription drug costs, he pointed out.

“I think many people would be surprised at the actual cost of a prescription when they have to pay the full price, not just the out-of-pocket amount,” he added.

Context: Medicare Advantage Plans Ending in 2026

The situation largely hinges on what insurers have received and disbursed financially over time.

“Sadly, it appears that people are utilizing their Medicare plans more than the insurance companies anticipated, leading to lower-than-expected income,” Kirst explained.

“So, many individuals are now taking more prescription medications, which could surpass what insurers had originally forecast,” he noted.

Kirst cited the rising use of GLP1 pills, which are expensive weight-loss medications, as a contributing factor.

The specific Medicare plans that will be affected vary widely depending on the city and healthcare system; for instance, coverage in Buffalo and Rochester differs significantly from that in Syracuse.

“Going into next year, your health status might change compared to the past,” Kirst warned. “If you have upcoming surgeries, you may want to explore other plans, but these choices need to be made by December 7.”

While the deadline for selecting a new plan has technically been pushed to February 28, Kirst advised that this could come with drawbacks, as coverage would change considerably on January 1.