Every September Medicare beneficiaries who are enrolled in a Medicare Advantage plan receive an Annual Notice of Change letter from their insurer spelling out any changes to their plan for the following year. But this fall, millions of Medicare beneficiaries will be receiving a different type of notification. CMS (Centers for Medicare and Medicaid Services) will be notifying them that their insurance carrier will not be offering their current plan for 2026. Here’s what you need to know if this happens to you.
Why Is My Plan Being Terminated?
Due to rising health costs and reduced government payments, many insurance carriers are under financial pressure and are facing difficult decisions. Some have chosen to reduce benefits and charge higher premiums and out-of-pocket costs. Others have chosen to scale back on the number of plans they offer, and in some cases exit certain markets entirely, known as a Medicare service area reduction.
What Are My Options if My Plan Is No Longer Offered?
If your Medicare Advantage plan is discontinued, you can make one of the following changes:
- You can switch to another Medicare Advantage plan
In most cases you will need to find a new Medicare Advantage plan. In some cases, your insurer could notify you that they have automatically enrolled you in a similar Advantage plan. Be sure to educate yourself on the details of the new plan to ensure it is right for you. If it’s not, you will need to take action to enroll in another plan.
- You can return to Original Medicare Parts A and B
If you opt to do this, you can also enroll in a stand-alone Part D plan for prescription coverage. If you lost your coverage due to a service area reduction, you may also qualify for a guaranteed issue right to enroll in a Medicare Supplement Plan (Medigap) plan. This means you can purchase a Supplement plan without undergoing a health screening, which is required in most states once your Initial Enrollment Period has passed. This guarantees you cannot be denied coverage or charged more based on pre-existing conditions.
With insurers focusing on areas where their plans are the most profitable, rural areas can be especially hard hit, leaving Medicare beneficiaries with few choices. If there is no Medicare Advantage plan available where you live, you will have no choice but to return to Original Medicare.
Important Enrollment Deadlines
- Annual Enrollment Period (AEP) – you are probably familiar with this enrollment period that runs from October 15 to December 7 every year. This is the time period when everyone can make changes.
- Special Enrollment Period for people losing their plans – this extra window extends from December 8 through February 28 of the following year.
It’s important to note that your current coverage will end December 31, so if you don’t take action to enroll in a new plan for January 1, CMS will automatically return you to Original Medicare coverage.
How to Prepare
Review your current plan and make note of which benefits are most important to you. Determine how much you can afford to pay in monthly premiums and out-of-pocket costs. Make a list of your doctors and your medications. Every Medicare Advantage plan has a unique provider network and drug formulary. You will need to check each plan to see if it meets your needs.
If you are satisfied with your current insurance carrier, you can start with them to see if they offer another plan that works for you. If they don’t offer anything comparable, or if they have pulled out of your area altogether, you will need to start looking at other insurance carriers.
How a Licensed Medicare Agent or Broker Can Help
Medicare agents and brokers can represent multiple insurance carriers, and they are knowledgeable about the Medicare plans offered in your area. They can help you review the coverage options available to find the plan that best meets your individual needs. They can even help enroll you in the plan of your choice. Meeting with a Medicare agent will never cost you anything. Their services are free.
If you have trouble affording your healthcare coverage, a Medicare agent can help you determine if you qualify for financial assistance through state and federal programs. These include Medicare Savings Programs, Extra Help, as well as State Pharmaceutical Assistance Programs.
As you might guess, this could take some time, so you want to get started as soon as possible. You can start talking to insurers on or after October 1 regarding coverage for next year. With so many people being impacted at once, appointments will fill up quickly.
Check out Silver&Smart’s Medicare Insurance Agent Directory to connect to a licensed Medicare agent in your state.
