WHITE RIVER JUNCTION — As upwards of 100,000 Vermont and New Hampshire residents prepare for their Medicare Advantage plans to be discontinued on Jan. 1, 2026, they are seeking alternative coverage options.
Over the past two years, nearly all Medicare Advantage providers have pulled their plans from the Twin States because rising health care costs and aging populations make it hard to turn a profit.
Companies also are pulling Advantage plans due to reduced federal payments to insurers and additional federal regulation changes, according to the New Hampshire Insurance Department’s website.
“This is the most chaotic year I’ve ever been a part of,” Eric Caswell, a Northfield, Vt.,-based insurance agent specializing in Medicare Advantage and supplement plans, said at an information session at Hartford’s Town Hall last week.
“Not only do I have to try and help my 500 clients, but every time I talk to somebody, they’ve got a friend or a family member who’s in the same boat,” Caswell said.
Medicare Advantage is offered by private insurers as an alternative to traditional Medicare, the federal health insurance program that predominantly serves those 65 and older. Advantage plans often include prescription, dental and vision coverage that traditional Medicare does not provide.
The Advantage plans generally have low monthly payments, but relatively high annual out-of-pocket maximums, which make them a good fit for those who aren’t often in the hospital, Caswell said.
Sterling Golder, a 74-year-old White River Junction resident among the 15 attendees of Caswell’s session last week, had no co-pays and a high deductible under his Advantage plan.
He felt confused when he learned his plan was being discontinued, he said.
“It’s terrible,” Golder said. “We had a nice program and everything was going great, and now it’s, you know, throwing our whole process into turmoil.”
Golder said he was not sure what he would do for coverage in the upcoming year.
Vermont Blue Advantage, the largest provider of Advantage plans in Vermont, has ended its coverage of the state. That followed a similar move last year by United Healthcare, MVP Health Care and WellCare.
This affects an estimated 25,000 to 30,000 Vermonters, Caswell said.
Blue Cross Blue Shield of Vermont, the insurance company that offered Vermont Blue Advantage, has attributed much of the company’s recent financial losses — over $62 million last year — to its Advantage plans, according to a financial overview by the president of the company from April.
While Humana will continue to offer Medicare Advantage plans in Vermont’s Bennington, Caledonia, Essex, Orange, Windham and Windsor counties, it will now treat many Dartmouth Health members as out-of-network, Caswell said.
Out-of-network coverage can result in higher patient costs and possible denial for non-emergency treatment.
In New Hampshire, Anthem and Martin’s Point will no longer offer individual Advantage plans, and Aetna will not offer plans in most counties, including Grafton and Sullivan. United Healthcare will no longer offer its plans to those who have both Medicare and Medicaid.
Around 77,000 residents are expected to be affected, the New Hampshire Insurance Department announced earlier this month.
Humana and WellSense will continue to offer Advantage plans in Grafton and Sullivan counties, according to Medicare.gov.
However, Humana did not renew its contracts to remain in-network with Dartmouth Hitchcock Medical Center, Alice Peck Day Memorial Hospital and New London Hospital, according to a statement written last week from Dr. Joseph Perras, CEO of Cheshire Medical Center in Keene, N.H.
Choosing an alternative
An alternative Medicare Advantage plan for the upcoming calendar year can be selected during the Medicare Advantage Annual Open Enrollment Period from Oct. 15 to Dec. 7, when it is possible to change Medicare coverage for the upcoming calendar year.
Those affected by discontinued Advantage plans have the option of enrolling in traditional Medicare, which can be supplemented with Medigap — federally-contracted private insurance plans.
Traditional Medicare coverage (Parts A and B) can optionally be supplemented through plans known as Medigap, which fill in the gaps of traditional Medicare with varying degrees of coverage.
Without a Medigap plan, those insured under traditional Medicare are responsible for costs that Medicare A and B do not cover — including hospital and medical deductibles and a typical 20% coinsurance for services, according to Medicare’s website.
Medigap plans F and G are the most comprehensive with the highest monthly cost, while plan N has a lower monthly cost with more costs for things such as office and emergency room visits, Caswell said. All Medigap plans have various private companies offering their own plans.
Centers for Medicare & Medicaid Services charges penalties for those who re-enroll after a period of no drug coverage. So, those taking any medication should enroll in Medicare Part D before December 7th to avoid the penalty.
Medigap plans have no network restrictions and are accepted everywhere Medicare is accepted. Regardless of which type of plan you select, emergency services will be available and treated as in-network.
However, one “blessing in disguise” is that discontinuing Advantage plans takes some power from private insurance companies, Caswell said.
Advantage coverage gave insurance companies control over the length of stays in nursing facilities, the number of physical therapy visits or requirements of prior authorization, but now, Caswell said, “all of that nonsense is going to go away, because now Medicare is the primary insurer.”
Those with Advantage coverage ending on Dec. 31, 2025, cannot be denied entrance into the Medicare Supplement market from now until March 4, 2026, even if they have pre-existing health conditions. They must present the letter from their insurer announcing the plan’s withdrawal.
Golder said that he had “some ideas” about which health insurance plan he would choose, but that he would have to talk with Caswell before making any decisions.
Other attendees at Caswell’s information session were similarly waiting for advice from the independent insurance agent.
Wanda Nalette, a 75-year-old Hartford resident whose Advantage plan also had zero co-pays, said she wasn’t sure which plan she would choose.
“I’ll know after I meet with (Caswell),” Nalette said. “I never understand it, it’s too complicated for me.”
Additional in-person information sessions are scheduled this week. Jessica Dunn, a Hanover-based independent Medicare insurance agent, will host one at 3 p.m. on Tuesday, Oct. 28 at the Claremont Savings Bank, or 145 Broad St., Claremont. For more information, contact Jessica Dunn at 603-304-8643 or jdunn@mycoreinsurance.com.
Eric Caswell will hold another session on Wednesday, Oct. 29 from 10 a.m. to 3 p.m. at the Hartford Town Hall, 171 Bridge St., White River Junction.
Further information is available through Medicare’s Plan Finder tool at medicare.gov or by calling 1-800-MEDICARE.
Granite Staters with insurance questions can contact the Aging & Disability Resource Centers: Medicare Support Services at 1-866-634-9412, or the New Hampshire Insurance Department’s Consumer Services Unit at 603-271-2261 or consumerservices@ins.nh.gov.
Vermonters can direct similar questions to Vermont Medicaid support center at 1-800-250-8427 or Vermont State Health Insurance Assistance Program (SHIP) at 1-800-642-5119.