Medicare advantage not going away

Knight

Knight

Well-known Member
For those that may be impacted

No, Medicare Advantage is not going away, but many insurers are scaling back or exiting certain plans and counties for 2026 due to financial pressures like lower government reimbursements and increased costs. This means coverage will look different, with some plans disappearing, fewer options in some areas, and a potential shift from PPO to HMO plans. You will still be able to enroll in Medicare Advantage or choose other options during the open enrollment period.

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That happened to me, Knight. I had a good UHC plan and it's not offered next year. The only PPO plans UHC is offering for 2026 in my zip code are HMO plans, and certain other plans that are only for those with chronic conditions or Medicaid. I had to switch to Humana. I chose a PPO "giveback" plan, which will reduce my part B Medicare premium by $90/month. However, it will have one annual $425 medical deductible which applies to tests and certain procedures, but excludes doctor visits, hospital visits and ER. That's ok with me, since I'm saving with the giveback with a larger SS check and that savings will more than cover the deductible.

In general however, it's true that we have less to choose from.

I would like to mention that if the Advantage plan you (or anyone) had in 2025 is discontinued for 2026, you will get a cancellation letter, as well as the right to go back to original Medicare and a Medigap policy regardless of your health and cannot be refused Medigap coverage if you do so within the first 63 days after cancellation. This isn't a consideration for me (I don't want Medigap due to very high costs) but is an option for some who do want Medigap but couldn't pass underwriting.

[Edited to include this link from Healthline which explains your Medigap rights when your Advantage plan is discontinued in your area.]

Edited to correct error in first paragraph.
 
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My neighbor who goes to dialysis every week was told by UHC doctors that his coverage was being changed with less coverage. Said he may have to pay for procedures he wasn't before.
 

I had Medicare and Medigap from 2018 - 2023. The monthly premium rose from $118 / month to start to over $200 / month at the end. So take an average of say $150 / month I paid for the 5 years, that's a total of $9,000, which is more than the maximum out of pocket liabilty for most Advantage plans. Additionally, I had to pay separately for a drug plan because (by law) Medigap plans cannot include drug coverage. [I could have paid a LOT of Advantage plan co-pays out of the $9000, with several thousand left over.]

And what I was paying was cheap compared to what people older than me were paying for their Medigap plans, since premiums are aged based. One woman's premium was at or over $500 / month. That works out to $6000 in just one year for her premiums.

My wife and I had Humana Advantage plans when she went through 2 years of ALS and constantly saw doctors and needed specialized equipment. We had some copays - like $135 toward an MRI, and we had to pay $325 / day for the first 5 days of a hospital stay, then the plan paid the remaining days. We paid -0- dollars for 2 weeks in rehab. The annual copays we were out totaled less than the annual premium we would have paid for a Medigap plan, and all her doctors were in network.

Now for the good news ("kind of") - The combination of Medicare and Medigap will pay more of your medical bills than you can hope for from an Advantage plan. If you develop a devastating illness, you can focus on that instead of money. You will not (generally) have to worry about pre-authorizations. If you have that kind of plan and are pleased, that's great.

I would love to have it, but Im not in the bracket with those seniors who have unlimited funds down at the Merrill Lynch offices - or wherever they keep it - and I also have to keep up other rising costs. Actually there aren't many options when electric rates, gas, water bills, trash services, groceries, home insurance and car insurance, car repairs - and so on go up, up, up - but medical insurance is one place I can make choices.
 
My Kaiser Senior Advantage Plus costs $20/mo. out-of-pocket. The "Plus" package covers gym membership, vision, hearing and dental. The gym membership coverage is worth the $20, my hearing is covered by the VA, the dental I've used once, for a crown. I don't like the choices of dentists on the Delta HMO dental that Kaiser provides, so I pay my own way with a dentist I like, but only accepts PPO. The vision coverage is worth it, but will only cover 1 pair of glasses every 2 years.
 
My BCBS zero premium plan is still available for 2026 but there have been substantial increases in the deductible and out of pocket costs for prescriptions.

It still offers a great deal, for me, compared to the out of pocket premium costs for traditional Medicare plans when I look at how much I would have paid over the last six years.

The biggest risk for me is having a serious medical condition that would hit the maximum annual out of pocket expense of around $11,000.00 for one or more years.

The important thing is to review your plan annually and see if it still makes sense for you, your health, financial situation, etc…
 
AnneTeak said:
Please enlighten us why an Advantage plan is a “scam”
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They are not scams, but they are often promoted with misleading ads. The ads strongly imply that Medicare Part C is your only option where as there are Medigap policies that allow you to stay on original Medicare with complete coverage and no networks, and for as little as $100 a month, at least at the start.

That said, I have friends on some really great Advantage plans.
 
The primary concern of all private insurance companies is their bottom line, whether they're selling Medicare Advantage or Medigap. Most major health insurers sell both.

Medigap plans must abide by original Medicare's decisions on claim approvals. Medicare pays their portion first, then Medigap pays their part, but not necessarily the entire balance. The amount a Medigap plan pays depends on the specific plan letter (such as, Plan G, Plan N) that you have. Some plans leave you with copays.

Medicare Advantage plans set their own rules for prior authorizations, networks, and other requirements. Their decisions on those matters may impact your care, but they cannot deny coverage for services considered "medically necessary" under original Medicare. If that happens, you have the right to appeal.

Appeals process per Medicare.gov
 
We have a BCBS Advanage plan. We have been very pleased with their coverage so far. Ron’s accident which put him in the hospital for 3 days, plus specialist services, drugs, physical therapy, equipment etc was expensive, but the plan covered most of it.

I had cataract and glaucoma surgery on both eyes, my cost was $275. Ron had to have a root canal, I believe that was fully covered. My glasses were several hundred dollars, I was fully reimbursed for that cost.

We will of course be checking the plan to see what changes there are for 2026, but so far we’ve been very pleased.
 
Trade said:
They are run by private insurance companies whose only concern is their bottom line.

https://cepr.net/publications/medicare-advantage-myth-busting/
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I read part of the article. I stopped at myth #2.

I pay taxes but I don't pay for anything in my advantage plan except for a $150.00 copay if I go to an ER. I have no way of knowing or calculating what tiny portion of my federal taxes would be used to supplement my no cost to me PCP & specialists advantage plan.

What I do know is my PCP & specialists cost me nothing. My few med needs cost me nothing. My complete rebuild of my cervical spine, hospital costs, rehab cost were zero dollars. My 8 days stay in the hospital for gall stone removal & stabilizing my heart was zero dollars.

I haven't kept track of my medical expenses since I became eligible for Medicare 19 years ago, my best guess would be $350.00 off set completely by the OTC allowance we get.

My plan may be unique, all I know is I'm happy & don't feel scammed. I checked with the rep that signed me up for my UHC plan & where I live there is no change to our plan.
 
A friend of mine went on an advantage plan because it was free and he would save all kinds of money. The max out-of-pocket he would have to pay per year was 7K. Then he had a string of bad luck and hit 7K out of pocket three years in a row. At that point, he’d have been better off with the regular Medicare and supplement plan.
 
You can have some nameless government bureaucrat manage your healthcare with Original Medicare.

Or you have have some predatory private insurance CEO like Brian Thompson of UnitedHealthcare manage it with Medicare Advantage.

It's all up to you.



Granted, it's not a very good choice, but to me it's still an obvious one.
 
That Lady in PA said:
MA has treated numerous friends and family well for over a decade.
I have no problem with it whatsoever.
I am always astounded when those who don't have it and know nothing of the particulars vehemently criticize it.
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The least they could do is post the yearly cost to themselves with whatever they have, & what if any copays they have. Would also be helpful for comparison of their surgery, hospital, specialists & med costs.

I heard this or not happy with how capitalism works as input IMO really isn't helpful.
 
The average male who retires at age 65 lives 18.6 more years.

"The average monthly premium among current Medigap policyholders was $217 in 2023, or $2,604 for a full year of coverage, according to KFF analysis of NAIC data from MFA.

18.6 years X $217.00 / month = $2604.00 / year = $48,434.00 / for 18.6 years.*

*It should be safe to assume that the average should rise considerably over the next 18.6 years.

Edited to add the following:
In addition to the potential $48,434.00 pay out, the insured will need to purchase a separate drug plan, since Medigap policies (by law) cannot include drug coverage.
 
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Part D, which is the drug plan is not very expensive. The most I’ve ever paid is 11/a month. For the past two years I’ve had well care which is free and this year it’s going up to 2.76/a month.
 
Teacher Terry said:
Part D, which is the drug plan is not very expensive. The most I’ve ever paid is 11/a month. For the past two years I’ve had well care which is free and this year it’s going up to 2.76/a month.
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Per Humana, the average cost of a Part D drug plan in 2025 is $46.50, and per Nerdwallet, the average cost is $38.00.

To keep calculations simple, say we take an overall average for most people of $40 / month for a Part D plan. That = $480 / year, which = $8,928 over 18.6 years.

We add the $8928 to the price of the Medigap plan, $48,434, for a total grand total of $57,362 over the 18.6 years.

You're getting a good deal on your drug plan. I know you're glad for that. When I had a stand alone Part D plan in 2022, my premium was $22.70 / month - I still have the payment book and just looked it up. Based on my own experience and the above averages from Humana and Nerdwallet, it seems that most people buying Part D plans are paying substantially more than $11 or $2.76 a month.

[. . . as if the $48,434 for Medigap isn't bad enough of itself.]
 
MACKTEXAS said:
Per Humana, the average cost of a Part D drug plan in 2025 is $46.50, and per Nerdwallet, the average cost is $38.00.

To keep calculations simple, say we take an overall average for most people of $40 / month for a Part D plan. That = $480 / year, which = $8,928 over 18.6 years.

We add the $8928 to the price of the Medigap plan, $48,434, for a total grand total of $57,362 over the 18.6 years.

You're getting a good deal on your drug plan. I know you're glad for that. When I had a stand alone Part D plan in 2022, my premium was $22.70 / month - I still have the payment book and just looked it up. Based on my own experience and the above averages from Humana and Nerdwallet, it seems that most people buying Part D plans are paying substantially more than $11 or $2.76 a month.

[. . . as if the $48,434 for Medigap isn't bad enough of itself.]
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Some years I changed my drug plan every year to get the cheapest plan. If people are paying $40 a month they’re not shopping around yearly like I do.
 
Teacher Terry said:
Some years I changed my drug plan every year to get the cheapest plan. If people are paying $40 a month they’re not shopping around yearly like I do.
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True, many people do not shop. Some rely on family or insurance agents to make all their decisions.

I do my own shopping and compare what I find to plans suggested by the Medicare advocate we have in town here. Don't know how I missed it, but I was not successful in finding any drug plan even 2 years ago for $11.00. You're a good shopper.

I'm just thankful to be free of the heavy financial burden of the Medigap Plan I had during those years, which was my main concern at that time, especially since the premium rose an average of 10-12% per year.
 
Mack, it could be location, but on another forum people in many other states were also on the well care plan that was free for the past two years so I don’t think it’s that uncommon. Actually this will be the third year that I’m on wellcare and that’s been the longest I’ve been on a plan because for a while I was switching on a yearly basis.

I was worried about getting priced out of a Medicare supplement plan as I aged, but now that my Social Security has increased so much that’s no longer a worry. I won’t consider an advantage plan because I know a few people that are only alive because they could seek the best medical care out of state.
 

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