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.
 

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