Thousands scramble for health coverage as Medicare Advantage firms leave N.H.
Published: 10-08-2024 12:37 PM
Modified: 10-11-2024 1:32 PM |
Tens of thousands of New Hampshire seniors will have to find new supplemental health insurance coverage next year because some companies, including Harvard-Pilgrim, Humana and Wellcare, are pulling out of the Medicare Advantage business in the state.
The moves are part of a nationwide trend in which shrinking profits have led some insurers and hospitals to stop selling Medicare Advantage, a private expansion of Medicare, the federal health insurance for people over 65. Among other things, it provides some coverage for prescription drugs.
“The big message is that when seniors get the letters from their current Medicare Advantage carrier, it is really important that they pay attention and put a plan together very quickly,” said D.J. Bettencourt, commissioner of the New Hampshire Insurance Department.
Current Medicare Advantage plans will end Dec. 31, although sign-ups can take place as late as Feb. 28, 2025, for people who are losing an existing plan.
If people who are losing an existing plan do not make any changes by Dec. 31, they will be automatically enrolled in original Medicare, which provides less coverage than Advantage plans.
“The piece of it that is of greatest concern to me is the implication as it pertains to prescription drug coverage, which so many of our seniors depend on,” Bettencourt said. “Seniors need to take these notices very seriously; they need to do their due diligence to understand what the next best step for them is.”
Affected clients should contact their insurance broker, Bettencourt said, or contact the New Hampshire Insurance Department directly for advice or to be directed to resources.
The two biggest providers of health insurance in the state, United Healthcare and Anthem, have not indicated any plans to stop selling Medicare Advantage plans here. Still, the loss of several other providers will limit options for many people.
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“Especially for northern counties, we are really hurting for plans right now,” said Colby Simpson, a broker with Patty Stewart Associates in Gorham.
New Hampshire is not alone. Companies including CVS have been shrinking their Medicare Advantage offerings this year as a result of changes in reimbursement.
That follows years of increases in the program. In 2024, according to the federal government, 32.8 million people are enrolled in a Medicare Advantage plan, accounting for 54%, of the eligible Medicare population.
The federal government sets Medicare rates annually. Changes over the past two years, the state Insurance Department noted in a statement, “resulted in an effective 1.28 percent reduction in Medicare funding, which is contributing to the challenges faced by these plans.”
“There are obviously financial pressures not limited to the Medicare Advantage space. Whatever Congress and the next president decide to do … there are some pretty significant warning signs that absent some reform, this model is not going to be sustainable going forward,” Bettencourt said.
In a statement, Harvard-Pilgrim Health Care said “As a result of a comprehensive review of the New Hampshire Medicare Advantage market, we recently made the decision to sunset our Stride Medicare Advantage plan in New Hampshire. … We will continue to offer an individual Medicare Supplement plan, as well as our commercial products offered to employer groups and on the New Hampshire exchange.”
Medicare, the health insurance program for people over age 65, is entirely run by the federal government. As a result, Bettencourt said, there is no requirement or direct mechanism for companies to notify his department when they pull out of Medicare coverage in New Hampshire.
That is in contrast to Medicaid, the insurance program for people with limited resources, which is jointly run by the state and federal governments and partly overseen by the state insurance department.
In September, the National Association of Insurance Commissioners State wrote the Centers for Medicare & Medicaid Services asking for guidance. “Departments of Insurance across the country are fielding consumer inquiries about the withdrawal of their providers from (Medicare Advantage) plans and since states do not regulate these plans, staff are unable to offer recommendations to consumers,” it noted.