Full Breakdown
Major Changes in Medicare Advantage Plans for 2026
10/1/2025, 9:00:05 PM
Overview of Medicare Advantage Exits
In a significant shift for the Medicare Advantage landscape, major insurers including UnitedHealth Group, CVS Health, and Humana are scaling back their offerings for 2026. UnitedHealth announced it will cease operations in 109 U.S. counties, affecting approximately 180,000 members. This decision is attributed to rising healthcare costs, increased utilization, and cuts in government reimbursements from the Centers for Medicare and Medicaid Services (CMS). The company’s government programs head, Bobby Hunter, emphasized that these challenges are unsustainable for any organization.
Impact on Beneficiaries
The exit of UnitedHealth, which manages the largest Medicare Advantage business in the U.S., will lead to a reduction of about 600,000 members across over 100 plans. The closures predominantly affect rural areas, where the company aims to streamline operations. Similarly, CVS Health's Aetna will reduce its prescription drug plans in 100 fewer counties, while Humana will operate in 85% of U.S. counties, down from 89% in 2025. These changes are expected to disrupt access to care for many seniors who rely on these plans.
In New Hampshire, two major providers, Anthem and Martin’s Point, are withdrawing from the market, while Aetna is significantly reducing its offerings. This will impact around 77,000 residents in the state. Vermont is facing a similar situation, with nearly all Medicare Advantage plans expected to be discontinued, leaving only Humana's plans available in select counties.
Official Statements & Responses
Bobby Hunter stated, “The combination of CMS funding cuts, rising healthcare costs, and increased utilization have created headwinds that no organization can ignore.” In New Hampshire, Insurance Commissioner DJ Bettencourt acknowledged the challenges posed by the market changes, asserting that while options will diminish, meaningful plans will still be available.
Criticism & Opposition
The scaling back of Medicare Advantage plans has drawn criticism from various stakeholders. In Vermont, state officials expressed concerns about the disruption caused by limited options for seniors. Mike Fisher, the state’s health care advocate, noted that while some may welcome the changes due to frustrations with Medicare Advantage plans, many beneficiaries have been satisfied with their coverage.
In Ohio, Kettering Health announced it would end contracts with Humana and Devoted Health due to operational burdens and payment issues, further complicating the landscape for Medicare beneficiaries.
Conflicting Reports & Gaps
While the overall trend indicates a reduction in Medicare Advantage offerings, some companies are expanding their services. Health Care Service Corporation is increasing its footprint, contrasting with the broader trend of withdrawal among major insurers. This discrepancy highlights the varying strategies within the industry as companies navigate the changing reimbursement environment.
What's Next
The Medicare Open Enrollment Period runs from October 15 to December 7, 2025, allowing beneficiaries to select new plans for 2026. Those affected by the exits will have until early February to find alternative coverage, although they may face gaps in insurance during the transition. Insurers and state officials are urging beneficiaries to review their options carefully and seek assistance to ensure continuous access to healthcare services.
