Maine Insurers Cut Medicare Advantage Plans Amid Cost Pressures

At least four insurance providers in Maine are reducing their offerings of Medicare Advantage plans due to rising costs and federal reductions in Medicare. Anthem and Aetna have confirmed significant cutbacks, while Martin’s Point Health and United Healthcare are also discontinuing specific plans. This shift raises concerns about the future of Medicare options for older residents in Maine.

The changes come as Anthem Blue Cross and Blue Shield announced it would scale back some plan options starting in 2026. A spokesperson for the company did not clarify how many Mainers would lose their plans. In a related decision, Aetna is set to eliminate its Advantage plans in Maine, affecting approximately 1,400 individuals. Despite these cuts, Aetna will continue to offer general Medicare plans and options for low-income seniors in select regions.

Martin’s Point Health is also discontinuing at least one plan, as indicated in a letter to its members, although no specific reason was provided for this decision. Meanwhile, United Healthcare is set to withdraw from Vermont and is cutting a plan in Maine next year, impacting around 100 members, who will have the option to switch to another plan with similar coverage from United Healthcare.

Impact of Medicare Advantage Cuts

The reductions in Medicare Advantage plans have raised alarms among state officials. Bob Carey, superintendent of the Maine Bureau of Insurance, stated that his office is investigating which insurers are pulling back and in what areas. Currently, there is no centralized source of information on the availability of these plans, largely due to the federal regulation of insurance providers. Carey noted that some counties may experience more significant reductions than others, similar to trends observed in New Hampshire and Vermont.

According to the health policy site KFF, more than 212,000 Mainers were enrolled in private Medicare Advantage plans last year. Nationwide, nearly half of the population eligible for Medicare—those aged 65 and older, as well as younger individuals with certain disabilities—utilize Advantage plans. These plans are designed by private insurers and provide coverage for the same services as traditional Medicare, often including additional benefits like vision, dental, and prescription drug coverage through a network of providers.

As insurers recalibrate their offerings, some individuals may be forced to revert to traditional Medicare, which can limit their access to additional benefits. Jeff Austin, vice president of government affairs and communications at the Maine Hospital Association, highlighted that while Advantage plans are marketed as affordable, they often place burdens on healthcare providers, leading some to stop working with certain plan carriers.

Options for Affected Members

Members whose plans are being discontinued will receive notifications from their insurers. These notices are crucial as they allow individuals to select new plans without undergoing medical underwriting. Affected members have the option to transfer to another Advantage plan or to enroll in a Medicare Supplement, also known as Medigap. It is important to note that Supplement plans do not include the additional benefits offered by Advantage plans, and members will need to secure prescription drug coverage separately.

Despite the ongoing changes, the Department of Health and Human Services has deferred inquiries to the Maine Bureau of Insurance, which continues to monitor the situation. The landscape of Medicare Advantage plans in Maine is shifting, leaving many older residents uncertain about their healthcare options moving forward.