In Medicare Advantage plans for 2026, Roswell Park won't be in network with Independent Health

Roswell Park Comprehensive Cancer Center and its Roswell Park Care Network community practices will no longer be in-network for Independent Health’s individual Medicare Advantage plans, beginning Jan. 1.

The health insurer said it has about 50,000 individual Medicare Advantage members, but noted that the change will not apply to the health plan’s roughly 15,000 group Medicare members.

The changes come as health insurers across the country tweak their Medicare Advantage offerings that are no longer as profitable due to increased usage by seniors seeking medical care, as well as policy changes in Washington, D.C., that have put financial pressure on reimbursements.

In addition, Roswell Park will not be in network next year with Medicare Advantage plans offered by Humana or UnitedHealthcare, according to a list on Roswell Park’s website. But patients in the statewide Roswell Park Care Network will have some United plan options, noted Daniel Weinrieb, vice president of payer relations at Roswell Park.

Meanwhile, several Medicare Advantage plans through Highmark Western and Northeastern New York include Roswell Park, while others do not. Roswell Park is listed as participating in all of Univera Healthcare’s Medicare Advantage plans.

“We really believe that we provide very high quality care, and are very concerned about patients not having access to this care, particularly this vulnerable population over the age of 65 who are, honestly, more likely to develop cancer over the next 10, 15, 20 years,” Roswell Park Chief Medical Officer Dr. Julia Faller told The Buffalo News on Friday.

It is key information for seniors, especially those receiving cancer treatment, to know as they head into open enrollment, which runs from Oct. 15 through Dec. 7.

In a message to Roswell Park employees Thursday, President and CEO Candace S. Johnson explained that the cancer center was recently informed that Independent Health “designed their 2026 Individual Medicare Advantage products to put more financial burden on our patients, shifting more cost to the community we care for and away from Independent Health.”

“This decision creates financial and emotional stress for patients who are already facing the challenges of cancer,” Johnson wrote. “We believe that cost should never be a barrier to receiving quality care and service, and we could not in good conscience participate in a plan that would put our patients and community at risk for financial harm.”

In her message, Johnson said that Roswell Park is launching a communications plan that will inform the community about the changes, including outreach to patients to explain their options during Medicare’s open enrollment period.

Independent Health responds

In a statement, Independent Health said it had been working with Roswell Park on a new agreement to continue as a participating provider in its individual Medicare Advantage plans for 2026.

“Unfortunately, despite extensive negotiations, Roswell Park chose not to participate in our individual Medicare Advantage plans starting January 1, 2026,” the health plan said, noting that Roswell Park will still participate in Independent Health’s group Medicare plans, as well as commercial, state and self-funded lines of business.

In discussions with Independent Health, Faller said Roswell Park didn’t feel as though “there was an option for us to negotiate with them on this particular topic.”

“We couldn’t move forward with any agreement that meant that our patients are going to face much higher cost,” Faller said. “They basically told us, ‘This is what we are offering you,’ and that wasn’t something that we felt comfortable with. We didn’t feel it was fair. It wasn’t right, and it’s just not in line with the quality of care that we want to make sure our patients receive.”

Independent Health reports a $66 million loss for last year, a big improvement from 2023

Despite the loss, it is a big improvement for Independent Health compared to 2023, when the insurer recorded a net loss of about $193 million on revenues of $2.3 billion.

Independent Health’s individual Medicare Advantage members will have access to a network of oncology providers that includes Buffalo Medical Group, Catholic Health, Great Lakes Cancer Care Collaborative (which includes Erie County Medical Center, Kaleida Health and UBMD, among others) and Wilmot Cancer Institute at Strong Memorial Hospital in Rochester.

In Medicare Advantage, the government pays private insurers – such as Independent Health, Highmark or Univera – to operate approved health insurance plans for those 65 and older as an alternative to what is often referred to as “traditional Medicare.” In 2023, 49% of Medicare beneficiaries opted to enroll in Medicare Advantage plans, a percentage that has been growing quickly in the last decade, according to The Commonwealth Fund.

Changes to Medicare Advantage

While Medicare Advantage plans have been historically lucrative for insurers, that appears to be changing.

Just this week, Reuters reported that massive insurers UnitedHealth, Humana and CVS Health are pulling back on Medicare Advantage offerings for 2026 as the profitability of those plans wanes. Since 2024, Reuters reported, the U.S. government has been scaling back payments in Medicare Advantage as it tries to cut spending.

In reporting a $66 million loss for 2024, Independent Health noted that changes to the Medicare Advantage program reduced reimbursements by about 3%. Despite the challenges, Independent Health last year grew membership in its Medicare Advantage business.

Highmark Western and Northeastern New York, the local affiliate of Pittsburgh-based Highmark Health, reported a net loss of $140 million in 2024, on revenue of $3 billion. Highmark attributed $106 million – about 75% of the total loss – to its Medicare Advantage business due to increased use and federal changes, which included increases in hospital payments, a cap on out-of-pocket expenses for members and government reimbursement rates that stayed flat.

In a statement Friday, Highmark said increased health care costs, driven by expensive new drugs and increased medical utilization, have outpaced the rate of federal reimbursement in the last three years.

In addition, a federal change to the Medicare Wage Index led to substantially higher hospital payments for upstate New York hospitals, further widening the gap between health care costs and the revenue provided to health plans to provide this coverage, Highmark noted.

While Highmark had to make changes to its Medicare Advantage plan options for 2026, it said it worked with Roswell Park to ensure the cancer center’s participation in several of its offerings. Roswell Park will participate in Highmark’s 2026 individual Medicare Advantage Senior Blue HMO plans, Forever Blue PPO and Freedom Blue PPO plans. It will not be participating in Highmark’s 2026 Community Blue individual Medicare HMO plans.

“Highmark made the decision to maintain Roswell Park as a participating provider in MA products with monthly premiums that more adequately cover the cost of their services,” said Highmark, noting that Roswell Park is in network in all other Highmark plans offered to Medicare Group retirees, large and small businesses and individuals.

Rochester-based Excellus BlueCross BlueShield, which includes Univera Healthcare, reported an operating loss last year of $163 million on revenue of $6.5 billion. But strong investment results offset the loss, allowing Excellus to post a profit of $25.6 million.

With the change to the Medicare Wage Index, Excellus last year reimbursed hospitals $100 million more for Medicare Advantage members, but the insurer did not see an increase in government funding. The health plan’s Medicare Advantage products lost more than $200 million last year due to the wage index changes and increases in health care costs.

For more information on Medicare coverage at Roswell Park, patients can visit www.roswellpark.org/innetwork.

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