Medicare plans to change

More than 1,700 Pottawattamie County residents will need to find new Medicare coverage for 2027 after their current plans were discontinued, raising the stakes for this year's Medicare open enrollment period.

The affected beneficiaries include 1,018 people losing standalone prescription drug coverage and 694 losing Medicare Advantage plans, according to Kristin Griffith, director of Iowa's Senior Health Insurance Information Program and Senior Medicare Patrol, known as SHIIP-SMP.

The changes are part of a larger wave of cancellations affecting more than 87,000 Medicare beneficiaries statewide. Griffith said the combination of major insurers leaving portions of the market and the loss of prescription drug plans has made this year particularly unusual.

"It's kind of a perfect storm," Griffith said.

A major change is Wellmark's decision to leave the Medicare Advantage market. Aetna also is discontinuing its SilverScript Choice prescription drug plan, which accounts for more than 39,000 affected beneficiaries statewide, Griffith said.

Insurance companies typically make annual decisions about which plans to offer, and those decisions can change the coverage available to beneficiaries from one year to the next.

"We usually aren't privy into the whys of that," Griffith said. "It tends to be a business decision."

What beneficiaries need to know

Medicare's annual open enrollment period runs through Dec. 7, giving beneficiaries an opportunity to compare coverage and select a plan for 2027.

Beneficiaries who do not select replacement coverage by Dec. 31 could face a gap beginning Jan. 1, Griffith said. Those losing Medicare Advantage coverage would return to Original Medicare, which does not automatically include prescription drug coverage. Those losing a standalone prescription drug plan would be left without that coverage.

People whose plans are canceled have additional time to select a replacement through a special enrollment period ending Feb. 28, 2027. But waiting until then could leave them without the coverage they need during January and February.

If beneficiaries miss that deadline, they could have to wait until the next annual open enrollment period, which begins Oct. 15, 2027, to enroll in a new plan.

Griffith urged beneficiaries to read any mail they receive from their insurance companies. Insurers must notify members about changes to their coverage, including when a plan will not be renewed.

"What's so important this time of year is that people read anything they get from their plan," Griffith said. "They've got to open and read their mail because that's where they're really going to find that information."

One of the most significant coverage changes involves the Mayo Clinic. With the discontinuation of Wellmark and Medica's Medicare Advantage PPO plans, Iowa beneficiaries will no longer be able to purchase Medicare Advantage plans offering in-network coverage with Mayo Clinic for 2027, according to the state.

Griffith said some patients receiving significant ongoing treatment, such as cancer care, may qualify for a continuity-of-care period that allows them to continue seeing their providers for a limited time after their plan ends. She said beneficiaries in that situation should confirm the details of their individual coverage.

For those choosing a replacement plan, Griffith recommended using the Medicare Plan Finder at medicare.gov. The tool allows users to enter their medications and health care providers to help identify plans that cover their prescriptions and include their doctors in their networks.

She also recommended contacting a provider's billing office to confirm network participation before enrolling.

"Those are not something that you can fix after the fact," Griffith said of network restrictions. "They either have those contracts in place or they don't."

Help available locally

Iowa's SHIIP-SMP program offers free, unbiased Medicare counseling through a statewide network of about 440 volunteer counselors. The program serves approximately 55,000 Iowans annually, Griffith said.

Six counselors serve Pottawattamie County. Residents can contact either of the following local sites for assistance: „

•Connections Area Agency on Aging: 712-328-2540 „

•All Care Health Center: 712-325-1990

Beneficiaries also can use the SHIIP-SMP website at shiip.iowa. gov for enrollment resources and plan-comparison guidance or call 1-800-MEDICARE (1-800-6334227) for assistance at any time.

Griffith said beneficiaries should review their coverage every year, even when they are satisfied with their current plan. Insurance companies can change covered prescriptions and other benefits between annual contracts.

She also warned people to be cautious of unsolicited calls from individuals claiming to represent Medicare, particularly during open enrollment, when beneficiaries may feel pressured to make decisions.

"Medicare never calls you," Griffith said. "They'll never do that."

Griffith said Iowa has not experienced a significant overall reduction in the number of Medicare plans available in recent years. However, negotiations between insurers and health care providers can affect where beneficiaries can receive care.

She encouraged people approaching Medicare eligibility, as well as current beneficiaries considering a change, to understand the differences between Original Medicare and Medicare Advantage before choosing coverage.

"I wish it was a lot simpler," Griffith said. "Unfortunately, there are a lot of pretty significant decisions you need to make about how you want to receive your Medicare."

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