MVP also among local insurers with changes to Medicare plans

Oct. 14—SCHENECTADY — MVP Health Care of Schenectady says that rising medical costs and new federal Medicare rules are driving changes to the Medicare Advantage plans it is offering members in 2026.

Local insurers MVP and CDPHP, which is located in Albany, are dropping some of their Medicare Advantage plans they had offered this year, forcing some members to look for new plans.

MVP is dropping three Medicare Advantage plans and adding three new ones. CDPHP also dropped one of its Medicare Advantage plans, the Times Union previously reported.

MVP and CDPHP are the only local firms to offer Medicare Advantage plans in the Capital Region, but other insurers — such as Humana, United Healthcare and Aetna — also offer such plans locally, adding up about 20 total choices. The move to drop plans is part of a national trend in the Medicare Advantage market.

The result in the Capital Region is the loss of several choices that had mid-tier monthly premiums, such as the $44-a-month MVP Patriot Plan and the $62 CDPHP Value Rx plan. Low-cost plans remain at both companies, including zero-premium plans and MVP's $15-a-month plan, MVP Medicare Complete Wellness.

Augusta Martin, chief market strategy and product officer at MVP Health Care, said the Medicare and health care markets have been undergoing so much change that the plans had to be revamped. The federal government approves Medicare Advantage plan premiums.

"The Medicare Advantage market is undergoing a fundamental shift, and MVP Health Care is adapting with purpose," Martin said in a statement. "Rising health care costs and evolving federal policy are reshaping how plans are designed and delivered."

When a typical person turns 65, they need to enroll in Medicare, the government-sponsored health insurance program. While the hospitalization part of Medicare, Part A, has zero monthly premiums for people with a work history, Medicare Part B, which includes preventive care, costs at least $185 a month (top earners can pay more than $600 a month).

Medicare Advantage plans are private plans that provide alternatives for seniors to get coverage offered under parts A and B. They often have additional benefits beyond original Medicare (parts A and B), such as vision and dental benefits, as well as prescription drug coverage, also known as Medicare Part D.

The enrollment period begins this month, so some people who have had their Medicare Advantage plans dropped are now receiving letters in the mail informing them that they must sign up for a new plan. That's especially important because a lapse in prescription drug coverage under Medicare can lead to financial penalties that will raise a consumer's Medicare premium.

CDPHP spokesperson Natalia Burkart says CDPHP has made "difficult but necessary" changes to its Medicare Advantage plan offerings for next year, all part of its efforts to respond to the federal government's decision in 2023 to increase Medicare payments to upstate New York hospitals by as much as 43%.

In general, this increase in the amount that hospitals charge Medicare patients did not result in insurers being able to dramatically increase their Medicare Advantage rates. CDPHP says the gap has hurt the company.

"CDPHP, for example, lost $168 million in 2024 because of this change, and losses are projected to continue without corrective action by Congress," Burkart said. "We are proud to continue offering four Medicare Advantage plan options to our members who have come to depend on our high-quality plans with superior customer service."

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