N.H. Medicare Advantage market is 'collapsing,' commissioner says

The state’s insurance commissioner said the Medicare Advantage insurance market for senior citizens is “collapsing” and warned that some parts of the state will have no access in 2026 or only a single carrier providing that health coverage.

D.J. Bettencourt said while his agency has no authority over such federally licensed plans, he’s monitoring it closely with a new law (SB 121) that compels insurance carriers to give the state notice of their intent to leave the marketplace.

“From what I am observing the Medicare Advantage market as it exists today is collapsing. There will be fewer players in that market, there will be fewer offerings,” said Insurance Commissioner D.J. Bettencourt who had asked permission on Wednesday to brief the House Commerce and Consumer Affairs Committee on the market disruption.

“We are doing everything we can to get out in front of this.”

After some major companies dropped coverage last year, Bettencourt asked and the Legislature passed a bill (SB 121) that starting Saturday requires all Medicare Advantage insurers to notify his agency within 90 days of plans to “significantly modify” their offerings in the state.

Bettencourt said officials with several carriers have informed their staff about their future presence in the state, though those talks at this early juncture have remained confidential.

“There will be more than one (leaving) and there will be names that you recognize that pull out of the market entirely,” Bettencourt said, adding it is a national trend, as firms have found these plans to be less profitable in recent years.

“We are all now in the same boat, seeing a lot of withdrawals, a lot of disruption.”

House Commerce Committee Chairman John Hunt, R-Rindge, said it’s possible the changes could make remaining insurers more financially flush as new customers grow their ranks.

Bettencourt said he remains concerned whether those carriers left in the market will have a large enough medical network to serve more who need that coverage.

“You are going to know the answer to that question and many others in the next few weeks,” Bettencourt said.

Presently 6 firms offering these plans

Currently there are six major companies offering a variety of Medicare Advantage Plans.

In the past decade, there’s been major growth in this option for seniors who looked for coverage beyond basic Medicare insurance to help them afford services such as prescription drug coverage, vision and dental care.

In the U.S. this year, 34 million or about 54% of those on Medicare have an Advantage plan.

Anyone who loses their Medicare Advantage carrier is not automatically enrolled with another company but eventually will default to basic Medicare if that person fails to make a choice.

The enrollment period for someone seeking an Advantage plan for the first time opens Oct. 15 and closes Dec. 7; those in a plan currently will have from Jan. 1 through March 31 to make their choice.

The open enrollment for basic Medicare coverage this year begins Oct. 7 and ends Dec. 15.

Last Oct. 18, Bettencourt’s agency informed the public that 44,000 seniors had lost their Medicare Advantage plan due to carrier decisions at that time which affected nearly half of those who had such a plan.

Harvard Pilgrim Health Care and Wellcare (Centene) left the state entirely for 2025, while Aetna and Humana reduced some availability.

A year ago, Anthem, Martin’s Point, UnitedHealthcare and WellSense made no changes to their plans in New Hampshire.

Since then, however, Modern Healthcare reported last month that Aetna is planning to close 90 Medicare Advantage plans across 36 states next year.

Nationally some players already announced cuts on the way

UnitedHealthcare and Humana have said they are likely to lose about 600,000 and 550,000 Medicare Advantage customers, respectively, as they exit some markets.

Bettencourt said all affected consumers will be notified about how changes to the plans affect them and the deadlines by which they must act.

Affected enrollees will get a Special Enrollment Period to select another plan or return to basic Medicare.

Seniors could also decide to add to their basic Medicare a standalone Part D prescription drug plan with its own monthly premium.

Bettencourt said if Medicare Advantage doesn’t exist in parts of the state, seniors might consider a Medicare Supplement (Medigap) plan to cover costs that basic Medicare does not.

Unlike Medicare Advantage, Medicare Supplement plans do not have network restrictions.

This Medigap offering is guaranteed to be offered to seniors without having to go through medical underwriting to become eligible for that coverage.

Medigap plans typically have higher monthly premiums but lower out-of-pocket costs and more provider flexibility, while Medicare Advantage plans usually have lower monthly premiums but higher out-of-pocket costs and more restrictive networks.

“Consumers should use their Special Enrollment Period to compare plans, confirm that their doctors and prescriptions are covered, and seek free, unbiased help from the Insurance Department, SHIP, or another legitimate resource,” said Deputy Insurance Commissioner Keith Nyhan. “Acting promptly will ensure uninterrupted coverage and continued access to quality care. Most importantly, consumers should know they are not alone — our team is with them and can help at every step of the way forward.”

The state insurance agency and the State Health Insurance Assistance Program (SHIP) are available to provide that free advice. Consumers can review their options using Medicare’s Plan Finder tool at www.medicare.gov or by calling 1-800-MEDICARE, and contact the state insurance’s Consumer Services Unit at 603-271-2261 or [email protected] for guidance.

In the coming weeks, the agency’s website will also have more advisory information for consumers.

[email protected]

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