Some NH seniors at a dis-Advantage

Oct. 18—"IMPORTANT NOTICE: Your Medicare plan won't be offered in 2025."

An estimated 10,000 New Hampshire seniors got that unsettling message in letters sent out earlier this month by Harvard Pilgrim Health Care, the company that currently covers them under Medicare Advantage plans.

And Harvard Pilgrim is not the only carrier making changes to Advantage plans, which are sold by private companies and cover some services that Medicare does not, such as vision, hearing or dental care.

Based on data from the Centers for Medicare & Medicaid Services (CMS) for 2022-2023, around 44,000 seniors in New Hampshire — more than half of the state's Medicare Advantage population — may need to choose a new plan or carrier, according to New Hampshire Insurance Commissioner D.J Bettencourt.

That's either because the carrier is getting out of the Advantage market (Harvard Pilgrim Health Care and Centene) or "narrowing their offerings" (such as Aetna and Humana), he said.

States do not regulate Medicare Advantage plans; that's the federal government's job. But Bettencourt said some insurance companies notified his department that they were ending or shrinking their Medicare Advantage plans in 2025. That prompted the Insurance Department to survey all companies that offer such plans here, he said.

It's not unusual for insurance carriers to change what they offer each year, whether through a Medicare Advantage, Medicare supplemental (Medigap) or prescription drug plan. But this year is particularly tumultuous, Bettencourt said.

"We have not witnessed this level of disruption in a considerable amount of time," he said.

Terri Vineyard, Medicare director at the state Bureau of Adult and Aging Services, wants to reassure seniors that help is out there to navigate these changes.

"My message is to take a deep breath," Vineyard said. "Don't panic."

Unless they elect to enroll in a new Advantage plan offered by another company, Vineyard said, seniors whose plans are going away will automatically be enrolled in "original" Medicare as of Jan. 1.

However, original Medicare does not include prescription drug coverage — that's a separate program known as Part D. That means seniors who had prescription drug coverage under Advantage plans that are not renewing for 2025 will no longer have that coverage as of Jan. 1.

"Those people want to be mindful of choosing a new either Part D plan or Medicare Advantage plan with prescription coverage before the end of December," Vineyard said.

Anyone whose plan is going away should have gotten a letter, Insurance Commissioner Bettencourt said, and some may get phone calls. He said he understands such notifications will prompt anxiety. But he echoed Vineyard's message: "Don't panic. You've got some time and you have options."

Why it's happening

This is not only happening in New Hampshire, Bettencourt said. Health care costs are rising and Medicare funding is not keeping up, and that's leading some carriers to cut back on what they offer in some smaller markets.

A spokesperson for Harvard Pilgrim said in a statement that the decision to "sunset" its Stride Medicare Advantage plan here came after a "comprehensive" review of the New Hampshire market. The company said it will communicate with its members, providers and insurance brokers "to ensure a smooth transition" for its Medicare Advantage customers here.

"We are not exiting the state of New Hampshire," the statement said. Harvard Pilgrim will continue to offer individual Medicare supplement plans as well as commercial programs offered on the New Hampshire exchange and to employer groups.

Another insurance company, United Healthcare, said in a statement that it will continue to offer a "comprehensive portfolio" of plans in New Hampshire, including Medicare Advantage and prescription drug plans, but benefits "may vary slightly depending on the county."

The changes coincide with the annual open enrollment period for Medicare members, which runs Oct. 15 to Dec. 7. Seniors whose plans are going away will have extra time to act; for them, a "special enrollment period" ends on Feb. 28.

But if they had their prescription drug coverage through an Advantage plan that's not being renewed, they'll have to find a drug plan elsewhere by the end of the year or face a gap in coverage, experts warn.

Not all companies are cutting back on Advantage plans.

In 2025, WellSense Health Plan will have "zero dollar" HMO and PPO Advantage plans, which include access to Northeast Delta Dental's network of 900 providers in the state, according to Paul Wingle, chief product and sales officer for the company.

It's serendipity that the rollout coincides with other companies curtailing their plans, Wingle said. "This has been a long planned evolution of our engagement with New Hampshire," he said.

WellSense, which is headquartered in Charlestown, Mass., with an office in Manchester, is a nonprofit health plan that operates in just two states, Massachusetts and New Hampshire, which allows it to offer competitive products, Wingle said. "We don't have the earnings expectations that some of these other big carriers do," he said.

As other companies cut back on Advantage plans, he said, "We're happy to be the answer for Granite Staters who are getting disappointing news from their current insurer, and we're asking folks to take a look at us."

Finding help

Seniors don't have to navigate the changes alone.

Free, unbiased counseling is available from the State Health Insurance Assistance Program (SHIP), offered at the Aging and Disability ResourcEs Centers located in every county (formerly known as ServiceLink).

Becky Rostron, training coordinator for SHIP, said seniors who are getting letters about changes to their Medicare Advantage plans can make an appointment with a counselor to go over their health care needs.

"You do have the option of going into another type of plan," Rostron said. "We can help show you those options."

"I think the biggest point is, breathe," she said. "There's help out there for you."

Insurance Commissioner Bettencourt said seniors also can contact his department with concerns about their Medicare plans, or work with independent agents who can help them compare plans to fit their individual needs. The New Hampshire Association of Insurance Agents has a directory of licensed local agents on its website (www.biginh.com).

"What I would stress is there is no wrong door to getting the information that you need," Bettencourt said. "We don't want our seniors to be in a place of high anxiety. We want to be able to be a resource to help people get through this."

Bettencourt said state insurance commissioners for years have been lobbying the federal government to give states more authority to oversee the marketing and advertising for Medicare Advantage plans. "We have seen some very, very problematic marketing practices, quite frankly abusive," he said. "And we obviously take our consumer protection mission seriously."

It also may be time for New Hampshire to pass legislation, he said, requiring companies to notify the state Insurance Department "if they're going to dramatically scale back on a set of products they're offering."

In the meantime, the commissioner offered a warning to seniors: "Please do not get your Medicare Advantage advice from William Shatner, or Joe Namath, or any of these other celebrities of old who are on television," he said.

"It really is important that you consider your own unique set of circumstances to determine whether a Medicare Advantage or Medicare supplemental product is best for you, given your unique health profile."

For help:

—Contact SHIP at 1-866-634-9412 or visit: www.shiphelp.org.

—Call 1-800-Medicare, or visit medicare.gov.

—AARP also has resources on its website: www.aarp.org/health/medicare-insurance.

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