'The most disruptive year we have seen': WNY seniors navigating change during Medicare enrollment

It is a busy time to work on the Medicare Solutions team at insurance firm Lawley. The phones are constantly ringing from seniors eager for help navigating which Medicare insurance plan might be right for them during a year of massive changes.

“I would say this is arguably the most disruptive year we have seen,” said Alyssa McGovern, director of Medicare at Lawley. “And even when you speak with people that have been in the business for decades, they would say the same.”

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One the largest changes to provider networks for 2026: Roswell Park will be out of network with Independent Health’s individual Medicare Advantage plans as well as Highmark’s $0 and low-premium individual Medicare Advantage plans.

McGovern’s team of consultants have opened up their schedules in the evenings, Saturdays and Sundays, a sign that more people than usual are seeking help during Medicare’s annual open enrollment from Oct. 15 to Dec. 7.

More Western New York seniors than ever received notices in the mail that their Medicare Advantage plan was being discontinued. Faced with rising health care costs and lower government reimbursements, area insurers have retired some plans, introduced new ones and tweaked provider networks to sustain Medicare Advantage offerings that aren’t as profitable as they used to be. Even Medicare brokers are experiencing changes, with altered commissions versus prior years on some plans.

“There’s so many different factors at play this year,” McGovern said. “I really would say it’s unprecedented in terms of disruptors and the confusion that people are having.”

In Medicare Advantage, the government pays private insurers – such as Independent Health, Highmark or Univera Healthcare – to operate approved health insurance plans for those 65 and older as an alternative to what is often referred to as “traditional Medicare.” In 2025, 54% of eligible Medicare beneficiaries opted to enroll in a Medicare Advantage plan, according to health policy organization KFF. The percentage is even higher in Western New York, federal data show.

As seniors navigate open enrollment, here is a primer on what they should know:

Many plans are being discontinued, and others changed, in 2026. Amherst-based Independent Health retired four of its Medicare Advantage plans, but will still offer seven “very affordable plans” for 2026, said Cathy Aquino, vice president for government sales.

Aquino said Independent Health retired its popular $0 premium plan, but it is reintroducing that, with some benefit changes, at a $40 monthly premium. Independent Health’s plans that include prescription coverage have monthly premiums ranging from $40 to $190. The insurer will still offer a $0 premium plan for 2026, but that doesn’t include prescription coverage.

Competitor Highmark Western and Northeastern New York has discontinued its BlueSaver (HMO), Senior Blue Select (HMO), Senior Blue Basic (HMO), Freedom Nation (PPO) and Freedom Nation Prestige (PPO) individual Medicare Advantage plans for 2026.

Highmark spokesperson Kyle Rogers said the insurer has reintroduced its $0 and low-premium products with different benefits and providers. Those new choices include Community Blue Medicare HMO Signature, Community Blue Medicare HMO Distinct and Community Blue Medicare HMO Merit.

Univera Healthcare eliminated one lower-cost PPO plan for 2026, but the rest of its plans will be available, including multiple $0 premium plans, noted Andy Napierala, vice president of Medicare and individual market sales.

Independent Health and Highmark each has around 50,000 individual Medicare Advantage members in Western New York, and Univera has just under 27,000 Medicare Advantage members.

There are also some big provider network changes for 2026. The one most people have heard about: 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, starting Jan. 1.

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.

Roswell Park also will be out of network with Highmark’s $0 and low-premium individual Medicare Advantage plans, such as the three new Community Blue Medicare HMO plans. But Roswell Park will remain in-network for Highmark’s higher premium Medicare Advantage plans, such as its Senior Blue HMO, Forever Blue PPO and Freedom Blue PPO plans.

In addition, Roswell Park will not be in-network next year with Medicare Advantage plans offered by Humana or UnitedHealthcare, though patients in the statewide Roswell Park Care Network will have some United plan options. Roswell Park is participating in all of Univera’s Medicare Advantage plans.

Primary care doctors from Buffalo Medical Group will be out of network with Highmark’s Medicare Advantage plans for 2026. But most of Buffalo Medical Group’s specialists remain in-network with Highmark’s Medicare Advantage plans, noted Rogers, of Highmark.

For Highmark Medicare Advantage members, Buffalo Medical Group primary care doctors will no longer be in network

As of July 1, 2025, patients on a Highmark Medicare Advantage plan will pay out-of-network cost-sharing amounts if they opt to receive care from Buffalo Medical Group primary care doctors.

Another potential major change was avoided in late October, when Kaleida Health and UnitedHealthcare reached an agreement. That means Kaleida will be in-network for UnitedHealthcare Medicare Advantage plans in 2026, Kaleida spokesperson Jacqueline Bett confirmed.

There are many reasons why we’re seeing so much change for 2026. Some Medicare Advantage offerings are no longer as profitable for insurers due to increased usage by seniors seeking medical care, as well as federal policy changes that have put financial pressure on reimbursements.

Rogers said Highmark has changed its plan offerings to account for rising health care costs. He noted health care costs are rising almost three times faster than other costs for families and individuals, driven by expensive new drugs and increased medical use.

In addition, a federal change to the Medicare Wage Index led to 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. The local Highmark affiliate reported a $106 million loss last year in its Medicare Advantage business.

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Univera Healthcare said it is up 400% year over year in annual enrollment period phone traffic and foot traffic at its resource center at 205 Park Club Lane in Amherst.

Rochester-based Excellus BlueCross BlueShield, which includes Univera, lost more than $200 million last year on its Medicare Advantage products.

“It’s really put the whole industry in a position where we’re making difficult decisions that we don’t want to make when it comes to the coverage that we’re able to offer,” said Napierala, of Univera.

Yes, this is happening beyond Western New York. Big insurers such as UnitedHealthcare, Humana and CVS Health are pulling back on Medicare Advantage offerings for 2026 as plan profitability wanes. Since 2024, the U.S. government has been scaling back payments in Medicare Advantage as it tries to cut spending.

Insurers have long sought to operate in markets that are profitable and exit ones that are not, noted Meredith Freed, a senior policy manager with KFF’s Program on Medicare Policy. Freed noted that UnitedHealthcare last year entered 42 counties across the country and exited 38 counties.

“They’re constantly tweaking their plan offerings to sort of address the concerns of their shareholders,” she said. “So that’s not new for Medicare Advantage plans to work that way.”

KFF found that the average Medicare beneficiary in the country will still have the option of 32 Medicare Advantage prescription drug plans in 2026, two fewer than the 34 options available in 2025.

Even amid all the change, it’s important not to panic. McGovern, director of Medicare at Lawley, said there are plenty of Medicare Advantage plan options for seniors to consider. She advised seniors to do their homework and be open to insurers they might be unfamiliar with. And also research each plan’s formulary (the list of prescription drugs that are covered), as that has always changed year to year.

“There is help out there for you,” McGovern said. “It might just take a little longer than you’re used to, but if you’re accustomed to your plan just rolling over, I would say don’t assume that your plan is rolling over, even if it’s a longstanding carrier, like Highmark or Independent Health.”

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While Independent Health has made changes to its Medicare Advantage plans for 2026, the insurer points out that its Medicare HMO plans have received five-star ratings from the Centers for Medicare and Medicaid Services.

While open enrollment runs until Dec. 7, seniors whose current plan is being terminated have until Dec. 31 to enroll in a new plan.

Further, McGovern noted, Medicare Advantage enrollees can change their plan during the first three months of 2026. During Medicare Advantage’s open enrollment period from Jan. 1 to March 31, those enrolled in a Medicare Advantage plan can switch to another Medicare Advantage plan or drop their plan and return to traditional Medicare.

“You can move again with no penalty, so you’re not locked in,” McGovern said. “There’s a lot of room to move.”

There is a lot of information and help available to seniors. Seniors can start at medicare.gov/health-drug-plans/open-enrollment, where they can view Medicare Advantage plans in their area after putting in their ZIP code, prescription drugs and providers. Here, seniors can see the star rating of each plan, rated out of five stars to assess quality, value and performance.

If Roswell Park being in network is important to you, the cancer center has set up a webpage where seniors can see every Medicare Advantage plan in the area and whether Roswell Park participates in it: roswellpark.org/innetwork.

The three largest area insurers also have webpages set up: medicare.highmark.com/resources/medicare-library/plan-documents; RedShirtTreatment.com/2026Plans; and univerahealthcare.com/plans/medicare-advantage.

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