Medicare Advantage plans are going through a lot of changes right now, and we want to talk about how you may be affected and what your options are if these changes impact you.
Losing your plan midyear can be very stressful—and even costly if you’re not prepared. These disruptions tend to hit low-income seniors the hardest, especially those living in rural areas. Rural areas and smaller plans appear to be facing the most disruptions right now.
However, if you do lose your plan, there is one important thing to remember: a forced disenrollment triggers a Special Enrollment Period, which means you will have an opportunity to switch plans.
If you are affected, our partners at Chapter can help answer questions and walk you through your options if you need assistance.
This is a transcript of our video. You can watch the full video on our YouTube channel: Low Income Relief.
What Medicare Advantage Is
First, let’s quickly talk about what Medicare Advantage is, since that’s the program most impacted by the changes we’re discussing today.
Medicare Advantage is a private insurance alternative to Original Medicare. In this system, the government pays a private insurer to manage your Medicare coverage.
Many people choose Medicare Advantage because it often includes additional benefits like:
- Dental
- Vision
- Hearing
However, not all plans offer the same benefits.
Some Medicare Advantage plans also offer $0 monthly premiums, and more than half of all Medicare enrollees now use Medicare Advantage.
Why Plans Are Disappearing
Right now, insurers offering Medicare Advantage plans are facing increasing pressure.
Medical costs are rising, and profit margins for insurers are shrinking. As a result, some companies are leaving certain local markets.
When insurers exit a market, the people enrolled in those plans are forced to find new coverage.
These decisions can be influenced by several factors, including:
- Rising healthcare costs
- Regulatory changes
- Changes in reimbursement rates
Regardless of the cause, the result is the same: many seniors are suddenly forced to switch plans.
Disruptions Are Increasing Nationwide
Historically, Medicare Advantage disruptions were relatively rare.
From 2018 to 2024, the disruption rate was about 1% per year.
In 2025, that number jumped to 7%.
In 2026, the disruption rate is expected to reach 10%, meaning one in ten Medicare Advantage enrollees may be forced to switch plans.
Considering there are about 35.5 million Medicare Advantage enrollees nationwide, that represents a very large number of people dealing with unexpected coverage changes.
Some States Are Seeing Major Disruptions
The impact isn’t the same everywhere.
Some states are seeing extremely high rates of forced plan changes.
For example:
- Vermont: Over 92% of Medicare Advantage enrollees were forced to switch plans.
- Idaho, North Dakota, South Dakota, and Wyoming: Disenrollment rates of 40% or higher.
Overall, 12 states had disruption rates above 20%, meaning more than two out of every ten enrollees had to change plans.
If this situation affects you, you’re certainly not alone. Many seniors across the country are dealing with the same issue.
Why This Can Be Hard For Low-Income Seniors
These changes can be especially difficult for seniors who receive the Low-Income Subsidy (Extra Help) or who rely on specific networks of doctors and pharmacies.
Switching plans can cause several problems, such as:
- Your current doctor may not be in the new plan’s network.
- Your specialists or hospitals may not be covered.
- Your medications may be covered differently or cost more.
Different plans have different formularies, which means the drugs they cover—and the price you pay—can vary significantly.
Why Comparing Plans Matters
Choosing a new plan can be complicated because there are now more than 20,000 Medicare plans nationwide.
When comparing options, it’s important to look at things like:
- Whether your doctors are included in the network
- Whether your prescriptions are covered
- What your out-of-pocket costs could be
This is one area where professional guidance can be helpful. Advisors can compare plans side-by-side to help determine which options best match your healthcare needs.
A Real Example
One viewer recently shared her experience.
Anne was unsure how Medicare changes might affect her. Then her plan suddenly disappeared.
She said, “Insurance plans are my worst nightmare.”
She contacted Chapter and was connected with an advisor named Brandon. Brandon spent two hours on the phone reviewing her medications, doctors, and benefits to make sure everything would still be covered.
The next day he called back with additional information.
As a result, Anne was able to switch to a plan that restored her over-the-counter benefits, along with better dental and vision coverage.
Watch Your Mail Carefully
The most important thing you can do right now is pay attention to any letters you receive from your Medicare Advantage plan.
If your plan is being discontinued or changed, the insurance company will notify you by mail.
These letters explain:
- Whether your plan is ending
- What your options are
- When you must choose a new plan
Ignoring these notices can lead to coverage problems.
What Happens If Your Plan Ends
If you are forced to leave your Medicare Advantage plan, you will qualify for a Special Enrollment Period.
During this time, you can:
- Choose a different Medicare Advantage plan
- Return to Original Medicare
- Explore other options that may fit your needs better
This window allows you to make changes outside the normal enrollment periods.
Common Mistakes To Avoid
There are a few mistakes people often make during this process.
One of the biggest is ignoring the letter notifying them of plan changes.
Another mistake is choosing the first plan available without comparing options.
Even if you’re in a hurry to replace coverage, it’s important to review your options carefully to make sure the new plan actually works for you.
You should also remember to check whether you qualify for additional assistance programs like:
- Medicare Savings Programs
- Extra Help
These programs can help reduce your out-of-pocket costs.
Questions To Ask Before Choosing A Plan
When considering a new Medicare plan, it’s important to ask a few key questions:
- Does this plan include my doctors?
- Are my prescriptions covered at the same or lower cost?
- What are the out-of-pocket maximums?
- Do I qualify for Extra Help or a dual-eligible plan?
Taking time to review these details can help you avoid unpleasant surprises later.
Free Medicare Resources
If you want to learn more about how Medicare decisions work, there are free educational resources available.
For example, you can download a free PDF copy of the book “It’s Not That Complicated: The Three Medicare Decisions That Affect Your Life and Money.”
You can find it at:
Final Thoughts
If your Medicare Advantage plan disappears, remember that you do have options.
A forced disenrollment triggers a Special Enrollment Period, which gives you time to select a new plan that fits your needs.
The most important steps right now are:
- Watch your mail carefully for notices from your insurer
- Review your options carefully before choosing a new plan
- Seek help if you need assistance comparing plans
I hope this information has been helpful.
Be sure to check out our other recent videos covering updates to Social Security, Medicaid, and other programs. There are a lot of changes happening right now, and we’re doing our best to keep you informed.
We’ll see you again soon with more ways to save money and get free stuff.
