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Medicare Advantage Plan Exits in 2025

by | Jan 15, 2025 | Medicare, Medicare Advantage, Medicare Prescriptions

Medicare Advantage Plan Exits in 2025

Several insurers made the decision to exit the Medicare Advantage market in 2025 due to various financial pressures and changes in reimbursement rates. Here are some of the major exits:

  • Aetna: Exited several counties and is expected to lose up to 10% of its Medicare Advantage members.
  • Humana: Exited 13 Medicare Advantage markets, primarily in the Southeastern states. This move affected approximately 560,000 members.
  • WellCare: Closed its Medicare Advantage business in six states: Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont.
  • Cigna: Exited Medicare Advantage markets in eight states, affecting about 5,400 members.
  • Moda Health: Discontinued all individual Medicare Advantage plans in Oregon.
  • Premera Blue Cross: Will not offer Medicare Advantage plans in 2025.
  • MVP Health Care and University of Vermont Health: Stopped offering their joint Medicare Advantage plan in Vermont.
  • Southwestern Health Resources: Shut down its Medicare Advantage plan, Care N’ Care, in Texas.
  • BCBS Arizona: Will not offer MA prescription drug plans in Arizona.
  • BCBS Kansas City: Exited the Medicare Advantage market at the end of 2024.

Impact on Beneficiaries

The sudden exits of these insurers have left many Medicare beneficiaries scrambling to find new coverage. The changes were primarily driven by the Inflation Reduction Act, which lowered reimbursement rates and increased financial pressures on insurers. As a result, many plans became economically unfeasible for insurers to maintain.

Medicare Advantage Open Enrollment Period (MA-OEP)

The Medicare Advantage Open Enrollment Period (MA-OEP) runs from January 1 to March 31 each year. During this period, current Medicare Advantage members can:

  • Switch from one Medicare Advantage plan to another, with or without Part D coverage.
  • Drop their Medicare Advantage plan and return to Original Medicare, and enroll in a standalone Part D plan.

What You Can and Cannot Do During MA-OEP

What You Can Do:

  1. Switch Medicare Advantage Plans: You can switch from your current Medicare Advantage plan to another Medicare Advantage plan, whether it includes drug coverage (MAPD) or not (MA-only).
  2. Return to Original Medicare: You can drop your Medicare Advantage plan and return to Original Medicare (Parts A and B). You can then enroll in a standalone Part D plan for prescription drug coverage.
  3. Change Prescription Drug Coverage: If your current Medicare Advantage plan does not include drug coverage, you can switch to a plan that does (MAPD) or enroll in a standalone Part D plan if you return to Original Medicare.

What You Cannot Do:

  1. Switch from Original Medicare to a Medicare Advantage Plan: The MA-OEP is only for changes within Medicare Advantage plans or returning to Original Medicare. You cannot use this period to switch from Original Medicare to a Medicare Advantage plan.
  2. Enroll in a Part D Plan if You Have Original Medicare: If you are already on Original Medicare and want to enroll in a standalone Part D plan, you cannot use the MA-OEP for this change. You would need to wait for the AEP or qualify for a Special Enrollment Period (SEP).

Case Study: John’s Experience

John, a Medicare beneficiary, was enrolled in a Medicare Advantage plan offered by Aetna. When Aetna exited the market in 2025, John was left without coverage. Here’s how John navigated the situation using the MA-OEP:

  1. Notification of Plan Exit: John received a notice from Aetna informing him that his Medicare Advantage plan would no longer be available in 2025. The notice included information about his options and the MA-OEP.
  2. Researching Options: John took the time to research other Medicare Advantage plans available in his area. He used the Medicare Plan Finder tool on the Medicare.gov website to compare plans based on coverage, premiums, and out-of-pocket costs.
  3. Consulting an Agent: John reached out to a licensed insurance agent to get personalized advice on his options. The agent helped him understand the pros and cons of different plans and guided him through the enrollment process.
  4. Using the MA-OEP: During the MA-OEP, John opted to switch to a new Medicare Advantage plan offered by another insurer. This allowed him to maintain his coverage without a gap and find a plan that better suited his healthcare needs.

John was initially concerned about the disruption caused by Aetna’s exit, but the MA-OEP provided him with an opportunity to explore new options and make an informed decision. By taking advantage of the MA-OEP, John was able to secure a plan that offered comparable benefits and ensured continuity of care.

Conclusion

The Medicare Advantage plan exits in 2025 have created challenges for many beneficiaries. However, the MA-OEP provides an opportunity to make changes and find new coverage. By understanding your options and taking advantage of the MA-OEP, you can ensure that you have the coverage you need to meet your healthcare needs.

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About the Author

Matt Feret is the author of the Prepare for Social Security – The Insider’s Guide and the Prepare for Medicare – The Insider’s Guide book series and launched PrepareforSocialSecurity.com and PrepareforMedicare.com to help people get objective answers to questions about Social Security and Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.