{"id":407634,"date":"2025-11-27T05:23:19","date_gmt":"2025-11-27T05:23:19","guid":{"rendered":"https:\/\/www.europesays.com\/us\/407634\/"},"modified":"2025-11-27T05:23:19","modified_gmt":"2025-11-27T05:23:19","slug":"medicare-advantage-plans-are-leaving-vermont-now-what","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/407634\/","title":{"rendered":"Medicare Advantage plans are leaving Vermont. Now what?"},"content":{"rendered":"

Bouncing from plan to plan for Medicare coverage has become an inadvertent, annual tradition for Becky Beerwald.<\/p>\n

When she moved to Essex Junction from the Connecticut coast in 2023, she selected a Medicare Advantage plan before it was <\/strong>discontinued<\/a> for the following year. Then she enrolled in a Vermont Blue Advantage plan, only for the insurer to announce in October that it would not offer the plans in 2026<\/a>. This fall, she went back to the drawing board but in an insurance landscape almost entirely stripped of the Medicare Advantage plans that nearly 51,000 people in the state had relied on.\u00a0<\/p>\n

Beerwald is just one of the thousands of Vermonters trying to make sense of the coverage that remains available now that Medicare Advantage has essentially left the state.<\/p>\n

READ MORE<\/p>\n

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\n\t\t\t\t\t\t\t\t\t\t\t\t\"Tens\t\t\t\t\t\t\t\t\t\t\t\t<\/a><\/p>\n

\t\t\t\t\t\t\tby Olivia Gieger<\/a>
\n\t\t\t\t\t\tOctober 1, 2025, 1:01 pmOctober 2, 2025, 11:18 am\t\t\t\t<\/p>\n

This year\u2019s open enrollment period for Medicare, which runs through Dec. 7, has been a \u201cchallenging one,\u201d said Sam Carleton, who directs the State Health Insurance Program, a state entity that provides guidance for Medicare beneficiaries. The small office has been flooded with inquiries since the start of October, when BlueCross Blue Shield and United Healthcare\u2019s departures from the Advantage market became public. Agewell, the elderly support agency Carleton leads in Northwestern Vermont has also seen a surge in interest for the webinars<\/a> they offer to explain how Medicare works and how people can get the coverage they need under it.<\/p>\n

Medicare is the federal health insurance program for people 65 and older and those with certain disabilities.\u00a0<\/p>\n

Medicare has four parts: Part A covers inpatient care while Part B broadly covers outpatient care, medical devices and preventative care, among other things. Together, these two are regarded as original Medicare. It generally covers 80% of the cost of services, meaning many people who opt for traditional Medicare coverage also opt for something known as a Medigap plan, or supplemental insurance, sold by a private insurer that can help cover the remaining 20% of costs.\u00a0<\/p>\n

Medicare Part D offers prescription drug coverage, which is also provided by a private insurer.\u00a0<\/p>\n

Part C plans bundle all of that \u2014 and often include additional benefits like dental, or vision. These plans, known as Medicare Advantage plans, are offered by private insurers.\u00a0<\/p>\n

While many people like their Advantage plans, others can feel trapped in them because they require approval before covering some drugs and services and often require people to see in-network providers.<\/p>\n

When the insurers providing Medicare Advantage plans in Vermont announced the end to their coverage<\/a>, it gave some people a welcomed exit ramp from plans that are otherwise difficult to leave, explained Kaj Samsom, the commissioner of the Department of Financial Regulation, the state office that regulates insurers.<\/p>\n

\u201cThis event, as really truly unfortunate as it is for folks who are no longer in Medicare Advantage and no longer have other options, there are some people who are probably happy,\u201d Samsom said.<\/p>\n

\"KajTax Commissioner Kaj Samsom. File photo by Mike Dougherty\/VTDigger<\/p>\n

When an insurer withdraws a plan, it triggers something called a special enrollment period, which comes with different privileges than the regular open enrollment period.<\/p>\n

In particular, it means people searching for new plans get something called \u201cGuaranteed Issue Rights.\u201d These rights mean that insurance companies cannot charge someone more for their insurance based on pre-existing health conditions \u2014\u00a0things like diabetes or cancer \u2014 that would make care more expensive for the insurer to pay out.\u00a0<\/p>\n

When someone is new to Medicare and enrolling for the first time, they are also protected from this type of underwriting. But after that initial enrollment, Medigap plans can reject or charge sicker patients more based on their health history. Samsom referred to this as the \u201cone way street<\/a>\u201d of Medicare Advantage, where individuals can\u2019t switch to traditional Medicare without the massive cost of a Medigap supplement plan looming over them.<\/p>\n

Now, nearly all Vermonters who bought Medicare Advantage plans will need to opt into original Medicare, with the option to buy the supplemental Medigap plans \u2014 protected from underwriting during this special enrollment.\u00a0<\/p>\n

The issue of underwriting became particularly concerning to Beerwald. As she scoured the best Medigap plan, she said some insurers asked for her health history, despite her guaranteed issue rights.\u00a0<\/p>\n

When open enrollment began, Beerwald said she started calling the insurers offering the least expensive Medigap plans<\/a> for 2026: Medco, State Farm and Aflac.\u00a0<\/p>\n

Each insurer offers a selection of Medigap plans: A, B, C,\u00a0 D, F, G. These letter plans are standardized<\/a>, so that plans with the same letter include the same benefits, no matter which insurer sells them. Price should be the only difference.\u00a0<\/p>\n

Beerwald said she wants a G plan because it offers the best coverage with the most diverse beneficiary pool \u2014 because of a 2015 law<\/a>, people who became eligible for Medicare after 2020 can\u2019t buy Medigap plans C or F. That restriction effectively leaves plans\u2019 pool older. Plans D and G now offer similar coverage, without the age restriction.<\/p>\n

\"TableA slide from a webinar titled \u201cAge Well Medigap\u201d organized by the State Health Insurance Assistance Program on Tuesday, Nov. 25. Screenshot via YouTube<\/p>\n

\u201cMy mother lived until almost 102 my dad was 87, so I\u2019ve got a long life ahead of me,\u201d Beerwald said. \u201cI don\u2019t want to be in the older pool, I want to be in the younger pool.\u201d\u00a0<\/p>\n

She said she worries that as the pools under plans C and F grow older and smaller over time, their premiums will soar or the plans could disappear altogether.\u00a0<\/p>\n

\u201cI don\u2019t want to be in the lurch again. I want to be in the popular plan with the popular kids,\u201d she said.\u00a0<\/p>\n

Insurers she found that honored the guaranteed issue rights for plan G charged higher premiums. She did notice, however, that insurers would honor these rights for C and F plans.\u00a0<\/p>\n

Eventually, she bought a TVHP Medigap Blue Plan G from BlueCross BlueShield of VT, for about $258 per month, she said.<\/p>\n

Still, the fact that she encountered some insurers who would not honor the guaranteed issue for every letter plan conflicted with her understanding of how the law should protect that right.<\/p>\n

Beerwald\u2019s quest to understand and rectify this issue offers a window onto the maelstrom that can arise when private insurers are tasked with delivering a government service. She said she reached out to the state office tasked with regulating insurers, their consumer protection line, U.S. Rep. Becca Balint\u2019s office, SHIP and Carleton, in an attempt to make sense of it all.<\/p>\n

\u201cI certainly feel that frustration. I mean, you\u2019re in a circumstance where you\u2019ve lost your insurance, you received notice from the federal government that you are getting a special enrollment period, and you\u2019re able to get another plan. You\u2019ve done the legwork. \u2026 You\u2019ve made a choice, and you then call this insurance company, those insurance companies say sure we\u2019ll sell you a policy, but only if you send us all your medical records. That stinks,\u201d Carleton said.\u00a0\u00a0<\/p>\n

However, Carleton and the Department of Regulation told Beerwald \u2014 and confirmed to VTDigger \u2014 that it is legal for insurers to not apply guaranteed issue rights to every letter plan.\u00a0<\/p>\n

It comes down to one small matter of wording in the regulation that applies to Medigap plans:\u00a0 \u201cIt\u2019s a \u2018must\u2019 for (plans) A, B, C, F,\u201d Department of Regulation Deputy Commissioner Mary Block said. \u201cIt\u2019s a \u2018may\u2019 for G, for people before that 2020 date.\u201d\u00a0<\/p>\n

\u201cSo some insurance companies will offer it, some will not,\u201d she added.\u00a0\u00a0<\/p>\n

There\u2019s nothing the state can do to rectify this frustration, according to Block, since federal law dictates Medigap plan regulations.\u00a0<\/p>\n

\u201cIn Vermont, we don\u2019t have the discretion to say Plan G is always going to be available to everybody,\u201d she said.\u00a0<\/p>\n

Block added that other consumers have run into confusion when dealing with insurance brokers, who may not be aware of which customers are receiving guaranteed issue rights and may mix up forms.\u00a0<\/p>\n

The best way to combat that, Samson said, is for people to advocate for themselves and make it very clear when they are on the phone that they need the guaranteed issue rights.\u00a0<\/p>\n

Beerwald remains unsatisfied with their explanation.<\/p>\n

Now, the only remaining Medicare Advantage plans in the state are Humana plans in six counties \u2014 including Orange, Windham and Windsor, where many of the available care comes from providers in the Dartmouth Health network. However, Dartmouth Health has long been out of network for Humana. During a Nov. 19 town hall<\/a> with the Vermont congressional delegation, Balint raised particular concern over this and cautioned beneficiaries in those counties to choose new plans.<\/p>\n

Carleton assured that even in the counties where Humana remains, if people have lost their other Advantage plan, they should still receive guaranteed issue rights for Medigap plans if they chose to buy one and opt into original Medicare.\u00a0<\/p>\n

\u201cWhat prompts the special enrollment period is your plan leaving, not necessarily the loss of all Medicare Advantage plans,\u201d he said.\u00a0<\/p>\n

Carleton said he worries about the overall sticker shock that comes with Medigap plans, and\u00a0 fears some people will opt into original Medicare and forgo supplemental plans, leaving them vulnerable to the 20% of costs that original Medicare doesn\u2019t cover.<\/p>\n

Beerwald said she\u2019s going to end up paying more than $7,500 for insurance this year. After her Medigap plan, she said she\u2019s buying a drug plan, vision and hearing plans, as well as a dental plan, to cover the cost of extensive dental work she needs\u00a0<\/p>\n

She said she worries not just for herself but for other older adults who are not as savvy as navigating all the pitfalls of the insurance system. But for now, she is locked in to her BlueCross BlueShield\u2019s plan for at least a year and whatever 2026 may have in store.\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"Bouncing from plan to plan for Medicare coverage has become an inadvertent, annual tradition for Becky Beerwald. When…\n","protected":false},"author":3,"featured_media":407635,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,1142,192067,28533,192068,67,132,68],"class_list":{"0":"post-407634","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-kaj-samsom","12":"tag-medicare-advantage","13":"tag-state-health-insurance-assistance-program","14":"tag-united-states","15":"tag-unitedstates","16":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115619995661830804","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/407634","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=407634"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/407634\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/407635"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=407634"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=407634"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=407634"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}