Some disadvantaged NH seniors

October 18 – “IMPORTANT NOTICE: Your Medicare plan will not be offered in 2025.”

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

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

Based on data from the Centers for Medicare and Medicaid Services (CMS) for 2022-2023, about 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 DJ Bettencourt.

That’s because the carrier is exiting the Advantage market (Harvard Pilgrim Health Care and Centene) or “narrowing its offerings” (like Aetna and Humana), he said.

States do not regulate Medicare Advantage plans; That’s the job of the federal government. But Bettencourt said some insurers notified his department that they were ending or scaling back their Medicare Advantage plans in 2025. That prompted the Department of Insurance to survey all the companies offering those plans here, he said.

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

“We haven’t witnessed this level of disruption in a considerable time,” he said.

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

“My message is to take a deep breath,” Vineyard said. “Don’t panic.”

Unless they decide to enroll in a new Advantage plan offered by another company, Vineyard said, seniors whose plans will be terminated will automatically be enrolled in “original” Medicare starting Jan. 1.

However, original Medicare does not include prescription drug coverage – it is a separate program known as Part D. This means that seniors who had prescription drug coverage in Advantage plans that are not being renewed for 2025 will no longer have that coverage starting from January 1st.

“These people want to be careful when choosing a new 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 received a letter, Insurance Commissioner Bettencourt said, and some may receive phone calls. He said he understands such notifications will cause anxiety. But he repeated the Vineyard’s message: “Don’t panic. You have some time and options.”

Why is this happening

This isn’t just happening in New Hampshire, Bettencourt said. Health care costs are rising and Medicare funding isn’t keeping up, which is leading some carriers to reduce what they offer in some smaller markets.

A Harvard Pilgrim spokesperson said in a statement that the decision to “discontinue” 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 will not leave 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 for employer groups.

Another insurer, 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 by county.”

The changes coincide with the annual open enrollment period for Medicare members, which runs from October 15th to December 7th. Seniors whose plans will be terminated will have more time to act; for them, a “special registration period” ends on February 28th.

But if they had prescription drug coverage through an Advantage plan that isn’t renewing, they will 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 reducing Advantage plans.

By 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, the company’s director of products and sales.

It’s serendipitous that the launch coincides with other companies scaling back their plans, Wingle said. “This has been a long-planned evolution of our engagement with New Hampshire,” he said.

WellSense, headquartered in Charlestown, Mass., with an office in Manchester, is a nonprofit health plan that operates in just two states, Massachusetts and New Hampshire, allowing it to offer competitive products, Wingle said. “We don’t have the profit expectations that some of these other big operators have,” he said.

As other companies cut Advantage plans, he said, “We’re happy to be the answer for Granite Staters who are receiving disappointing news from their current insurer, and we’re asking people to check us out.”

Finding help

Seniors don’t have to navigate change alone.

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

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

“You have the option of adopting another type of plan,” said Rostron. “We can help show those options.”

“I think the most important thing is to breathe,” she said. “There is help out there for you.”

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

“What I would like to emphasize is that there is no wrong door to get the information you need,” Bettencourt said. “We don’t want our elderly people to be in a situation of great anxiety. We want to be a resource to help people get through this.”

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

It may also be time for New Hampshire to pass legislation, he said, requiring companies to notify the state Department of Insurance “if they intend to drastically reduce a set of products they offer.”

However, the commissioner had a warning for seniors: “Please do not take advice about Medicare Advantage from William Shatner, or Joe Namath, or any other old celebrity who appears on television,” he said.

“It’s really important that you consider your own unique set of circumstances to determine whether a Medicare Advantage product or a Medicare supplement 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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