Updated at 4:01 p.m.
Nearly all Vermonters on Medicare Advantage individual plans are expected to lose their current health insurance for 2026. New data from the Centers for Medicare & Medicaid Services reveal all but one provider in the state will discontinue coverage for 2026.
Neither UnitedHealthcare nor Vermont Blue Advantage has renewed its individual Medicare Advantage plans for the 2026 year, CMS data show. These plans cover the large majority of the more than 51,600 people insured by Medicare Advantage plans in Vermont. Vermont Blue Advantage’s individual plans alone currently serve 26,000 people in the state. An additional 7,800 people will lose their UnitedHealthcare coverage.
Humana will continue to offer its Medicare Advantage plans in Bennington, Caledonia, Essex, Orange, Windham and Windsor counties. CMS’s data for the coming year did not show any 2026 Medicare Advantage plans available for individuals living in the state’s other counties to enroll in.
“Without a doubt, it’s very disruptive for seniors to have limited options to these plans,” said Kaj Samsom, the commissioner of the Department of Financial Regulation.
These changes impact only the market for individual Medicare Advantage plans. Large employers may offer their retirees continued coverage with Medicare Advantage plans provided by the employer. In September, the State Treasurer’s Office announced that the health insurance plans it manages for retired teachers will transition from Vermont Blue Advantage to HealthSpring. Vermont Blue Advantage is run by Blue Cross and Blue Shield of Vermont in conjunction with its counterpart and parent company in Michigan.
Medicare Advantage plans are an option for people eligible for Medicare, a federal health insurance program for those 65 years and older and those with certain disabilities. The Medicare Advantage plans, sometimes called Part C plans, are operated by a private company but receive funding from the federal government. They often include broader coverage, including prescription coverage, than standard Medicare, and they have a cap on annual out-of-pocket expenses. Generally, standard Medicare covers 80% of health expenses.
Last year two Medicare Advantage plans pulled out of Vermont, leaving only the Humana, Blue Advantage and UnitedHealthcare plans for individuals to choose from. At the time, only 50 people were enrolled in Humana plans.
This week UnitedHealthcare, which is the nation’s largest provider of Medicare Advantage plans, announced an end to its MA coverage for 600,000 patients in 109 counties — 14 of which are in Vermont. A representative from the company told Reuters that in total 600,000 patients across the country will no longer be covered in 2026, mostly in rural areas.
All across the country Medicare Advantage providers have been scaling back their coverage, as the plans become less profitable for the companies that run them. Many companies cite a decrease in the amount of money the private insurers receive from the federal government, higher numbers of patients seeking and paying for care, and a shift in federal rules outlining how much insurers can pre-pay providers for care.
“Many plans across the country have been impacted by a fluid regulatory environment, increased competition, and rising health care costs and consumer expectations,” Teresa Anderson, Blue Cross Blue Shield of Vermont’s director of brand and engagement strategies, wrote in an email. “The unique challenges here in Vermont – specifically with limited competition – resulted in membership growing at an unsustainable rate, resulting in escalating healthcare costs. These factors forced our organization to pull back its Medicare Advantage offerings.”
UnitedHealthcare spokesperson Megan Sergel also confirmed the end of the Vermont plans over email. She wrote: “UnitedHealthcare is making strategic adjustments to its Medicare Advantage offerings for 2026 to ensure long-term affordability and stability for the millions of members who rely on us. Some of these changes include plan closures and market exits, and impacted individuals will receive a CMS-required notice in early October, with clear guidance on their options and next steps.”
Current plans will remain in effect through the end of the year. Medicare’s annual open enrollment period, for patients to choose plans for the coming year, runs Oct. 15 through Dec. 7.
People losing their coverage can expect to receive two different letters, explained Sam Carleton, the director of Vermont’s State Health Insurance Program (SHIP), which provides assistance to Medicare beneficiaries in the state. The first letter should come from CMS, outlining that the plan will not be offered in 2026. The second should be the official notice of change from the insurers themselves.
“Anytime there’s a massive disruption like this, you worry about people who slip through the cracks or don’t understand what the mail they’re getting means. It’d be very, very easy for someone to miss those notifications,” Carleton said.
Without access to the Medicare Advantage plans, individuals have the option to opt into standard Medicare for coverage. Those in traditional Medicare plans often need to buy a Medicare Supplement plan, or Medigap plan for short — which offers coverage for the remaining expenses that traditional Medicare does not cover. Many people on traditional Medicare also need to buy prescription drug plans, often referred to as Part D plans.
“This is disruptive, yes, but don’t panic. You have time, you have options. There are resources available to help guide you through it,” Samsom said.
Individuals who lose their Medicare Advantage coverage are guaranteed eligibility to enroll in any plan in the Vermont Medicare Supplement market, without consideration of pre-existing medical conditions, up to 63 days after the coverage ends, a press release from the Department of Financial Regulation explains. For those whose coverage runs through the end of this year, that leaves until March 4, 2026.
The department advises people to hold on to the notice they receive from their insurer announcing the end of coverage, as proof to secure guaranteed access to the supplemental plans.
Samsom pointed people toward SHIP and the Medicare handbook for navigating coverage. Carlton confirmed that both Medicare.gov and 1-800-Medicare remain up and running despite the government shutdown that began Oct. 1. Both, he said, are good resources for people who may want assistance before SHIP’s small team can get to them.
Another concern is that Vermont’s Medigap plans are expensive: “There’s a real risk of this change driving more people to be in Medicare with no secondary coverage,” said Mike Fisher, the state’s health care advocate.
Yet Medicare Advantage plans have also received serious criticisms.
“We regularly hear from people who feel like they have been sold something that doesn’t meet their needs,” Fisher said. “And we regularly hear from providers across the whole system of care who are really frustrated with underpayment.”
“There is a lot of frustration about them, so I think that there will be some people who will see this as a good thing,” he added. “But we also know that there’s a lot of Vermonters who have been quite satisfied and well served [by the Medicare Advantage plans].”
Carleton echoed this view: “There is a part of me that’s like, ‘Maybe people will be better off in certain circumstances where they’re not on an Advantage plan,’” he said. “Not always, though. I think there are people who it did work for, and I know that the Blue Cross plan did work for folks.”
He added that for his office, the biggest concern with these plans’ closures is the timing and volume of people affected.
“When it happens all at once, like this, it is really a challenge. There is going to be a giant wave of folks who reach out to us during open enrollment this year.”
Clarification: This story has been updated to better describe how Medicare Advantage plans are funded. Premiums are generally required on top of the federal funding.
