For more than 17 years, I have worked in health insurance and Medicare, developing national expertise in Medicare Advantage while sitting across the table from seniors and people with disabilities trying to make Medicare decisions that fit both their health needs and their household budgets.
For many people, Medicare Advantage is a fantastic option. Low or even $0 plan premiums, prescription drug coverage, predictable copays and benefits like dental, vision and over-the-counter allowances can make a real difference in their lives.
In 2026, 55% of Medicare beneficiaries enrolled in a Medicare Advantage plan, that’s about 35.2 million Americans and that number is continuing to grow. Seniors build their budgets around these plans. They choose doctors, pharmacies and hospitals based on their plan’s network. . They plan for the year believing the coverage they chose will be there. That is exactly why the growing instability in the Medicare Advantage market deserves IMMEDIATE attention.
Here in Maine, 2026 brought significant changes to the Medicare Advantage market, with several insurance companies reducing the number of Medicare Advantage plans they offered or exiting certain areas of the state altogether. Mainers who had built their health care around plans that were discontinued were forced to evaluate new coverage for 2026. When an insurance company leaves a state, or does what is called a service area reduction (SAR) and stops serving a county, that plan doesn’t simply disappear from an insurance company spreadsheet. It disappears from somebody’s kitchen-table budget.
A person who had a low-premium Medicare Advantage plan may suddenly have to find another Medicare Advantage plan, if another suitable option is available, or return to Original Medicare. That can mean adding a standalone Part D prescription drug plan and, for those who choose one and are eligible, a Medicare Supplement (Medigap) policy with an additional monthly premium. Without supplemental coverage, Original Medicare can also leave beneficiaries responsible for significant out-of-pocket costs. For somebody living mostly on Social Security or another fixed income, that is not a minor insurance change. It can fundamentally change what they have to budget each month for health care.
The Inflation Reduction Act brought improvements to Medicare prescription drug coverage, but at the same time, this redesign changed how high-cost prescription expenses are divided among insurance plans, drug manufacturers, beneficiaries and Medicare. That changed the economics of providing prescription drug coverage.
Risk-adjustment rules also changed for Medicare Advantage; medical utilization and prescription drug costs continue to put pressure on plans, and ultimately, private insurance companies decide every year which plans and counties they believe they can continue to serve.
This issue is more complicated than simply saying that Washington “cut Medicare Advantage.” Medicare Advantage operates on a reimbursement model where CMS pays insurance companies a set amount each month for each person enrolled, with payments adjusted based on factors including the health and expected costs of those members. CMS projects that its finalized 2027 payment policies will result in a 2.48% net average increase in Medicare Advantage payments nationally, representing more than $13 billion in additional payments to plans. But national averages do not tell the whole story. The economics of offering a Medicare Advantage plan can vary significantly from one market to another, and an increase nationally does not guarantee that an insurance company will continue offering a particular plan in a rural county. That is the part we need to pay attention to.
We spend a lot of time talking about whether Medicare benefits are technically available. We spend less time asking whether the coverage people built their lives and budgets around will still be available next year.
I’m not an apologist for insurance companies, and I’m also not asking Congress or CMS to protect any insurance company. What I am asking them to do is pay attention to the people caught in the middle. Congress and CMS should take a hard look at how Medicare Advantage payment policy, Part D changes, medical costs and carrier decisions are unfolding at the local level, particularly in rural America.
Lastly, we need to look much more seriously at how much notice beneficiaries receive when a carrier decides to leave a market or reduce its service area. Seniors, families, health care providers and the people helping them navigate Medicare need time to understand what’s happening and what options are available for them.
Medicare Advantage is not the villain in this story, and this shouldn’t become an argument against it. When more than half of eligible Medicare beneficiaries in America have chosen Medicare Advantage, stability in this program matters to millions of families.
If Medicare Advantage is going to remain an important and affordable choice for seniors and people with disabilities, then stability needs to become part of the conversation. The people affected by these decisions are not rounding errors in a corporate profit & loss statement.
They are retirees sitting at a kitchen table trying to figure out whether a new substantial monthly premium fits next to groceries, heating oil, property taxes and everything else that comes out of a fixed income.
This isn’t a partisan issue, this is the time that Congress, CMS, insurers and those of us who work with Medicare beneficiaries need to come together to make sure Medicare Advantage can continue to be a stable, dependable option.
Brad Dyer is the CEO of Hometown Senior Solutions, a New Hampshire-based company helping seniors navigate Medicare, insurance, and the challenges that come with aging. With 17 years of experience working directly with seniors and families, he brings a boots-on-the-ground perspective on how healthcare and insurance policy decisions affect people in their everyday lives. Brad is also building Hometown Senior Solutions into a national franchise with the goal of creating trusted, community-based resources for seniors across America.
Opinion pieces reflect the views of the individual author, and do not reflect the views of the Daily Bulldog, Mt. Blue TV, or Central Maine Media Alliance. Publication of an opinion piece does not equate to endorsement of the content of the piece.
