A couple of weeks ago, Jeff Anderson and his wife got news that upended their plans for health coverage.
They were told their Medicare Advantage plan was being canceled for next year.
“I looked at it and thought, ‘We’re going to have to change,’” said Anderson, 68, of Libertyville. Anderson and his wife began shopping for a new plan — for the first time since they originally enrolled in Medicare — a process that can sometimes be daunting.
Many seniors across Illinois are finding themselves in a similar situation this open enrollment season, with fewer choices of Medicare Advantage plans and, in some cases, higher costs.
Medicare Advantage plans are Medicare plans offered by private insurers. They appeal to many people because, unlike traditional Medicare, they often offer perks such as dental and vision coverage, and they cap yearly out-of-pocket costs. They also, however, tend to have more limited networks of doctors than traditional Medicare, and may require patients to get prior authorization or referrals for certain services.
In Illinois, about 57% of seniors had traditional Medicare and 43% had Medicare Advantage or a different type of plan in 2024, according to KFF, a nonprofit organization focused on health policy.
For next year, however, the average U.S. senior will have fewer Medicare Advantage plans from which to choose. In Illinois, the average Medicare beneficiary has 30 plans with drug coverage to choose from for next year, compared with 38 plans this year, according to KFF. Plan choices vary by county.
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That loss of eight plan choices, on average, is the second largest drop in the country, according to KFF.
About 57,000 Illinois residents will be affected by the plan discontinuations, including about 12,000 in Cook County, according to an analysis of federal data by HealthScape Advisors, which is a Chartis company and Chicago-based management consulting firm focusing on health insurers.
“There are insurers leaving and plans being terminated, so that is definitely disruptive to the people who had been enrollees in those plans,” said Meredith Freed, a senior policy manager at KFF.
The last couple of years have also been a departure from previous years, when the Medicare Advantage market was often growing, said Michael Boshardy, co-founder and CEO of The Pocket Protector, a Chicago-based Medicare insurance agency that recently launched an online platform to help seniors shop for Medicare Advantage plans.
Up until the last couple of years, “folks had been getting more benefits and better pricing,” Boshardy said. “What we’re seeing here is an economic contraction in the Medicare space.”
The Trump administration, however, has described the Medicare Advantage program as “stable” for next year. The federal Centers for Medicare & Medicaid Services noted in a September news release that 97% of seniors will still have at least 10 Medicare Advantage plan choices, and the weighted average monthly premium for Medicare Advantage plans nationwide is projected to fall by more than 16% for next year.
In the Chicago area, monthly premiums for Medicare Advantage plans with drug coverage are falling by about $2.46, on average, but the average out-of-pocket maximum is increasing by $625 and the average drug deductible is going up by $154, Boshardy said.
Locally, one of the companies slashing its Medicare Advantage offerings for next year is Health Care Service Corp., which is the parent company of Blue Cross and Blue Shield of Illinois, as well as of Blues plans in a number of other states.
This year, the company offered Medicare Advantage plans with drug coverage in 948 counties, and for next year, it will offer plans in 450, according to KFF.
In Illinois, seniors in eight counties will have access to Health Care Service Corp. Medicare Advantage plans for next year, down from 100 counties this year, according to the company.
A spokesperson for the company said in an email that rising medical costs and use, “tighter quality expectations, network pressures and changing payment dynamics are causing plans across the country to reassess products and service areas.”
The changes come about a year and a half after Health Care Service Corp. acquired Cigna’s Medicare and Medicare Advantage businesses.
Centene is also offering Medicare Advantage plans with drug coverage in 20% fewer counties than this year, according to KFF. Other insurers, including Group 1001, marketed as Clear Spring Health, and Molina Healthcare, decided to stop offering Medicare Advantage plans with drug coverage altogether for next year, though Molina is still offering some Advantage plans for people who meet certain criteria, according to KFF.
“I think the Medicare Advantage market is really going through what we would call a reset,” said Alexis Levy, a senior partner at HealthScape. “That’s led to a lot more shopping and switching for seniors.”
The changes are part of the reason it “behooves you to make sure you’re shopping every fall,” Boshardy said. Medicare open enrollment runs through Dec. 7.
People whose Medicare Advantage plans were terminated will have to select a new Advantage plan or they’ll be automatically switched into traditional Medicare, Freed said.
To compare plans, seniors can talk to brokers, go to Medicare.gov or use Illinois’ Senior Health Insurance Program, which is a free statewide health insurance counseling service for people with Medicare.
Boshardy’s company, The Pocket Protector, launched an online platform this year aimed at making it easier for seniors to shop for Medicare Advantage plans by explaining their options in clear, simple language and offering phone assistance. The Pocket Protector gives recommendations based on all available plans, regardless of commissions, Boshardy said.
Anderson turned to The Pocket Protector recently after he learned that his Blue Cross Medicare Advantage plan was being discontinued.
“It gets a little crazy with all the Medicare plans out there,” Anderson said. “It’s not like an employer-based plan where you can pick an HMO or a PPO.”
Ultimately, The Pocket Protector helped him find a new plan, offered by a company called Devoted Health, he said.
Anderson likes that his new plan will continue to pay for many over-the-counter medications, offer dental and vision benefits and give him a free gym membership. He also likes that it will put money toward his Medicare Part B premium, leaving him paying only about $17 a month in premiums.
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“Now I’m all done and I don’t really have to worry about the changes,” Anderson said.