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For 18 months, a Medicare Advantage plan from the health insurer Anthem has been covering a prescription medication for Richard Godek of Winchester. The medication reduces the 81-year-old’s risk of heart attack and stroke. But on Oct. 2, Anthem sent Godek a letter. “IMPORTANT NOTICE: Your Medicare plan won’t be offered in 2026,” it states. Godek is one of many local seniors with Medicare Advantage plans who have received this or a similar letter. Citing decreased federal payments and rising health care costs, the private health insurers Martin’s Point, UnitedHealth, Wellsense and Anthem are pulling their Medicare Advantage plans from New Hampshire in 2026. In Cheshire County, the only remaining Medicare Advantage plans next year will be through Humana, which Cheshire Medical Center and several other members of the Dartmouth Health system do not accept. This means that for seniors who switch to the sole remaining option for Medicare Advantage in the county, Cheshire Medical Center will be out of network. To get in-network care, these patients would be faced with a choice: travel to Brattleboro Memorial Hospital, which is a 30-minute drive from Keene, or go to Monadnock Community Hospital in Peterborough, a 40-minute drive from Keene. This has left Cheshire County residents like Godek scrambling to find a new health insurance plan before they lose coverage. Without insurance, Godek said, he would pay $427 out of pocket monthly for his prescription. Although the other plans he has looked at might help with some of the cost, he said he’d still be on the hook for hundreds of dollars. “Anthem dropped me like a hot potato,” Godek said. Other local seniors who are also losing their Medicare Advantage insurance told The Sentinel that on limited incomes, higher health care costs may force them to go without essentials like food and clothing. Withdrawal of Medicare Advantage plans Medicare Advantage is a privatized version of Medicare, the public health insurance program that provides health insurance to those 65 and older as well as people with disabilities. Though Medicare Advantage plans have less comprehensive care and require more prior authorizations, they offer beneficiaries lower premiums than traditional Medicare, and have grown in popularity in recent years. Of the 344,813 Granite Staters enrolled in Medicare, roughly 35 percent of them were on Medicare Advantage plans in 2024, according to federal data. But the trend of Medicare Advantage growth began to change in October 2024, when the N.H. Insurance Department warned that 44,000 seniors would lose coverage the following year as insurers Harvard Pilgrim and WellCare stopped offering Medicare Advantage plans in the state. Aetna also scaled back its Medicare Advantage offerings. “This development is driven by rising healthcare costs and a federal decision that effectively reduced Medicare funding by 1.28% over the course of 2024-2025,” the state insurance department said in an Oct. 18, 2024, news release. Nearly one year later, the insurance department advised Granite Staters on Oct. 1 of another contraction within New Hampshire’s Medicare Advantage market. In 2026, 77,000 people throughout the state would be affected by Medicare Advantage plan withdrawals, the department warned. The withdrawals leave each New Hampshire county in a different situation. Martin’s Point and Anthem will withdraw their Medicare Advantage plans from the entire state. In Cheshire County, all Medicare Advantage plans are being withdrawn except for Humana’s. Nearby Hillsborough County will have a stronger carrier presence with Humana introducing new plan options, the insurance department said, while Sullivan County will see Aetna pull its Medicare Advantage plans. The withdrawals happening in New Hampshire are also being seen across the country as part of a national change in the Medicare Advantage market. Lower government reimbursements, rising health care costs and an increase in beneficiaries’ use of plans are cutting into the profits of insurers that manage Medicare Advantage plans, according to the health policy nonprofit KFF. In an analysis of Centers for Medicare and Medicaid Services data, KFF found that New Hampshire will lose 13 Medicare Advantage plans in 2026, the highest number of any state in the country. In a statement responding to a list of questions from The Sentinel, a spokesperson for Anthem said that withdrawing from New Hampshire’s Medicare Advantage market “allows us to focus our resources on the Medicare offerings where we continue to deliver strong, differentiated value, specifically our Group Retiree Solutions and Medicare Supplement plans, which remain available in the state. We are committed to supporting impacted members with timely notice and assistance to ensure a smooth transition for coverage in 2026.” As of press time, WellSense had not responded to a request for comment; Martin’s Point declined. Network status of local hospitals The withdrawal of all but Humana’s Medicare Advantage plans from Cheshire County will make Cheshire Medical Center less accessible to seniors on Medicare Advantage plans. If a Humana Medicare Advantage plan-holder needs to be hospitalized at Cheshire Medical, “Humana Medicare Advantage would have to approve the hospitalization before it occurs since the admission would be to an out-of-network hospital,” said Audra Barnes, Dartmouth Health’s media relations director, in an email. The reason the Keene hospital won’t accept Humana Medicare Advantage plans is because of a contractual dispute between the insurer and members of the Dartmouth Health system. In statements to The Sentinel, Cheshire Medical and Humana offered different characterizations of the dispute. Dr. Joseph Perras, CEO of Cheshire Medical Center, said in an emailed statement Wednesday that “It was Humana’s unilateral decision not to renew contracts for certain Dartmouth Health members; this was not a decision made by our health system.” As a result, Perras wrote, “this is outside of Dartmouth Health’s control.” Dartmouth Health members have agreed to meet with Humana’s leadership, Perras wrote, but “it is almost certain a new contract will not be developed before Jan. 1, 2026.” “I recognize that these unexpected Medicare changes have created real frustration and uncertainty for many of our patients who are just trying to maintain their care and coverage,” Perras wrote. In response to questions about the dispute, a Humana spokesperson said via email Thursday that “we are open to continuing discussions with Dartmouth Health to renew our agreement. These conversations are focused on finding a path forward that balances affordability, care quality, and long-term sustainability for our members.” When asked for specific details on the timeline of negotiations, the spokesperson said: “We cannot provide further comment on ongoing contract conversations.” Monadnock Community Hospital in Peterborough accepts Humana’s Medicare Advantage plans. But an influx of patients on these plans would likely cause additional strain on a hospital already losing $3 million per year because of Medicare Advantage, according to Richard Scheinblum, the hospital’s chief financial officer. This loss is due to the high levels of administrative work and denials from private insurers that manage Medicare Advantage plans, according to Scheinblum. As a Critical Access Hospital, Monadnock Community Hospital is reimbursed by traditional Medicare based on the actual cost of their services instead of by standard Medicare fees. But since Medicare Advantage plans are managed privately, when a patient switches from traditional Medicare to a Medicare Advantage plan, the Peterborough hospital’s losses increase. Losses from Medicare Advantage plans are also affecting Cheshire Medical Center; in September, Perras told The Sentinel that for the Keene hospital, the amount of uncompensated care from Medicare Advantage plans is double that of traditional Medicare. A migration of patients on Medicare Advantage plans coming from a different health system would undoubtedly create more administrative work for Monadnock Community Hospital’s limited staff, Scheinblum worries. But the financial effects of absorbing new Medicare Advantage patients is yet to be seen. “I don’t know what the impact of that would be,” Scheinblum said. “We’re here to take care of patients, but we’re also resource constrained.” As of now, he continued, “we have not made any decisions to not participate in Medicare Advantage plans.” Effects on local seniors The changes in New Hampshire’s Medicare Advantage landscape have been a source of confusion and outrage for local seniors like Donna McOwen, who is losing coverage through an Anthem plan she said she has had for nearly 10 years. “It makes me unsteady with everything,” said McOwen, 75, of Keene. “I don’t particularly want to get an out-of-network plan. But what choice do I have?” Local organizations have been trying to help residents as they try to get coverage during this year’s enrollment period. Although open enrollment for all types of Medicare ends Dec. 7, Medicare Advantage’s open enrollment period runs from Jan. 1 to Mar. 31, according to Medicare.gov. Fred Huber, a Cheshire County-based sales agent at the insurance brokerage firm Benefits Resource Group, has been guiding locals as they try to straighten out their health insurance situation. Huber said he has received hundreds of calls from seniors throughout the region who are trying to find new plans. “What’s happening has never happened before,” Huber told a crowd of 40 this week at the Keene Senior Center, where he has been every Monday afternoon helping local seniors. “It’s a mess.” But since Medicare Advantage is funded and regulated by the federal Centers for Medicare and Medicaid Services, the N.H. Insurance Department cannot regulate the insurers withdrawing their plans. The department is directing Medicare Advantage beneficiaries to their local Aging and Disability Resource Center and the state’s Health Insurance Assistance program to help them take next steps. The state’s Aging and Disability Resource Centers helped numerous local residents during last year’s withdrawal of Medicare Advantage plans, according to Executive Director Madeline Ullrich. But this year, across “the entire state the appointments are booked up,” Ullrich said. Some seniors will switch back to traditional Medicare with supplemental coverage, a more expensive option. Joan Allen, a 75-year-old Keene resident, already pays more for this coverage and said she also faces confusion when navigating the system. “We work hard our entire lives, we paid into Medicare, and then at the end it’s ridiculous,” Allen said. “I pay a fortune for everything, and I’m pretty healthy. I just think it’s appalling that our government doesn’t take better care of us in our senior years.” Godek isn’t yet sure if he will choose to join Humana’s plans, go back to traditional Medicare, or find another option. But the rapid exit of private insurers from the Medicare Advantage market in the state speaks to a systemic flaw within the health insurance industry, Godek believes. “I think that it’s terrible that our laws allow insurance companies to do this,” Godek said. “Nobody’s policing it, it’s like nobody cares. It doesn’t seem like the insurance companies have any responsibilities.” The Sentinel’s Monadnock Region Health Reporting Lab will continue reporting on how the withdrawal of Medicare Advantage plans is affecting local seniors. If you are losing coverage through Medicare Advantage, health reporter Elijah de Castro can be reached at edecastro@keenesentinel.com.
