This year, some 2.9 million Medicare Advantage enrollees lost their coverage and were forced to find a new plan or switch to Traditional Medicare. If you were in a Medicare Advantage plan in Vermont, you might have no choice of another Medicare Advantage plan, reports Caroline Catherman for Healthcare Brew. Only in traditional Medicare can ensure continuity of care your physicians from one year to the next, without worry about prior authorizations and inappropriate denials of care.
You have a lot more choice in traditional Medicare than in Medicare Advantage, and you will almost always be covered for the care your treating physicians and you believe you need. Traditional Medicare also covers care from virtually every physician and hospital across the US. Our federal government directly administers traditional Medicare. There’s no insurer middleman second-guessing your treating physicians as there is in Medicare Advantage.
The paucity of Medicare Advantage options in Vermont speaks volumes about the insurers offering Medicare Advantage. If they don’t see good returns, they leave the market. And, to maximize profits, they try as best possible to keep their networks narrow and delay or deny complex and costly care. The only Medicare option you can count on to cover the care you need from the physicians and hospitals you want to use, year after year, is traditional Medicare.
In 2026, nearly three million people with Medicare across the country lost their Medicare coverage and struggled to find new coverage that meets their needs. Medicare Advantage plans are always a gamble. Will they cover the care you need or inappropriately deny it? Will they let you see the doctors you want to see or will those doctors be out of network? Will your Medicare Advantage plans continue to be available in your community or will they pull out next year? There’s no way to know.
In many ways, if you’re among the 92 percent of Vermonters or people who lost their Medicare Advantage plan in another state, you should consider yourself lucky. You should have had a special enrollment period during which insurers offering supplemental coverage to fill gaps in traditional Medicare are required to sell you this coverage. (Your guaranteed right to supplemental coverage lasts 63 days from the time your insurer leaves.) That said, the cost can be high, depending upon the plan you pick.
Traditional Medicare needs an out-of-pocket limit so that it is an affordable option for everyone with Medicare. Unfortunately, because traditional Medicare lacks an out-of-pocket cap, millions of people with Medicare are effectively locked out of it. It’s too big of a financial gamble. And, with some exceptions, such as your Medicare Advantage plan pulling out of your community, you have no right to buy supplemental coverage if the insurer won’t sell it to you.
Here’s more from Just Care:
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
- Insurers dump 1.5 million + Medicare Advantage enrollees
- Your right to buy a Medigap policy when you enroll in traditional Medicare
- Adding an out-of-pocket cap to Traditional Medicare should be Congress’ top Medicare priority
- 2026: Take advantage of the Medicare Advantage Open Enrollment Period
