As major insurance companies prepare to exit Medicare Advantage markets across the country, millions of beneficiaries could face significant changes to their healthcare coverage in 2027. During a recent edition of KNCT News Spotlight, Medicare specialist Gary Gerstenhaber joined host Gary Emmert to discuss what the upcoming changes mean and how consumers can protect themselves during the enrollment process.
Gerstenhaber explained that many Medicare Advantage enrollees will receive an Annual Notice of Change informing them that their current plan is being discontinued or substantially altered. Those affected will need to carefully review their options and make important decisions about their healthcare coverage.
“People need to read their Annual Notice of Change documents carefully,” Gerstenhaber said. “Many beneficiaries will have the opportunity either to select a different Medicare Advantage plan or move to a Medicare supplement plan under guaranteed issue rights, which allows them to enroll without medical underwriting.”
The changing landscape comes as insurers reevaluate participation in numerous markets, creating uncertainty for seniors and individuals with disabilities who rely on Medicare Advantage plans for healthcare and prescription drug coverage.
Special Needs Plans May Offer Additional Options
Gerstenhaber highlighted the importance of Special Needs Plans, particularly for beneficiaries managing chronic health conditions.
Chronic Condition Special Needs Plans (C-SNPs) are designed for individuals with qualifying medical conditions, while Dual Eligible Special Needs Plans serve those who qualify for both Medicare and Medicaid. These plans often provide enhanced benefits and coordinated care services tailored to specific healthcare needs.
For beneficiaries uncertain about available options, Gerstenhaber encouraged listeners to seek assistance rather than attempting to navigate the changes alone.
Independent Guidance Available
One of the key messages from the discussion was the value of independent guidance during the enrollment process.
Gerstenhaber recommended contacting the State Health Insurance Assistance Program (SHIP) at 800-252-9240. SHIP counselors provide free, objective information about Medicare coverage choices and can help beneficiaries evaluate available plans.
He also stressed the importance of working with independent insurance agents who can compare plans from multiple carriers.
“When you call an insurance company directly, they can only discuss their own products,” Gerstenhaber explained. “An independent agent can review a broader range of options and help determine which plan best fits your needs.”
Be Prepared Before You Call
Gerstenhaber advised beneficiaries to gather key information before speaking with a counselor or agent.
Having a list of current physicians, prescription medications, and preferred pharmacies readily available can help ensure plan comparisons accurately reflect an individual’s healthcare needs and costs. That information is often critical in determining whether a plan’s provider network and drug formulary are a good fit.
For listeners seeking additional guidance, Gerstenhaber made himself available for questions and plan reviews at 512-791-4000.
Opportunity Amid Change
While the disruptions may create challenges for many Medicare beneficiaries, both Gerstenhaber and Emmert noted that the enrollment period also presents an opportunity to reassess healthcare coverage and potentially find plans that better meet individual needs.
The discussion also touched on recent network changes affecting healthcare access in some communities, including the loss of provider contracts and hospital participation in certain insurance networks. Such developments, they said, reinforce the need for consumers to remain proactive and not wait until the last minute to review coverage options.
With enrollment decisions carrying significant financial and healthcare implications, beneficiaries are encouraged to begin reviewing their options as soon as information becomes available.
“Don’t wait,” Gerstenhaber emphasized. “The earlier you review your choices, the better prepared you’ll be to find the coverage that’s right for you.”
Need Help?
SHIP (State Health Insurance Assistance Program): 800-252-9240
Independent Medicare Assistance: Gary Gerstenhaber, 512-791-4000
Beneficiaries should have a current list of doctors, medications, and preferred pharmacies available before discussing coverage options.
