Joy Emeh
Updated on: October 15, 2024 2:27 am GMT
In a significant shift in healthcare dynamics, approximately 6,000 older Vermonters will need to find new Medicare insurance coverage as the UVM Health Advantage Plan is set to be discontinued. MVP Health Care, the carrier managing this plan, announced that the termination stems from rising healthcare costs and dwindling federal Medicare reimbursement rates.
Impact on Vermonters
The discontinuation of the UVM Health Advantage Plan will primarily affect residents directly enrolled in this Medicare Advantage plan in Vermont. Here are the essential points regarding this change:
- Who is affected?
– Only MVP’s MA customers in Vermont will be impacted, including the Employer Group Waiver Plans (EGWP).
– Customers with commercially insured plans through the State of Vermont Health Connect or employer-sponsored insurance will remain unaffected.
– All MVP members will still have access to UVM Health Network providers.
– UVM Health Network will continue to offer emergency care to everyone, regardless of their insurance status.
According to Jordan Esetey of MVP Health Care, those losing their coverage will receive a letter detailing the next steps for enrollment in alternative plans. Residents can either opt for a different Medicare Advantage plan, revert to traditional Medicare, or consider purchasing a supplemental Medicare insurance.
Timelines for Enrollment
The UVM Health Advantage Plan will officially end on January 1, 2025, but residents will have the chance to explore new health plan options during the Annual Enrollment Period, which starts on October 15 and concludes on December 7.
For those affected, here are some recommended next steps:
- Contact the Vermont State Health Insurance Assistance Program at 1-800-642-5119 for free consultation about health coverage options.
- Reach out to 1-800-MEDICARE for 24/7 support and information.
- Visit Medicare.gov to compare different plans and learn about Medigap policies.
Healthcare Landscape Changing Elsewhere
In addition to the situation in Vermont, Southwestern Health Resources (SWHR) is also facing challenges. The organization has announced it will terminate its Care N’ Care Medicare Advantage health plan and lay off 125 employees. This decision followed their exit from the 2025 CMS Medicare Advantage bid process due to factors such as market competition and increased member utilization.
Understanding the SWHR Changes
The SWHR internal email indicated various external pressures led to this decision, including:
- High medical loss ratios.
- Regulatory requirements under new CMS rules.
- An increasingly competitive healthcare marketplace.
However, SWHR disputes claims regarding unsustainable operations, asserting that it remains a robust network offering quality care and achieving substantial savings for the Medicare Trust Fund. In fact, SWHR saved over $55 million in 2022 alone and has accumulated $223 million in savings since 2017.
The Broader Medicare Advantage Landscape
The Medicare Advantage sector is encountering turbulence, as evidenced by many health systems discontinuing their respective plans. Recent reports indicate that 24 health systems have opted to drop their Medicare Advantage plans, indicating a wider trend that reflects the struggles many insurers face in this challenging environment.
This change impacts the healthcare choices available to many older adults who rely on Medicare. Consumers are encouraged to stay informed and make proactive decisions regarding their health insurance options.
Conclusion
As health insurance plans like the UVM Health Advantage Plan face discontinuation, it highlights the need for vigilance among consumers and healthcare providers alike. Individuals affected by these changes should explore all available options and resources to ensure they select a plan that offers the support and coverage they need. Staying informed and proactive is vital, especially as the landscape continues to evolve.
If you want to learn more about health insurance changes, check out Medicare.gov. This website has helpful information that can guide you through the tricky world of insurance and help you make smart choices.
