New Hampshire's Medicare Advantage market is undergoing a significant contraction, with Anthem and Martin's Point entirely exiting and Aetna substantially reducing its coverage, impacting approximately 85% of the state's 90,000 enrollees. Insurers cite rising compliance and prescription drug costs as drivers for the upheaval, which leaves only two statewide providers. This disruption forces a large cohort of seniors to seek new coverage by October 15th, likely prompting a substantial shift towards original Medicare combined with Part D and state-regulated Medigap plans, thereby creating an anticipated surge in demand for the latter.
Roughly 85% of all New Hampshire residents with Medicare Advantage plans will soon have six weeks to find different health care coverage as two major insurers are leaving the market and a third significantly reduces its reach. State Insurance Commissioner D.J. Bettencourt had told lawmakers last month the Medicare Advantage market was “collapsing,” but this shake-up is even more extensive than had been expected for the estimated 90,000 seniors who have this coverage. “It’s been quite a week,” Bettencourt said during an interview. “This level of disruption is greater for these seniors since Medicare Advantage came onto the scene. Our message to them is there are still some great options in the marketplace for you, but begin doing your homework so you can make an informed choice that is the best fit.” Gov. Kelly Ayotte said seniors should to reach out to state regulators for help if they need it. “I urge anyone with questions to reach out to the Department of Insurance for free assistance in finding more information about the options available to them,” Ayotte said. “In the meantime, we’re going to continue working at the state level to help ensure seniors have access to the best possible health care close to home.” The impact is so significant because two of Medicare Advantage’s biggest players, Anthem Health Plans of New Hampshire and Martin’s Point, are exiting the state entirely. This summarizes the impact of changes for seniors who get their health coverage from a Medic… A third carrier, Aetna, owned by CVS Health, is dropping its coverage in seven counties, offering plans only to residents in the state’s two biggest counties, Hillsborough and Rockingham. That leaves Humana and WellSense as the only companies with statewide Medicare Advantage coverage. State officials note Humana is expanding the number of these plans it will offer. “The bottom line is this will affect virtually everyone in Medicare Advantage. Why? That’s because even if your plan is still available, the coverage is likely to change and, in some cases, significantly, so everyone needs to get under the hood and see how their plans would look for 2026,” Bettencourt said. Unlike original Medicare that’s run by the federal government, seniors purchase Medicare Advantage plans directly from private insurance companies. “This crisis really has been building. We had 44,000 seniors affected by changes in 2024 and the national landscape informed us some time ago that this was going to be even bigger,” Bettencourt said. In October 2024, Harvard Pilgrim Health Care and Wellcare pulled out of the Medicare Advantage market here; Humana and Aetna reduced some offerings in the state at that time as well. Limited state role The state’s role in the matter is limited because Medicare Advantage is regulated only by the federal government and even state insurance departments get incomplete information about the marketplace. “This is a sore point. States have been trying for years to get better data from the feds about this program and the response has always been negative,” Bettencourt said. New Hampshire regulators only learned of all these changes earlier as a result of a new state law requiring insurance companies to notify the state of their intent to leave all or part of the state markets. Companies’ explanations All this upheaval is driven by national market trends. Company executives say the costs to comply with federal requirements for the program have become more expensive as they also deal with the increased use and rising cost of prescription drugs. In a statement, Anthem said dropping Medicare Advantage here allows it to improve its other Medicare options. “This change 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,” Anthem said. “We are committed to supporting impacted members with timely notice and assistance to ensure a smooth transition for coverage in 2026.” Aetna offered a similar comment about its retraction in New Hampshire. “We remain committed to serving our Group Medicare clients and the needs of their retirees in all the U.S. geographies in which they have retirees,” a CVS spokesperson said. Martin’s Point hasn’t publicly commented on its departure. Most affected seniors have yet to have been told by their carrier about these changes, Bettencourt said, but they should receive something soon because the open enrollment for the 2026 year starts Oct. 15 and ends Dec. 7. Seniors seeking information about next year’s offerings are urged to call 1-800-MEDICARE or go to www.medicare.gov. Bettencourt’s customer services unit is at 1-800-852-3416 or consumerservices@ins.nh.gov and the State Health Insurance Assistance Program (SHIP) offers local counselors to give one-on-one support to help seniors compare plans and change enrollment. What are the alternatives? State officials expect many seniors to choose to drop Medicare Advantage and go back to original Medicare and pick up some further coverage. They could add a Part D plan that provides prescription drug benefits, and they could add a Medicare Supplement (also called Medigap) plan that includes additional coverage. Both are offered through private insurers. Because of the disruption, affected seniors can get that Medicare Supplement coverage without medical underwriting — which means they get the coverage regardless of their health history. “Our hunch is that more will go the Medicare Supplemental route,” Bettencourt said. “At the State House this year we heard many seniors testify about their dissatisfaction with Medicare Advantage. Clearly, it’s been popular for many but not for all and this special enrollment gives them the opportunity to make the change.” In that vein, the Insurance Department has asked all companies selling Medicare Supplement products to provide by Nov. 15 a report on how they would be able to handle an influx of additional seniors onto their coverage plans. Unlike Medicare Advantage, the Medicare Supplement market does come under the review of state regulators, Bettencourt said. The agency also issued a bulletin last week to clarify to what extent these companies can receive “reasonable fees” from seniors related to the purchase of Medicare Advantage of Medicare Supplement coverage. “These clarifications help consumers and producers alike by setting clear expectations for what is allowed, what requires disclosure and agreement, and how the Department will evaluate complaints,” said Deputy Insurance Commissioner Keith Nyhan. During last year’s open enrollment, Bettencourt said, the state uncovered how some third-party actors working for insurers engaged in “manipulative and downright abusive” practices in marketing their plans. In the coming weeks, the agency plans to host a public webinar on the topic and is exploring how it can work with advocacy groups such as AARP to provide more information. AARP State Director Christina FitzPatrick declined comment for this story due to a misconception among many about AARP’s endorsement of UnitedHealthcare plans. “There’s already confusion in the general public about AARP’s role,” FitzPatrick said. “Lots of people think that we’re an insurance company when we’re actually not. We license our name to products and services that we are comfortable with.” New Hampshire's Medicare Advantage market is experiencing a structural collapse, with the complete exit of Anthem (ANTM) and Martin's Point, and a significant reduction in coverage by CVS Health's Aetna (CVS). This disruption will directly impact approximately 85% of the state's 90,000 enrollees, forcing a mass migration to new plans. Insurers attribute the withdrawals to national trends of rising federal compliance requirements and prescription drug costs, which are eroding profitability in the segment. The competitive landscape is now dramatically consolidated, leaving Humana (HUM) and WellSense as the only statewide providers; notably, Humana is expanding its plan offerings to capitalize on the exodus. State officials anticipate a substantial number of the displaced seniors will shift from private Medicare Advantage plans to original Medicare, supplemented by state-regulated Medigap and Part D plans. This is creating an expected surge in demand for Medicare Supplement products, a market where state regulators are actively coordinating with insurers to manage the influx and ensure capacity.
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