Why Medicare Advantage Plans Are Disappearing in 2026 — What Every Senior Should Know

By Brad Dyer

Owner, Hometown Senior Solutions

For 16 years, I’ve worked side by side with seniors to help them navigate the complexities of

Medicare. In that time, I’ve seen the program change in ways both good and bad. But what is happening right now in New Hampshire, Vermont, and across rural America is unlike anything I’ve ever seen. Medicare Advantage (MA) plans—the ones that many of you rely on for dental, vision, hearing, prescriptions, and even help with groceries or rides—are collapsing. Entire counties are being left with one option, or sometimes no option at all.

I want to explain why this is happening in clear terms. This isn’t about politics—it’s about seniors losing access to coverage, care, and financial security. And it’s happening right here in our communities.

The Role of Federal Subsidies

First, it’s important to understand how Medicare Advantage works. Unlike Original Medicare,

where the government pays providers directly, Medicare Advantage plans are run by private

insurance companies. The federal government pays these companies a fixed monthly amount for each enrollee, adjusted by county and health status. That means Medicare Advantage is heavily subsidized by federal dollars. Those subsidies are what made it possible for plans to offer “extras” like dental, vision, hearing, gym memberships,

groceries, and transportation—benefits that Original Medicare never included.

When those subsidies shrink or the rules change, the entire financial structure of these plans is shaken. And that’s exactly what’s happening now.

The Big Shifts Driving the Collapse

Three major changes from Washington have created a domino effect:

1. The $2,000 Cap on Prescription Drug Costs (Inflation Reduction Act):

Starting soon, no senior on Medicare will pay more than $2,000 a year out-of-pocket for

prescriptions. That sounds like great news—and for many, it is. But here’s the problem:

the insurance companies now have to pick up most of the cost above that cap. The

government did not raise subsidies to cover this. That means the financial risk was

shifted from Washington onto the plans themselves.

2. The V28 Coding Rules (CMS Risk Adjustment Model):

For years, Medicare Advantage plans received higher subsidies for taking care of

seniors with multiple health problems. The more complex the health issues, the higher

the federal payment to the plan. But under the new “V28” rules, thousands of diagnosis

codes have been removed. Conditions like diabetes with complications, heart disease, or

other chronic illnesses don’t count the way they used to. This slashes the subsidies

plans receive to care for sicker seniors—the very people who most need the help.

3. Flat or Falling Benchmarks in Rural Counties:

Each county has a “benchmark,” which is the maximum Medicare will pay a plan per

enrollee. In many rural or lower-income areas—like much of Central and Northern New

Hampshire—those benchmarks are barely growing or even going down. In plain terms,

the federal subsidy that funds your plan is flat while medical costs keep climbing.

What This Looks Like on the Ground

Put all of this together, and here’s what happens:

● Plans cut back on the extra benefits seniors have come to rely on.

● Margins shrink until plans can’t sustain themselves.

● Companies pull out of entire counties—or even entire states.

● Some counties are now left with just one plan, and others with no Medicare Advantage

plans at all.

● Seniors are left scrambling with fewer or no options.

This isn’t a theory. It’s happening right now. Vermont is losing its leading Medicare Advantage carrier in 2026. Several counties in New Hampshire are down to just one plan, and others already have none. And it’s likely to get worse before it gets better.

The Ripple Effect on Medigap (Supplement Plans)

When a Medicare Advantage plan leaves a county, seniors are given the right to buy a Medigap (Supplement) plan without medical questions. That sounds good—but there’s a catch. In New Hampshire and Vermont, Medigap premiums are based on your age. So while a 65-year-old might find it affordable, a 75-year-old may face premiums that are sky-high.

As more older, sicker people move into Medigap, the risk pool worsens, and premiums climb

even higher. That creates a vicious cycle where fewer and fewer people can afford coverage.

The end result? Many seniors are left with only Original Medicare—which means unlimited 20% cost-sharing, with no cap on what you might owe.

Why This Matters to Every Senior

This isn’t just about losing dental or vision coverage. It’s about whether you can afford to see

your doctor, get your prescriptions, or stay out of medical debt. It’s about whether rural hospitals and clinics—already on thin ice—can keep their doors open when plans and patients disappear. And it’s about fairness. Seniors who worked their whole lives, paid into the system, and now need the most help are the ones being squeezed out.

Where We Go From Here

What we’re experiencing in New Hampshire and Vermont is just the beginning. The same forces will hit other rural states soon. Without changes at the federal level to stabilize subsidies, the Medicare Advantage system as we know it may not survive in wide parts of the country. As someone who has spent my career helping seniors navigate Medicare, I believe we need to sound the alarm now. The seniors I meet with every day aren’t statistics—they’re people. They’re our neighbors, our parents, and our grandparents. And they deserve a system that works for them, not against them.

For now, the best thing you can do is stay informed, review your options carefully each year,

and don’t assume the plan you had last year will be available next year. Talk to someone you

trust who understands these changes.

This isn’t about politics—it’s about people. And if Washington doesn’t act soon, it’s the people in places like Central and Northern New Hampshire who will pay the price first.