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GailL1
Community Champion ⭐⭐⭐
September 2, 2025

What Would You Do in this Situation ?

  • September 2, 2025
  • 2 replies
  • 1172 views

BaltimoreSun.com- 09/02/2025 - Maryland market threatens to push more Medicare Advantage plans out of the state 

 

So what would you do IF all or a big majority of Medicare Advantage plans disappeared in your state and you had to go on Traditional Medicare but access to a Medigap plan was out of reach financially?

 

I am pretty sure that there will be a solution to this dilemma in Maryland - they have been dealing with it for a very long time but then again, maybe not.  Worth at least thinking about it if it might affect you and your benefits.

 

I mean, beneficiaries would still have Traditional Medicare to go to and there would be a special guaranteed issue (SEP) period for a Medigap plan if one’s Medicare Advantage plan closes up shop in a state.  Course, some of the Medigap plans may be out of reach based on their monthly premiums but others may not be - like the High Deductible Plan G - 

 

I urge ALL beneficiaries to review their [whatever] Medicare coverage during open enrollment this year (Oct. 15 - Dec 07 ) - and your prescription drug plan also - cause there does seem to be some major changes brewing for 2026 / 2027 and each insurer will be deciding how to best handle these changes.  

 

 

 

    2 replies

    WebWiseWoman
    Community Champion ⭐⭐⭐
    September 3, 2025

    Why aren't national issues dealt with on national levels? e.g., health care?

     

    I don't understand Gail? Why?

    GailL1
    GailL1Author
    Community Champion ⭐⭐⭐
    September 3, 2025

    @WebWiseWoman 

    In this case, the problem is with only Maryland and the way they have regulated the amounts that are paid to hospitals - they are the only state in the nation that uses a “global budget” type payment method for their hospitals.  This makes it impossible for insurers- private insurers or MA insurers - to negotiate directly with the hospitals for a better rate. 

     

    This has been the case for a very long time and up to now, Maryland has always issued the MA insurers a waiver for this negotiation - is this year different?  IDK - guess we will see.  If they do not continue the waiver for these MA insurers to negotiate, then yes, there is a possibility that MA insurers will leave the state, perhaps leaving only Trad. Medicare as the option.  

     

    We have a lot of Federal programs and laws which state laws go against - and they always cause problems one way or another.   

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna