topic What Would You Do in this Situation ? in Medicare & Insurance

What Would You Do in this Situation ?

GailL1 — Tue, 02 Sep 2025 16:02:02 GMT

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.

Re: What Would You Do in this Situation ?

WebWiseWoman — Wed, 03 Sep 2025 02:58:15 GMT

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

I don't understand Gail? Why?

Re: What Would You Do in this Situation ?

GailL1 — Wed, 03 Sep 2025 17:50:51 GMT

@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.