Vermont Medicare Advantage Plans Face Major Changes for 2026
Vermont Blue Advantage will discontinue offering Medicare Advantage plans in Vermont for 2026, impacting approximately 26,000 residents and signaling a broader trend of insurers reassessing the viability of these plans nationwide.
The decision, announced yesterday, affects both individuals enrolled in Vermont Blue Advantage plans and those covered through employer-sponsored retiree programs. Andrew Garland, a vice president and spokesperson for the insurer, stated that a return to the Vermont market “depends on whether market conditions improve, or new opportunities open that would enable Vermont Blue Advantage to offer sustainable and competitive plans.” The state Treasurer’s office announced in September that a contract covering 7,000 retired teachers would not be renewed due to a proposed 50% premium increase from Vermont Blue Advantage. This prompted a shift to HealthSpring, which will offer coverage with a 16.2% rate increase.
The changes come as Blue Cross Blue Shield of Vermont has experienced significant financial losses – $152 million between 2021 and 2024, with at least 20% attributed to Vermont Blue Advantage. This mirrors a national trend, as federal regulatory changes have reduced the profitability of Medicare Advantage plans, leading insurers like UnitedHealthcare to also withdraw from the Vermont market. As a result, most Vermont counties will have limited or no Medicare Advantage options for individual purchasers next year, with only a few Humana plans remaining in select areas. Individuals losing coverage will have the option to explore Medigap plans to supplement traditional Medicare benefits.
State officials are working to mitigate the impact of these changes, with Treasurer Mike Pieciak emphasizing the importance of scale and stability in healthcare coverage. “The scale that [HealthSpring is] able to bring to the challenge that we’re facing here in Vermont on health care affordability is beyond anything that we can do on our own,” he said. The annual open enrollment period begins October 15, but those losing coverage have a special enrollment period extending through February 28, 2026.
