For 2025, insurers move back slightly on Medicare Advantage footprints

Health insurance companies that are the biggest players in privatized Medicare Advantage coverage are pulling back after years by expanding their geographic footprint, even as they offer new benefits.

With more than half of the nation’s eligible seniors enrolled in Medicare Advantage plans, competition has been fierce, providing seniors with more lucrative benefits and more choices. A year ago, CVS Health’s Aetna, Cigna, Elevance Health, Humana and UnitedHealth Group expanded to many new counties for 2024.

But this fall, seniors will discover during open enrollment that many of these plans, including Aetna, Cigna, Humana and some regional insurers and startups, no longer offer Medicare Advantage in some states and counties for the year of health benefits 2025. Health plans are unveiling benefit options this month ahead of Medicare open enrollment, which runs from October 15 to December 7.

Elevance Health and UnitedHealth say they are expanding to many new counties for the next year, with UnitedHealth’s UnitedHealthcare saying “its total individual MA footprint will increase from 2,854 counties in 2024 to 2,896 counties in 2025 – in 49 States and the District of Columbia” and Elevance. saying the insurer “will have a presence in 99 additional counties, 23 states and Puerto Rico.” Neither UnitedHealthcare nor Elevance would disclose whether they would leave a county for 2025.

In the case of Humana and Aetna, their stocks were hit hard earlier this year after reporting higher-than-expected medical costs from their Medicare Advantage businesses, as the entire industry grapples with new rules and below-average rate increases from the government. In Cigna’s case, the company is also in the process of selling its Medicare business to Health Care Service Corp., an operator of Blue Cross and Blue Shield plans in five states.

Humana, which offers Medicare Advantage and Medicare Advantage prescription drug plans in 2,907 counties in 49 states, plus Washington, D.C. and Puerto Rico this year, will reduce its footprint to have Medicare Advantage and prescription drug plans in 2,852 counties in 48 states plus Washington and Puerto Rico. .

Meanwhile, Aetna will be in 10 fewer counties and two fewer states. “Aetna, which operates in 2,269 counties and 46 states plus Washington, D.C., with now 4.3 million Medicare Advantage enrollees today, will offer plans in 2,259 counties in 44 states plus Washington, D.C. in 2025 ” the company said, referring to its Medicare Advantage. and Medicare Advantage prescription drug plans.

Regional health insurers that include startups and some Blue Cross and Blue Shield plans are also leaving some counties and states. Take Alignment Health, for example, is exiting the competitive Florida market but will remain present in six other states. The fast-growing startup, which listed on Nasdaq in 2021, will sell Medicare Advantage in 45 counties by 2025, up from 53 this year, as the company strives to achieve profitability.

“Our strategy is focused on targeting markets and members where we see the greatest demand and greatest potential for impact,” said Dawn Maroney, CEO of Alignment Health Plan and president of markets for its parent company. , Alignment Health. “By focusing our resources, we have achieved stability in our core markets and expanded our offerings to 56 plan options next year, including more choices for seniors with special needs.

Cigna Group’s health insurance business said “the service area reductions will impact three counties.” Cigna Healthcare, which sells Medicare Advantage plans in 29 states and Washington, D.C., and 603 counties in 2024, “largely maintains its existing service areas for 2025, serving 600 counties in 29 states and Washington, D.C.,” it said. the company.

Still, Cigna and other plans say that in the vast majority of counties where they sell Medicare Advantage, many plans will be available for a $0 premium. “Medicare shoppers can expect to see a wide range of choices from Cigna Healthcare so they can choose the plan that best meets their unique health and lifestyle needs, with the benefits that they value it the most,” said Chris DeRosa, president of U.S. government operations at Cigna Healthcare.

Medicare Advantage contracts with the federal government to provide traditional coverage available under traditional Medicare, as well as additional benefits and services for seniors, such as disease management and telephone helplines for seniors. nurses, with some also offering vision, dental and wellness programs.

“Based on member feedback, Humana annually includes coverage for new glasses in every plan offering a vision benefit,” the company said. “Humana also offers plans with comprehensive dental coverage that includes deep cleanings, fillings and crowns in almost every county it serves.”

These extras offered by Medicare Advantage plans are popular, and insurers are adding them to more plans, including some that address social determinants of health like transportation to and from doctors’ offices.

“Elevance Health takes a comprehensive, patient-centered approach, addressing the physical, behavioral and social aspects of health,” Elevance Health said in announcing its 2025 benefits package.