Aetna and Humana are leaving markets and trimming Medicare Advantage benefits, Cigna is selling its Medicare business to Blue Cross Blue Shield, and WellCare Medicare Advantage has announced that it will be closing its Medicare Advantage business in six states. A lot of movement is happening in Medicare.
Medicare households spend, on average, $7,000 annually on healthcare expenses. Healthcare accounts for nearly 14% of household income and is twice the amount that a non-Medicare household spends on healthcare. Because of fixed incomes and healthcare utilization, Medicare beneficiaries are acutely impacted by Medicare and healthcare cost changes.
WellCare Medicare Advantage (MA), a subsidiary of Centene, will close its Medicare Advantage plan business in six states in 2025. Almost 40,000 Medicare beneficiaries on Medicare Advantage plans will be impacted in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont. The most significant impact will occur in New Mexico, with approximately 12,600 Medicare beneficiaries without WellCare Medicare Advantage plan coverage.
WellCare experienced a decline in Medicare Advantage plan enrollment between 2023 and 2024 after experiencing growth between 2010 and 2023. Exiting these six states is partly due to the loss of more than 200,000 enrollments (13% of enrollment) over the past year and cost pressures. The Centers for Medicare and Medicaid Services (CMS) has made several cuts to its rates, causing many insurers, like WellCare, to adjust their plan coverage or leave markets altogether.
WellCare Health Plans stated that it will continue to offer Part D prescription drug plans in the states where it’s withdrawing its WellCare Medicare Advantage business. According to CMS, WellCare has the country’s largest share of standalone Medicare Part D plans, 29% of the market. WellCare provides 4.5 million Medicare beneficiaries with their stand-alone Medicare Part D prescription drug plan.
Although WellCare Health Plans has promised to remain in the states of Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont for stand-alone Part D plans, it’s critical that individuals enrolled in Medicare Part D review their plan this fall. The Inflation Reduction Act (IRA) is shaking up Medicare Part D costs and coverage for 2025.
Beginning in 2025, the IRA will cap out-of-pocket prescription drug costs, and Biden-administration drug price negotiations could lower many people’s out-of-pocket costs. Both of these are great for out-of-pocket costs, but the downside is that where there are cuts in one area, there is usually an increase in another. It’s likely that the IRA out-of-pocket cap and drug price negotiations will lead to higher Part D monthly premiums.
Agent tip:
“If you’re enrolled in a WellCare Medicare Advantage or prescription drug plan, contact a local licensed agent to have your Medicare plan reviewed this fall.“
There is also concern that Wegovy’s CMS approval for use by beneficiaries with Heart Disease and other similar medications could also drive up Medicare Part D premiums. So, while we’re seeing a reduction in out-of-pocket spending and an expansion in coverage, this might increase your monthly premium. With all these changes, what is your next best step?
A lot is happening in Medicare, including WellCare Medicare Advantage exiting states. Look at it with a silver lining: it is an opportunity for individuals and caregivers to schedule a plan review to ensure that they and their loved ones have the coverage they need in 2025. By having a plan review, you can ensure you’re not left without a plan – or with rising prescription drug plan costs. A plan review will ensure you get the care you need at an affordable price.
Everyone on Medicare can schedule a plan review during the Medicare Annual Enrollment Period between October 15th – December 7th. You can schedule your annual review appointment starting October 1st. Call to speak with a local licensed Connie Health agent in your area.
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Centene Medicare offers Medicare plans under its subsidiary, WellCare. WellCare offers Medicare Advantage plans and is one of the largest market shareholders and providers of standalone Medicare Part D prescription drug plans to Medicare beneficiaries. WellCare also has Medicaid plans available to those who qualify.
WellCare (WellCare Health Plans, Inc.), operated under Centene Corporation, offers WellCare Medicare Advantage plans. It also provides standalone Medicare Part D prescription drug and Medicaid plans. WellCare Medicare Advantage will be exiting six states in 2025: Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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