A Massachusetts man expects his monthly health insurance costs to nearly triple to $315 in 2027 after Blue Cross Blue Shield discontinued his Medicare Advantage plan, leaving him and thousands of other seniors searching for new coverage.
Here's what to know
About 20,000 Massachusetts seniors will need replacement insurance plans as Blue Cross Blue Shield of Massachusetts scales back its Medicare Advantage offerings, according to The Boston Globe.
The insurer reported $275 million in losses on those plans across 2024 and 2025.
New applicants will have limited access to the Medicare Advantage options Blue Cross retains, with a small number of openings available on a first-come, first-served basis. The discontinued plans affect Middlesex, Essex, and Worcester counties.
Both PPO and HMO plans are being eliminated. PPOs generally provide broader access to health care providers at a higher cost, while HMOs typically cost less but require members to use in-network providers.
People 65 and older can receive coverage through Medicare Advantage, a privately operated part of the federal insurance program.
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More background
Blue Cross's pullback is part of a wider disruption affecting Medicare Advantage coverage, which serves most people eligible for Medicare nationwide, according to the Globe.
For 2027, Mass General Brigham Health Plan will discontinue every Medicare Advantage PPO option it offers, while Point32Health, which owns Harvard Pilgrim Health Care and Tufts Health Plan, will eliminate a single PPO option.
Worcester County's Mass Advantage said on its website that it is leaving Medicare Advantage entirely and shutting down.
Blue Cross returned to profitability in the first half of 2026 following cost-cutting measures that included employee buyout offers and discontinuing obesity coverage for GLP-1 drugs, The Globe reported.
Still, medical and pharmaceutical costs continue to put pressure on premiums. The insurer expects its Medicare Advantage pullback to be temporary and hopes to rebound in 2028.
What can be done?
For Tom Stambaugh, a 74-year-old in Somerville, finding replacement coverage meant facing a substantial increase in household expenses.
After reviewing other Medicare Advantage plans in Middlesex County, he found only a few options, each considerably more expensive than his existing coverage.
Stambaugh chose government-operated Original Medicare and will purchase two additional policies to help pay prescription costs and copays.
"It's a cost issue and it's an inconvenience for my wife and I," he said, according to the Globe.
Sharon Kling, 74, of Sutton, and her husband also chose Original Medicare after about a decade with Blue Cross.
The couple wanted to keep their primary care doctor, which narrowed their Medicare Advantage options to one plan they did not like. They will also enroll in Medigap coverage to help with out-of-pocket costs.
Along with finding new coverage, Kling faces the challenge of managing additional paperwork.
"We're going to get three different bills potentially between Medicare, Medigap, and prescriptions, and we're going to have a couple different insurance numbers," Kling said, per the Globe. "There's some anxiety about that."
Where can I learn more?
Seniors outside Massachusetts are also facing Medicare plan disruptions and higher premiums.
• Across the U.S., 2.4 million seniors could lose their plans as Medicare Advantage advertisements return.
• Medicare commenters say Original Medicare beats Advantage when patients face a "million-dollar illness."
• A new Medicare enrollee tallied $938 in monthly premiums, exceeding their previous $803 private plan.
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