Medicare Advantage plan options are set to change significantly for seniors in Illinois next year, with many counties witnessing a sharp decline in available choices. According to data analyzed by HealthScape Advisors, a Chicago-based management consulting firm specializing in health insurers, approximately 57,000 Illinois residents will be affected by plan discontinuations, including around 12,000 in Cook County. The average reduction of eight plan choices per county ranks as the second largest decrease nationwide.
The shift is driven largely by major insurers scaling back their Medicare Advantage offerings. Health Care Service Corporation (HCSC), the parent company of Blue Cross and Blue Shield of Illinois, is cutting its Medicare Advantage plans with drug coverage from 100 Illinois counties this year to only eight next year. Nationally, HCSC’s coverage will shrink from 948 counties to 450. The company cited rising medical costs, increased utilization, tighter quality requirements, network constraints, and evolving payment dynamics as reasons for reassessing product lines and service areas. The changes come roughly 18 months after HCSC’s acquisition of Cigna’s Medicare and Medicare Advantage business.
Other insurers are also withdrawing or reducing presence. Centene plans to offer Medicare Advantage plans with drug coverage in 20% fewer counties next year. Meanwhile, Group 1001, marketed as Clear Spring Health, and Molina Healthcare are exiting the Medicare Advantage drug coverage market altogether, though Molina will continue to provide select Advantage plans for particular populations.
Experts characterize the current environment as a market “reset.” Meredith Freed, a senior policy manager at the Kaiser Family Foundation (KFF), described the insurer departures and plan terminations as “disruptive” for affected enrollees. Alexis Levy, a senior partner at HealthScape, said the changes have prompted increased shopping and plan switching among seniors.
Despite the reduced plan availability in some areas, the federal Centers for Medicare & Medicaid Services (CMS) maintains that the overall Medicare Advantage program remains stable. A CMS notice in September projected that 97% of seniors nationwide will still have at least 10 plan choices next year, with an expected weighted average monthly premium decline exceeding 16%. In the Chicago area, average monthly premiums for plans including drug coverage are decreasing by about $2.46. However, this comes alongside increases in average out-of-pocket maximums by $625 and drug deductibles rising by $154, as noted by Michael Boshardy, CEO of The Pocket Protector, a Chicago-based Medicare insurance agency.
For seniors whose plans are discontinued, options include selecting a new Medicare Advantage plan during the open enrollment period, which runs through Dec. 7, or defaulting into traditional Medicare coverage. Resources such as Medicare.gov, the Illinois Senior Health Insurance Program—a free counseling service—and insurance brokers provide assistance in comparing and enrolling in new plans.
To simplify the selection process, The Pocket Protector launched an online platform this year offering clear explanations of plan choices and personalized recommendations, independent of commissions. One user, Anderson, shared that after losing his Blue Cross Medicare Advantage coverage, the service helped him secure a new plan through Devoted Health that includes dental and vision benefits, over-the-counter medication coverage, and a gym membership, with a low monthly premium.
The evolving Medicare Advantage landscape in Illinois highlights the importance for seniors to actively review their options annually to ensure coverage aligns with their needs amid market fluctuations.