If you have Medicare Advantage plans in Omaha, Papillion, Bellevue, Council Bluffs or anywhere in the surrounding metro area, 2027 could bring some of the biggest Medicare changes we've seen in several years.
Some Medicare Advantage plans are leaving the Nebraska and Iowa market, some plans are being changed or "cross walked" into other plans, and new enrollment caps may limit who can join certain Medicare Advantage plans. At the same time, prescription drug plans and Medicare Supplement premiums are expected to increase.
Nationwide, health insurers have announced market exits for 2027 that are projected to affect over one million Medicare Advantage members, with Humana alone dropping plans covering approximately 600,000 members.
Medicare Advantage Plans Terminating in the Omaha Metro, Nebraska, and Iowa in 2027
As of this writing, the following Medicare Advantage Plans are terminating. More may be added to this list. Feel free to check the website at hiattagency.com or follow Mary the Medicare Lady on Facebook or Nextdoor for more information as updates come in.
BCBS Core HMO H1370-001
BCBS Core HMO H1370-002
BCBS Core HMO H1370-003
BCBS Access PPO H8181-001
BCBS Secure PPO H8181-003
Humana Full Access PPO H5216-411
Medica Value PPO H8889-010
Medica Preferred PPO H8889-011
Medica Select PPO H8889-015
Medica is terminating ALL Medicare Advantage plans in Butler, Cass, Dodge, Douglas, Lancaster, Sarpy, Saunders and Washington Counties in Nebraska; and Harrison, Mills and Pottawattamie counties in Iowa
Wellmark is terminating ALL Medicare Advantage plans in Iowa
Although some insurers are reducing the number of plans they offer for 2027, it does not mean Medicare Advantage is disappearing from this area. Some companies are in growth mode and eager for the business, so there will still be excellent Medicare Advantage choices in the Omaha metro area.
Not Every Plan Change Means Your Plan Is Leaving
There is another term Omaha Medicare beneficiaries may hear in 2027: "crosswalk." A crosswalk occurs when an insurance company moves members from one Medicare Advantage plan into another plan, generally as part of changes to its plan offerings.
In other words, you may receive a notice that your current plan is ending, but that doesn't necessarily mean you are losing coverage or even leaving the same insurance company. You may automatically be moved into a replacement plan.
But don't make the mistake of assuming the replacement plan is automatically the best choice. An automatic crosswalk is convenient, but convenient doesn't necessarily mean best. You should still review the replacement plan carefully before deciding to stay with it.
New Medicare Advantage Enrollment Caps
Another 2027 change that could affect the Medicare Advantage marketplace in the Omaha metro involves enrollment caps.
There is an important distinction between a plan being discontinued and a plan being unavailable to new members. Effective with this Annual Election Period, an insurance company may now continue a Medicare Advantage plan for people who are already enrolled, while limiting or closing enrollment to new members.
That means a plan could still appear to be available in the Omaha area, but that doesn't necessarily mean anyone can enroll in it. If you’re considering a plan that has declared a cap on the number of enrollees, you may think that you’ve enrolled in a plan… but if the time stamp on the application comes in after the enrollment cap has been reached, the application can be denied. Then you will need to go through the process of picking out a different Medicare Advantage plan.
For consumers, the takeaway is simple: Don't assume that because a Medicare Advantage plan exists in your county in Nebraska, it is necessarily open for enrollment.
The Medicare Advantage marketplace is becoming more complicated, working with a local licensed independent insurance agent is more important than ever.
What Happens If Your Medicare Advantage Plan Leaves?
The potentially good news for Omaha area beneficiaries is that a terminated Medicare Advantage plan creates an important opportunity. If your plan is leaving the Medicare program, you have a one-time guaranteed-issue right to purchase a Medicare Supplement.
Normally, in Nebraska and Iowa, someone who has been enrolled in Medicare Advantage for several years and wants to switch to Original Medicare and a Medicare Supplement would have to answer health questions and go through medical underwriting. If your health has changed since you first enrolled in Medicare, that could make obtaining a Medigap policy more difficult.
That doesn't mean a Medicare Supplement is automatically the right choice, it still may be too pricey for you. But it absolutely means you should understand your options before simply enrolling in another Medicare Advantage plan.
Medicare Supplement Prices Are Rising
Medicare Supplement premiums are also something to watch in 2027. The good old days of small price increases are ending, at least for now. It is not unheard of to see price increases as high as 25% or even more on some plans.
Medigap policies help pay many of the deductibles, coinsurance and other costs not covered by Original Medicare. Because healthcare costs continue to rise, insurance companies must account for higher claims when setting premiums.
Prescription Drug Plans Are Changing Too
Medicare Part D is also undergoing changes. For 2027 the annual out-of-pocket threshold is scheduled to increase to $2,400.
As of this writing, there is no information available on changes in premiums, formularies and plan availability.
Why Is Medicare Changing?
There isn't one single reason for all these changes. Here are some
COVID-19 dramatically disrupted healthcare utilization and increased costs throughout the healthcare system. Hospitals, doctors and insurance companies have continued to deal with the financial effects of the pandemic. Beneficiaries who may have put off surgery during that time are getting those tune ups taken care of now.
Then came inflation, which increased the cost of labor, medical services, supplies and virtually every other component of healthcare. New drugs are being introduced, and they tend to have astronomical price tags associated with them.
The Inflation Reduction Act of 2022 dramatically changed Medicare prescription drug coverage, including establishing an annual limit on certain Part D out-of-pocket costs and changing how insurers, drug manufacturers and Medicare share prescription expenses.
The CMS (Center for Medicare and Medicaid Services) system that rates plans changed; this created uncertainty and the potential for significantly less revenue for Medicare Advantage and Drug plans.
What Should Omaha area Medicare Beneficiaries Do?
Don't let your Medicare coverage renew on autopilot. The 2027 Medicare changes are a reminder that the best Medicare plan for you this year may not be the best plan next year. And as always, remember that the best Medicare plan for you is not the same as your neighbor, family member, or friend. Everyone has different budgets and health journeys.
Whether your plan is leaving, being cross walked or simply changing its benefits, take the time to review your options before you automatically renew.
Working with a licensed independent insurance agent who communicates with you all year long, has been to all the carrier rollouts, knows the plans, and has the name and number of each plan’s broker representative in their phone is more important now than ever before.
Mary Hiatt is a Retirement Insurance Advisor and President of Mary the Medicare Lady (A non-government entity.) She is Certified in Long Term Care Programs, Policies, Partnerships and Annuities. She offers Educational Workshops on Medicare, Long Term Care and more at no charge. She helps retirees convert their 401Ks and IRAs into hybrid annuities with Long Term Care riders as well as helping clients get Medicaid with eligible spend-down plans and Funeral Expense Trusts. Not connected with or endorsed by the U.S. government or the federal Medicare program. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. See www.hiattagency.com or contact licensed independent agent mary [at] hiattagency [dot] com or call 402 672 9449 for more information. This article is for educational purposes only and should not be treated as tax or legal advice. Rules can change, and individual facts matter.