Re : Part 1
"It is important to clarify that no states are removing Medicare Advantage coverage entirely in 2026. Medicare Advantage is a federal program offered by private, Medicare-approved insurance companies.
The changes for 2026 are that particular corporate insurers are scaling back their plan options in certain states and counties due to financial pressures (rising costs and reduced government reimbursements).
Here is a breakdown of what is happening:
Insurer Decisions: Major insurers like UnitedHealthcare, Humana, and Aetna are reducing their footprint for 2026.
Humana is exiting the Medicare Advantage market in two states (reducing its presence to 46 states).
Aetna is dropping nearly 90 plans across 34 states.
UnitedHealthcare is stopping plan offerings in 109 U.S. counties.
Impact Varies by Location: The availability of plans varies by state and even county. Some areas, such as certain counties in Minnesota, Ohio, Illinois, and Georgia, will lose many plan options. In contrast, other states like Alabama, West Virginia, and Kansas will see a net gain in plan options.
Medicare Advantage Remains Available: While specific plans are being discontinued, other plans from different insurers will still be available in most areas. In fact, all Florida residents with Medicare still have access to a Medicare Advantage plan with a $0 premium.
Options for Affected Individuals: If an individual's plan is discontinued, they will not be left without coverage. They can switch to a new Medicare Advantage plan or enroll in Original Medicare {note added, if allowed by OM, insurer, etc., with return of '2010' prior condition(s) or one being excluded from new coverage, etc.} during the Annual Enrollment Period (October 15 – December 7) or a Special Enrollment Period (SEP).
In short, the changes are a result of corporate insurer decisions, not state mandates to eliminate the program. The overall number of plans available nationwide is expected to remain stable in 2026, though options for specific individuals may change."
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Re : Part 2
"During the 2010 debate about the Affordable Care Act (ACA), the primary issue with the Medicare Advantage (Part C) option was the significant overpayment of federal funds to private insurance plans compared to the costs of traditional Medicare.
Key issues and arguments included:
Excessive Costs: Reports from the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) found that the government was paying Medicare Advantage plans, on average, around 13% to 14% more per beneficiary than it cost to cover beneficiaries in the traditional fee-for-service (FFS) Medicare program.
Funding Source: A central part of the ACA's financing mechanism relied on reducing these {"excessive"} Medicare Advantage payments to help fund other provisions of the health care reform and extend the solvency of the Medicare Part A trust fund.
Impact on Benefits/Premiums: Opponents of the cuts argued that the extra payments were used by plans to offer additional benefits (such as dental, vision, or gym memberships) and lower out-of-pocket costs or premiums, which would be jeopardized by the ACA's reductions.
Plan Design Concerns: Critics of Medicare Advantage argued that plans sometimes used their payment flexibility to design benefit packages that {"cherry-picked"} healthier beneficiaries and discouraged enrollment by sicker individuals (e.g., by imposing higher cost-sharing for services like chemotherapy or skilled nursing care).
Political Opposition: The proposed cuts generated significant political controversy, with reform critics warning that the changes would weaken Medicare and reduce choices for seniors. The phrase {"Keep your hands off my Medicare"} became a memorable slogan during the debate.
Ultimately, the ACA implemented a plan to gradually reduce payments to Medicare Advantage plans to bring them closer to traditional Medicare costs, while also adding requirements for plans to spend a minimum portion of premiums on medical benefits (rather than overhead/profits) and providing bonus payments for high-quality plans.
In 2025, a common issue with Medicare Advantage (MA) plans is that while they are widely overpaid by the government, the supplemental benefits they offer, like allowances for over-the-counter (OTC) items or healthy food, can have significant limitations that effectively reduce or eliminate their value for members.
Specific problems often noted by beneficiaries include:
Network Restrictions: Plans often limit where you can use your benefit card to a specific network of participating retailers. Walmart is a participating retailer for many plans (often facilitated through benefits administrators like NationsBenefits), but not necessarily all plans. If your specific MA plan (from an insurer other than United Healthcare, for example) doesn't have an agreement with Walmart.com, you cannot use your allowance there.
Limited Eligible Items: Even within a participating store, only specific, plan-approved items are eligible for purchase with the benefit card. Beneficiaries may find that many items they want or need are not covered, or that the prices for eligible items are inflated compared to non-eligible alternatives.
Forfeited Benefits: About two-thirds of MA members never use their full OTC benefits, resulting in billions of dollars of forfeited benefits annually, often due to confusion over what is covered and where they can shop.
Lack of Integration: Until recently, shopping with these cards online was difficult. Walmart only launched a feature in May 2025 that helps customers easily identify plan-specific, eligible products and check out with a mixed basket, but this requires the customer's plan to be supported by the specific benefit administrator (e.g., NationsBenefits) integrated with Walmart's system.
Benefit Reductions for 2025: Following changes to federal payment rates, some insurers have scaled back the generosity of supplemental benefits for 2025. Many members faced decreases or total removal of their OTC allowance compared to the previous year.
These issues mean that a benefit that looks attractive on paper can be hard to access and use in practice, leading many to feel it's a {"zero benefit"} in their case. "
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Disclaimer: "AI responses may include mistakes. For financial advice, consult a professional."
[ Part 1 (&) Part 2 ] Source AI "Gemini" - re : Google. (Date @ 11.12.2025)
note added: ye11ow-sub per opinion / op.
