Centene Ends Medicare Advantage: 40,000 Affected in 2025!

Big changes are on the horizon for Centene’s Medicare Advantage plan members. I’ve got some important news to share with you today that will affect you during this upcoming Annual Enrollment Period.

Almost 40,000 Centene Medicare Advantage members will be forced to select a new plan for the 2025 year.

If you currently have a Centene Medicare Advantage plan, coverage will be good through the remainder of 2024.

So, if you’re enrolled in a Centene Medicare Advantage plan, it’s more important than ever to look for the Annual Notice of Change (ANOC) that every Medicare Advantage company has to send to its members each Annual Enrollment Period.

Many people overlook these notifications and just throw them away, assuming they’re happy with their plan and they have no desire to shop or change plans. This year will be different. I highly encourage you not to overlook this notification.

• If your plan is being terminated: you will actually receive a second notice that refers to the plan not renewing.
• If your plan is staying in place: you will generally receive an ANOC about any minor benefit detail changes going into the new year.

Hi. My name is Mark Prip, and I’ve been helping people understand various Medicare plans for over 15 years. This is the sixth video that I’ve made on different Medicare Advantage companies dropping members as we enter into the 2025 Annual Enrollment Period.

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Let’s get right into it and start with the announcement from Centene.

The Centene Announcement

I pulled this article from Newsweek.com and will list the source at the bottom of this page so you can read the full article.

This is a statement from Centene CFO Andrew Asher:

“We’ve said before that we expect to shrink in 2025 as we think about what business is going to serve this well in the long run.

First we’ve got to chip away at the degree of run rate negative margin and push towards break even, and then we can talk about what the margin opportunity is in Medicare.”

So you’re probably wondering why this is happening.

Why Is This Change Happening?

Basically, the company takes in a reimbursement rate from CMS, and with that money, they’re able to:

• Build the plan
• Give you a policy
• Set up the network
• Pay the claims

So, that reimbursement rate they receive structures everything, and then that money goes out to pay claims.

This year, CMS’s reimbursement rate is less than all of these companies anticipated. Now that they’re receiving fewer dollars, they’re having a harder time paying claims and staying out of the negative. 

Does this affect you?

If you do have a Centene Medicare Advantage plan, Newsweek actually gives us data on which states will be affected. Let’s take a look.

Who Is Affected?

According to Newsweek, the states affected will include Alabama, Massachusetts, New Hampshire, Rhode Island, New Mexico, and Vermont.

Roughly 37,000 Medicare Advantage members will be impacted by the market exit.

Vermont is especially vulnerable, as Centene previously controlled 9% of the market.

So, if you’re in Vermont, there’s a much higher likelihood that you will receive a non-renewal notice.

• Important:

  Check your mail to determine if you’re just receiving a plan change notification or a non-renewal notification.

Should you receive a non-renewal notification, here are my two tips on what you can do as we come into this year’s Annual Medicare Enrollment Period.

Option #1: Find Another Medicare Advantage Plan

If you lost your plan and want to stay with a Medicare Advantage plan, I tell all of our clients to do this to expedite the comparison and shopping process:

Make a list of your medical doctors, hospitals, prescriptions, and any medical facilities that you use. Make sure you have the correct spelling and dosage of the prescriptions. 

That way, when you compare your current plan to a new one, you can ensure that the new plan covers all of your providers in the network, keeping your out-of-pocket costs as low as possible. 

You can also look at Medicare.gov for alternate options, but having that personal information available will help you be prepared to compare plans that are the most suitable for your list of doctors and your list of medications.

The greatest time to shop and compare plans is during this year’s Annual Election Period, which runs from October 15 through December 7.

Option #2: Switch to a Medicare Supplement Plan

Now, you will have a second option. If you do receive notification that you’re losing your Centene Medicare Advantage plan, there is a silver lining opportunity. 

Here’s what I mean.

If you’ve lost your plan and you want to switch to a Medicare Supplement (or also known as Medigap) plan, because your Advantage plan will not renew, you will now have a guaranteed issue rights period.

This means you receive a period of time where you can avoid medical underwriting when applying for a Medigap plan.

If you’ve wanted a Medigap plan in the past but have not been able to enroll due to medical reasons, you now have this period in which you can enroll with a guaranteed issue. That means when you go to apply, you state that there was a loss of coverage.

You will probably need to provide proof that you lost your Medicare Advantage plan with Centene, but that will allow guaranteed approval with that Medigap company. 

Benefits of a Medicare Supplement Plan

Many people prefer Medicare Advantage because it’s lower cost per month. But if you can see the opportunity with the Medigap guaranteed issue right, I highly recommend you consider it. Yes, it’s more expensive per month, but a Medigap plan works much differently than a Medicare Advantage plan.

Here’s a couple of ideas about how they’re different.

With Medigap, you do not deal with Medicare’s reimbursement problem with the company. That goes away.

The second (and probably the most important) fact is that Medigap plans or Medicare supplement plans do not have prior authorizations.

What does that mean?

All Medicare Advantage plans have prior authorizations. That means that when you need certain testing or care, you must wait for the insurance company to approve that procedure.

With Medigap, there are no prior authorizations.  That’s a significant difference in how your healthcare is handled.

Also, with Medigap, there are no provider networks or provider disputes between the company and the doctors.

There are no referrals.

You can go virtually anywhere in the United States where Original Medicare is accepted.

Yes, Medigap has a monthly premium, let’s say between $150 and $200, but the coverage is far, far superior to Medicare Advantage.

My Final Thoughts

As I said at the beginning of the article, this is the sixth company for which I have created the exact same style of video/content because the industry has been experiencing so much change during this year’s Annual Enrollment Period.  I’ve also covered providers like Aetna, Cigna, and Humana.

If you have any questions about these changes or how to navigate them, please give us a call. We do this daily, helping people compare and find new plans due to this massive loss.

Again, my name is Mark Prip with Policy Guide. Let us know if there’s anything we can do to help. Thanks!

Source:  Newsweek  

FAQs

• What should I do if I receive a non-renewal notification for my Centene Medicare Advantage plan?

  If you receive a non-renewal notification, it is important to act quickly. Begin by gathering information about your current healthcare providers and prescription medications. Consider switching to a Medicare Supplement (Medigap) plan to take advantage of guaranteed issue rights. Ensure you have proof of your Medicare Advantage plan loss when applying for Medigap.

• How does a Medigap plan differ from a Medicare Advantage plan?

  Medigap plans offer several advantages over Medicare Advantage, such as no prior authorizations for tests and procedures, no provider networks, and no requirements for referrals. 

• Are Medigap plans more expensive than Medicare Advantage plans?

  Yes, Medigap plans typically have a higher monthly premium, generally ranging between $150 and $200. However, they provide more comprehensive coverage and eliminate issues like prior authorizations and network restrictions, which can lead to greater savings on out-of-pocket health care costs.

• Can I switch to a Medigap plan without medical underwriting if I lose my Medicare Advantage plan?

  Yes, if you lose your Medicare Advantage plan, you can utilize the guaranteed issue rights period, which allows you to enroll in a Medigap plan without undergoing medical underwriting. 

• When is the best time to compare and choose new Medicare plans?

  The Annual Election Period, from October 15 through December 7, is the ideal time to compare and switch Medicare plans.