Medicare Open Enrollment closes on December 7, and rural seniors are facing especially urgent choices. Major insurers are trimming where they offer Medicare Advantage (MA) plans, so beneficiaries outside metro areas should review their Annual Notice of Change (ANOC) and compare options now to avoid being left with costlier or less suitable coverage in 2026.
While nobody likes getting older, one advantage of turning 65 is the opportunity to go on Medicare. What the embattled program’s future looks like remains to be seen, as some project it could be insolvent as soon as 2033. It provides seniors with greater protection as opposed to regular insurance. Along with traditional Medicare, many Americans opt for a Medicare Advantage Plan over a Medicare Supplement (Medigap) because Medicare Advantage plans offer near-zero premiums for dental, vision, and drug coverage that is not generally included with traditional Medicare. Healthcare providers such as Blue Cross and Blue Shield, Aetna, and UnitedHealthcare provide these plans to seniors through government-funded programs. However, for some in rural areas, these Advantage plans may be getting ready to change.
My father turned 65 several years ago and chose to get a Medicare Advantage plan instead of a supplement. He chose Aetna to fulfill his coverage and was incredibly happy with the plan’s benefits and cost ($0 a month). However, after being on the plan for well over a year, he found that his current Advantage plan would no longer be available to residents in our small, rural county. Still, plans like it would remain available to residents in the urban counties surrounding us. Aetna did offer him another Advantage plan, but with his current prescriptions and the limited benefits the new plan provided, he sought a different provider for better coverage. These experiences are becoming increasingly common among seniors in rural areas.
Unfortunately, the situation my father experienced is becoming increasingly common. The Insurance Department Commissioner of New Hampshire, D.J. Bettencourt, announced that multiple insurance providers are likely to leave New Hampshire’s rural residents in 2026, leaving them with very few options. While it is required by law to notify Medicare recipients of changes to their Advantage plan, most notifications are sent by mail or phone, and many seniors shred them or send them to voicemail, fearing they are scams.
This is not just an issue for residents in a few states. It is becoming a nationwide issue. Aetna’s prescription drug plan will cover almost 100 fewer counties nationwide. UnitedHealth and Humana also announced plans to scale back the number of counties their plans could serve.
These changes in offerings from primary healthcare providers all across the country will change how a significant portion of seniors get their health insurance. Some may be forced into purchasing a Medigap plan to ensure their hospital visits and prescriptions are covered to a greater extent. Others will settle for a worse Advantage plan that does not fit their needs to the same degree.
Either way, it is vital for government officials, as New Hampshire officials have done to a large extent, to inform seniors better and not ignore mailers from insurance providers. With the significant increase in spoofing in recent years, it is key to notify seniors of these changes by mail, not over the phone, as cybercriminals can impersonate legitimate healthcare phone numbers and trick seniors into disclosing important information, such as social security numbers and addresses.
Many seniors in rural areas are likely to see either harmful or more expensive changes to their Medicare options, and all need to pay attention through the end of the year to determine what steps they need to take to secure the best, most price-conscious plan available.