Curated News
By: NewsRamp Editorial Staff
August 31, 2025
Maryland Medicare Crisis: Thousands Face Loss of Health Coverage
TLDR
- Maryland's Medicare Advantage market challenges offer opportunities for insurers to renegotiate terms or explore alternative coverage models as federal reimbursement rates remain misaligned.
- Maryland's unique hospital payment system sets higher rates than federal Medicare Advantage reimbursements cover, creating financial losses that may force insurers to exit the state.
- Thousands of Maryland seniors face potential loss of vital supplemental benefits like dental and vision care, threatening healthcare stability for vulnerable retirees.
- Maryland has one of the nation's lowest Medicare Advantage participation rates due to its unique hospital payment model conflicting with federal reimbursement calculations.
Impact - Why it Matters
This situation directly impacts tens of thousands of Maryland seniors who rely on Medicare Advantage for comprehensive healthcare coverage, including dental, vision, and transportation benefits not available through traditional Medicare. The potential loss of these plans could force elderly residents to change doctors, disrupt medication routines, and face higher out-of-pocket costs during a period of life when consistent medical care is most critical. The disruption highlights systemic healthcare financing challenges that could serve as a warning for other states considering similar payment models, emphasizing the need for stable, accessible healthcare for aging populations.
Summary
Tens of thousands of Maryland retirees face potential disruption to their healthcare coverage as major insurance providers consider terminating Medicare Advantage plans in the state. The crisis stems from Maryland's unique hospital payment system, where the Health Services Cost Review Commission (HSCRC) sets fixed hospital rates that create a financial mismatch with federal reimbursement calculations. This disconnect makes Medicare Advantage more expensive to operate in Maryland than in other states, leading insurers like Aetna, Humana, Cigna, and United Healthcare to reconsider their presence in the market.
Key players including Mark Puente of Alterwood Health and Gene Ransom of MedChi highlight how Maryland's 27% Medicare Advantage participation rate ranks among the lowest nationally, far below the 50% typical in most states. The situation has been exacerbated by the elimination of state grants that previously helped insurers offset costs. With approximately 295,000 seniors currently enrolled in these plans, the potential exit of major carriers threatens access to vital supplemental benefits including dental, vision, and transportation services that traditional Medicare doesn't cover.
The looming disruption echoes previous incidents like Johns Hopkins Medicine's 2021 termination of plans for Baltimore residents, which left 5,000 seniors scrambling for new coverage. Insurance broker Andrew Rosenberg emphasizes that such changes severely impact seniors' continuity of care, often forcing them to change doctors and pharmacies. However, hope remains as state and federal officials negotiate the new AHEAD model, which may provide solutions to stabilize the Maryland market and protect vulnerable retirees from losing their healthcare security.
Source Statement
This curated news summary relied on content disributed by citybiz. Read the original source here, Maryland Medicare Crisis: Thousands Face Loss of Health Coverage
