Lions and Tigers and Canceled Plans? Oh My!

PPO PLANS ARE BEING CANCELED — AND WHAT YOU CAN DO ABOUT IT

Across the country this year, many Medicare Advantage PPO (Preferred Provider Organization) plans are being discontinued, leaving beneficiaries confused and concerned. While each insurance company has its own reasons, several common factors explain the wave of cancellations.

First, the financial side of healthcare is changing. Insurers design Medicare Advantage plans in partnership with the federal government. Recently, reimbursement rates from Medicare have tightened, while the cost of medical services, prescriptions, and provider contracts has gone up. When a plan becomes too expensive to maintain, insurance carriers may decide to pull it rather than operate at a loss.

Second, network challenges play a role. PPO plans allow beneficiaries to see a wider range of doctors, both in and out of network, compared to HMOs. That flexibility comes at a higher cost to the insurer, especially in rural or smaller communities where contracting with providers is more difficult. If a plan struggles to secure enough participating doctors or hospitals, it risks compliance issues—and cancellation can become the simpler option.

Third, companies are reshaping their portfolios. Large insurers constantly review which plans are profitable and which are not. If participation in a specific PPO plan is low, or if claims costs are higher than expected, that plan may be eliminated in favor of other products, such as HMOs or Special Needs Plans.

So, what does this mean for people enrolled in one of these discontinued plans? Most importantly, no one loses Medicare coverage entirely! Beneficiaries whose PPO is canceled will receive a formal notice and have the chance to choose a new plan. This typically happens during the Annual Enrollment Period (October 15–December 7), though in cases of plan termination, a Special Enrollment Period is also granted.

IF YOU RECEIVE A CANCELLATION NOTICE, HERE ARE A FEW KEY STEPS TO TAKE:

 Read the letter carefully. It will explain when your current plan ends and outline your options.

 Compare alternatives. Look at other Medicare Advantage plans in your county, including HMOs and regional PPOs. While HMOs have stricter networks, many offer lower premiums and extra benefits.

 Consider Original Medicare with a supplement. Depending on your health needs and budget, moving back to traditional Medicare with a Medigap policy and Part D drug plan might provide greater stability, while at a higher upfront cost.

 Talk with a licensed agent or counselor. Medicare rules can be complex, and personal guidance is invaluable when weighing coverage, costs, and doctor access.

For many, a plan cancellation feels unsettling. But it’s also a chance to review your coverage and make sure it still fits your needs. Healthcare is never one-size-fits-all, and each year brings new options. The key is not to ignore the notice—act promptly, explore your choices, and find the plan that offers the right balance of access, benefits, and peace of mind.

We do not offer every plan available in clients’ area. Currently we represent 13 organizations which offer 92 plans in your area. Please visit Medicare. gov or contact 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all of your options. We also offer many top rated Medicare Supplement organizations.

Hanson Insurance | Emily Hanson

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