Why Should Delaware Care?
Delaware seniors enrolled in Highmark Medicare Advantage plans may have to reconsider what plans they pursue ahead of this year’s annual enrollment period, following an announcement from the state’s largest insurer.
Delaware’s largest commercial insurer is dropping at least one of its Medicare Advantage plans for seniors beginning next year, citing a “focus on long-term sustainability.”
The change comes as federal cuts to Medicare enacted by the One Big Beautiful Bill Act are estimated to reach $490 billion in the next decade, according to the Congressional Budget Office, and insurers begin to lose subsidies.
According to a letter obtained by Spotlight Delaware, some patients on Highmark’s Freedom Blue PPO Prestige plan will lose their coverage on Dec. 31. It is unclear whether any of the insurer’s other Medicare Advantage plans are being dropped or reorganized in 2026, but the insurer said benefits, provider networks, prescription drug coverage, and the availability of some plans in certain markets could be affected.
The letter recommended that Freedom Blue PPO patients consider switching to the federally-managed version of Medicare, which doesn’t always come with the same benefits and prescription coverage as a private plan. It also recommended patients shop around for a private Medicare plan that meets their needs.
With Medicare Advantage, seniors receive the hospital, outpatient medical and prescription coverages offered under the federally-managed Medicare Parts A, B and D, along with other benefits provided by a private insurer, such as dental, vision, or hearing coverage, or allowances for over-the-counter drugs or transportation.
A preferred provider option, or PPO, like the discontinued Freedom Blue plan would allow the insured to see out-of-network providers for higher costs, while a health management organization, or HMO, is another type of plan that limits a customer to in-network providers except in emergencies.
Meanwhile, all hospitals are required to accept the federally-managed Original Medicare.
When asked if other plans within Highmark’s Medicare Advantage program would be terminated, a spokesperson said the insurer is replacing some of its older plans with new options.
“Insurers will use new names of products to help signify changes to the premiums or benefits to be sure that everyone understands their new options for the upcoming year,” Anthony Matrisciano, a spokesperson for the organization, said in an email.
Highmark, which is the largest provider in Delaware’s health insurance market and an influential presence, announced it was making changes to its Medicare Advantage plans earlier this month.
The changes come amid rising health care costs, which the insurer said are being driven by the price of new prescription drugs and people seeking care more often. The release also said Highmark is “committed” to its Medicare Advantage plans, and that it would continue to offer plans across its network next year.
While a press release said changes are coming to the plan, the insurer did not outline specific changes coming to policies or how coverage would be impacted for seniors. However, Matrisciano said the insurer would still offer Medicare Advantage products in all three of Delaware’s counties.
“Our members have been notified about any changes to their coverage for next year and we encourage them to use the Annual Enrollment Period to find the coverage that best fits their needs,” Matrisciano said.
The Annual Enrollment period, a specific number of weeks where people sign up for their insurance for the coming year, opened last week and will run through Dec. 7.
Highmark put out its press release two weeks prior to the enrollment period opening, saying consumers would likely see many different insurers announce changes to their Medicare Advantage coverage.
Ellen Galardy, Highmark’s president of Medicare business, said in the release that health care costs across the industry have risen, and they’re continuing to grow. The release also claimed that prescription medications and outpatient treatment made up 69% of the cost increases for consumers.
“Despite these challenges, Highmark is committed to the Medicare Advantage market and will continue to offer Medicare Advantage plans across our footprint in 2026,” Galardy said in the release.
The changes to Medicare Advantage plans come as the federal government slashed funding for the subsidy for the next decade, with an estimated $490 billion in cuts.
Hospital leaders told Spotlight Delaware in August that cuts to federal subsidies like Medicare and Medicaid would eventually trickle down to commercially insured patients as hospitals and insurers may negotiate higher rates to make up for lost revenue.
The Delaware Medicare Assistance Bureau will host weekly in-person and virtual workshops at its offices across the state until Nov. 20 for Medicare enrollment questions and assistance.
