Medicare Advantage Contraction in Rural Oregon Highlights Market Sustainability Challenges
Multiple disruptions in Medicare Advantage (MA) plan availability are impacting Lincoln County, Oregon, and similar rural areas nationwide for the 2026 enrollment year.
Samaritan Health Plans announced it will no longer offer its MA plan in Lincoln County, which currently serves about 5,000 seniors there and contributes to one-tenth of the county’s Medicare Advantage membership. This exit narrows options, leaving Devoted Health as the sole provider for Lincoln County seniors in 2026. Nationally, other major insurers including UnitedHealthcare, Humana, and Aetna have also announced rollbacks or plan closures affecting hundreds of thousands of MA members, signaling a broader challenge in the Medicare Advantage market.
Insurance experts attribute these changes primarily to market sustainability issues. Smaller or regional insurers like Samaritan face financial difficulties because their risk pools are concentrated in older, sicker, and lower-income populations typical in rural counties, leading to higher than average healthcare costs per member. This dynamic undermines the viability of offering diverse MA plans in less populated areas. Lincoln County, for example, has far fewer MA plan options compared to urban centers like Portland due to demographic and health cost profiles.
The impact on seniors is significant, as they must now navigate limited plan choices amid tight timeframes. Agents who specialize in Medicare Advantage are actively preparing to assist beneficiaries in identifying and enrolling in alternative plans. Devoted Health is expanding its presence and offering competitive premium options with a range of benefits including moderate co-pays and dental coverage, although dental and some ancillary benefits are not universally covered by all plan types.
The withdrawal of Samaritan plans triggered a special enrollment period for affected members, allowing them more time beyond the typical October to December annual election window to select new coverage without penalties. This special period also exempts them from medical underwriting if they switch back to original Medicare with a supplemental Medigap plan. However, Medigap plans lack prescription drug and certain ancillary benefits, which beneficiaries must purchase separately.
To address confusion and help seniors make informed decisions, multiple educational events are scheduled locally. Additionally, the state’s Senior Health Insurance Benefits Assistance (SHIBA) program offers free counseling and resources to Medicare beneficiaries and their families. SHIBA emphasizes the urgency for seniors to act promptly due to increasing demand and limited assistance resources as the open enrollment period progresses.
This trend of insurer withdrawals and consolidation of offerings in rural markets underscores challenges in balancing risk pools and maintaining access to affordable Medicare Advantage plans. Industry stakeholders and regulators may need to monitor and consider policy adjustments to support coverage continuity and market stability in diverse demographic areas. The evolving MA landscape requires careful oversight to ensure that vulnerable senior populations continue to have viable insurance options.
Seniors in affected areas are encouraged to utilize certified agents and programs like SHIBA to navigate plan changes. Expert guidance can help mitigate the risk of coverage gaps and optimize benefit utilization amid shifting MA provider networks. Understanding the complex balance between premiums, out-of-pocket costs, and benefits is critical in a time of market contraction and insurer retrenchment.
Insurers expanding into new rural counties, such as Devoted Health’s entry into neighboring Tillamook County, may partially offset market exits but also reflect ongoing volatility in MA plan offerings. The overall situation reflects systemic industry challenges related to demographic risk concentrations and reimbursement structures that affect insurers’ ability to sustain diverse, competitive plan portfolios in less dense regions.
The transition’s implications extend to healthcare providers contracted within MA networks, who may experience changes in patient coverage patterns and reimbursement arrangements. Payers and providers should anticipate adjustments as plan availability shifts and prepare for the operational impacts of enrollment changes and customer service demands.
The release of 2026 MA plan details on Medicare.gov starting October 1 provides beneficiaries a centralized platform to compare plans. However, vigilance is needed to ensure consumers use the official federal site to avoid confusion or exploitation. Medicare counselors emphasize early review and enrollment to avoid last-minute complications and to secure appropriate coverage.
The Lincoln County case exemplifies broader trends affecting rural Medicare beneficiaries nationwide, highlighting the need for data-driven strategies and responsive support mechanisms from insurers, industry groups, and government programs to navigate the evolving Medicare Advantage market environment effectively.