Cigna, a global health service company, has announced significant changes to its Medicare Advantage (MA) plan offerings across eight states, affecting thousands of members. These modifications, aimed at optimizing Cigna’s Medicare portfolio, include plan exits and reductions that will impact members in certain counties, with Florida being the most affected. This restructuring comes at a time when major insurers, including Cigna, are navigating a rapidly evolving Medicare landscape driven by regulatory changes and rising service demands.
Overview of Cigna’s Medicare Advantage Plan Changes
Cigna has made the strategic decision to reshape its Medicare Advantage plan lineup in eight states. The announcement, shared through Pinnacle Financial Services, indicated that 36 health plans will be affected, with up to 5,395 beneficiaries required to find new coverage options. Despite the number of affected plans, Cigna emphasized that most of these plans have low membership, and alternative Medicare Advantage plans will be available in all but four counties.
States Affected by the Changes
The states impacted by Cigna’s Medicare Advantage changes include:
– Colorado
– Florida
– Illinois
– Missouri
– North Carolina
– Tennessee
– Texas
– Utah
While some states will see the discontinuation of certain plans, Cigna has assured members that alternatives will be available. However, in specific counties in Missouri and North Carolina, Cigna will be fully exiting the market, requiring beneficiaries to seek new providers.
Impact on Cigna’s Florida Membership
Florida is poised to see the most significant impact from these plan adjustments. Of the 5,395 beneficiaries affected across all eight states, 4,000 are located in Florida. In addition, Cigna will no longer offer Preferred Provider Organization (PPO) plans in Florida and several other states. This leaves many residents, particularly those in rural or underserved areas, needing to switch to alternative plans.
For affected Floridian beneficiaries, the discontinuation of PPO plans may pose challenges. However, Cigna is offering other Medicare Advantage plans to cover the gaps left by the PPO withdrawal. The company remains committed to maintaining network adequacy and ensuring members have access to necessary healthcare services.
State-by-State Breakdown of Plan Changes
Colorado
In Colorado, Cigna is reducing plan availability in certain counties, but members in affected areas will have alternatives available.
Florida
Florida, home to the largest group of impacted beneficiaries, will no longer have Cigna’s PPO plans in several counties. Affected members must switch to new plans or find coverage with another insurer.
Illinois
Illinois sees minimal disruption, with only a few counties affected. However, like in other states, alternative plans will be offered.
Missouri
Cigna is fully exiting some counties in Missouri, meaning affected beneficiaries will need to find a new provider altogether.
North Carolina
Similarly to Missouri, Cigna is exiting specific counties in North Carolina, requiring beneficiaries to seek new coverage.
Tennessee
Tennessee will experience reduced plan options in certain counties, but Cigna will offer alternative plans for most members.
Texas
Texas, one of the largest markets for Cigna, will see a reduction in Medicare Advantage plan offerings in certain counties. However, members will have alternatives available.
Utah
In Utah, Cigna is streamlining its plan offerings, reducing options in certain areas, but providing other plans to affected members.
Reasons for Cigna’s Medicare Advantage Plan Adjustments
Cigna’s decision to trim its Medicare Advantage plan offerings stems from several key factors:
1. Service Area Viability: Each year, Cigna assesses the viability of its Medicare Advantage plans. This includes reviewing the adequacy of provider networks and the availability of services in certain areas.
2. Network Adequacy: If gaps are identified in Cigna’s provider networks, the company may choose to reduce or eliminate plans in those areas.
3. Provider Engagement: In areas where Cigna struggles to engage with healthcare providers effectively, plans may be discontinued.
4. Regulatory Changes: Cigna, along with other insurers, has faced increasing pressure from regulatory changes affecting Medicare Advantage plans, which have led to plan modifications and exits.
According to a statement from Cigna, “If any gaps are identified in these areas that cannot be resolved, it can result in Cigna Healthcare reducing these service areas and/or not renewing plans.” The company continues to evaluate its Medicare Advantage offerings based on these factors.
The Sale of Cigna’s Medicare Business to Health Care Service Corp (HCSC)
In January 2024, Cigna agreed to sell its Medicare business to Health Care Service Corp (HCSC) in a deal worth $3.7 billion. This sale included not only Medicare Advantage plans but also Part D prescription drug plans, supplemental benefits, and Cigna’s CareAllies business.
While HCSC will take over the Medicare business, Cigna will continue to have a partnership through Evernorth, its subsidiary, to provide pharmacy services. This deal allows Cigna to focus more on its core health services while ensuring its Medicare customers remain well-served through HCSC’s offerings.
Industry-Wide Impact of Medicare Advantage Regulatory Changes
Cigna is not the only insurer adjusting its Medicare Advantage plans. Humana, another major Medicare provider, is also exiting 13 markets in 2025, impacting roughly 10% of its Medicare Advantage members. The health insurance industry is grappling with regulatory changes and increased utilization of Medicare services, which is leading to adjustments in plan offerings and market exits across the board.
Medicare Advantage plans are experiencing heightened service demand, with rising costs and evolving regulatory requirements creating additional pressure on insurers to maintain sustainable networks. As a result, companies like Cigna and Humana are strategically reducing their plan offerings to align with their business goals and network capabilities.
Conclusion
Cigna’s decision to trim its Medicare Advantage plans in eight states is part of a broader industry trend where insurers are reevaluating their Medicare offerings in response to regulatory pressures, service area viability, and network adequacy challenges. While these changes will affect thousands of beneficiaries, particularly in Florida, Cigna is committed to offering alternative plans where possible to ensure continued access to healthcare services.
As the Medicare landscape continues to evolve, Cigna’s strategic decisions aim to optimize their service offerings while ensuring that members receive quality care. This move, coupled with the sale of its Medicare business to HCSC, reflects a broader shift in the industry as insurers adapt to new regulatory environments.
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FAQs
1. Why is Cigna trimming its Medicare Advantage plans?
A. Cigna is reducing its Medicare Advantage plan offerings due to service area viability, network adequacy, provider engagement, and evolving regulatory requirements.
2. Which states are affected by the plan changes?
A. Eight states are impacted by the changes: Colorado, Florida, Illinois, Missouri, North Carolina, Tennessee, Texas, and Utah.
3. How many beneficiaries are affected by Cigna’s plan exits?
A. Up to 5,395 beneficiaries are impacted, with 4,000 residing in Florida.
4. Will Cigna offer alternative plans for affected members?
A. Yes, Cigna plans to offer alternative Medicare Advantage plans in most affected counties, except for full market exits in select counties in Missouri and North Carolina.
5. What does the sale of Cigna’s Medicare business mean for members?
A. Cigna’s Medicare business was sold to Health Care Service Corp (HCSC), which will continue to offer Medicare Advantage, Part D, and supplemental benefits.
