Overview of CDPHP’s Plan Changes
Capital District Physicians’ Health Plan (CDPHP), one of the largest regional health insurers in New York’s Capital Region, has announced the discontinuation of its mid-tier Medicare Advantage program. The Value Rx Medicare Advantage plan will no longer be available starting January 1, 2026, leaving thousands of members scrambling to find alternative coverage before critical enrollment deadlines.
This significant change affects seniors aged 65 and older who rely on Medicare Advantage programs for supplemental Medicare benefits beyond what Original Medicare provides. Unlike traditional Medicare, Medicare Advantage plans bundle hospital insurance, medical insurance, and often prescription drug coverage into comprehensive packages offered by private insurers like CDPHP.
What Is the Value Rx Medicare Advantage Plan?
Plan Features and Benefits
The CDPHP Value Rx Medicare Advantage plan served as a middle-ground option for members seeking balanced coverage without breaking the bank. With a $62 monthly premium, the plan positioned itself between CDPHP’s no-premium option and its more expensive $100 and $135 monthly plans.
Standout Benefits
What made the Value Rx plan particularly attractive was its generous $1,650 annual dental allowance—one of the highest dental benefits among CDPHP’s Medicare Advantage offerings. This robust dental coverage proved especially valuable for seniors requiring extensive dental work, making the plan’s discontinuation particularly concerning for members who depend on these benefits.
Extended Geographic Coverage
The Value Rx plan also distinguished itself through its extensive service area, reaching all the way to Tioga County. This broader geographic footprint exceeded the coverage areas of CDPHP’s three remaining Medicare Advantage pharmacy plans scheduled for 2026, leaving some rural members with fewer convenient options.
Critical Deadlines for Affected Members
December 1, 2025: Primary Action Deadline
Current Value Rx members received urgent notifications warning them about crucial enrollment deadlines. The December 1, 2025 deadline represents the first critical date by which members should select a replacement plan to ensure seamless coverage transition. Missing this date means losing prescription drug coverage and reverting to Original Medicare starting January 1, 2026.
February 28, 2026: Final Grace Period
Because CDPHP is discontinuing the plan (rather than members choosing to leave voluntarily), affected individuals receive an extended grace period. Members have until February 28, 2026 to enroll in a new Medicare Advantage plan with prescription drug coverage without facing immediate penalties.
Delayed Effective Dates
It’s important to note that any plan selected after December 31, 2025, won’t become effective until one month later. This delay could create coverage gaps for members who wait too long to make their selection, potentially leaving them without prescription drug benefits during the interim period.
Understanding Your Coverage Options
Without action, Value Rx members will automatically default to Original Medicare, which covers hospital stays (Part A) and doctor visits (Part B) but does not include prescription drug coverage. Members would then need to purchase a separate Part D prescription drug plan to maintain medication benefits.
Late Enrollment Penalties Explained
Lifetime Financial Consequences
Medicare’s late enrollment penalties carry serious long-term financial implications. Members who fail to select a prescription drug plan by the February 28, 2026 deadline will face a lifetime late-enrollment penalty added to their monthly premium. This penalty isn’t temporary—it continues for as long as you maintain Medicare prescription drug coverage.
How Penalties Are Calculated
The penalty typically equals a percentage of the national base beneficiary premium, multiplied by the number of months you went without coverage. Even a few months of delay can result in permanently higher healthcare costs.
Alternative CDPHP Medicare Advantage Plans
CDPHP continues offering three Medicare Advantage plans with prescription drug coverage for 2026:
No-Premium Plan
- Monthly Cost: $0
- Best for: Budget-conscious seniors with minimal healthcare needs
- Trade-offs: Higher co-pays and reduced supplemental benefits
Mid-Tier Plan
- Monthly Cost: $100
- Benefits: Lower co-pays than the no-premium option
- Enhanced vision and supplemental benefits
Premium Plan
- Monthly Cost: $135
- Benefits: Lowest co-pays among CDPHP options
- Maximum vision, dental, and supplemental benefits
Geographic Coverage Changes
The Value Rx plan’s discontinuation particularly impacts members in outlying counties. With coverage extending to Tioga County, the Value Rx plan served more rural areas than CDPHP’s remaining 2026 Medicare Advantage offerings. Members in these regions may need to explore plans from other insurers to maintain similar geographic convenience.
How to Choose Your New Plan
When evaluating replacement plans, consider:
- Monthly premium affordability
- Prescription drug formulary (ensure your medications are covered)
- Annual out-of-pocket maximums
- Dental and vision benefits
- Provider network accessibility
- Pharmacy network convenience
CDPHP’s Response to Member Concerns
CDPHP spokesperson Natalia Burkart acknowledged member frustrations in a statement to the Times Union: “We understand that changes to a health plan can be frustrating, and we are here to help. In 2026, CDPHP will continue to offer Medicare Advantage plans, and we remain deeply committed to helping our members find the coverage that best fits their needs.”
However, CDPHP has not disclosed why it’s discontinuing the Value Rx plan or how many of its Medicare Advantage members are affected by this change. The company also hasn’t revealed its total Medicare Advantage enrollment numbers, leaving members uncertain about the scale of this disruption.
Getting Assistance
Current Value Rx members should contact CDPHP directly to discuss alternative coverage options and ensure they select the most appropriate replacement plan before critical deadlines pass.
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