How Loss of Medicare Advantage Plans Impacts LRCD Tenants

​In 2026, nearly 77,000 New Hampshire residents lost their Medicare Advantage plan, as the market faced “significant disruptions.” According to the New Hampshire Insurance Department, this breakdown is the result of federal changes, including “Reduced federal payment rates to insurers, additional federal regulations and compliance requirements, and changes in federal administrative formulas that affect plan design.”
 
While Medicare Advantage recipients did not necessarily lose their coverage (federal law currently guarantees that Medicare-eligible people will continue to have coverage), many people lost the additional and vital benefits that Advantage plans offered. These additional benefits included vision, dental, and even rides to medical appointments. As Advantage plans left the state, as many as 5% of New Hampshire residents lost access to oral health and vision care, but perhaps most consequentially, many of them lost access to transportation.
 
In the state of New Hampshire, Medicaid recipients have access to an admittedly very flawed transportation assistance program. A transportation coordination center verifies appointments and contracts with transportation providers to pick patients up, bring them to their appointments, and return them home. While this program is riddled with issues (including no shows and late arrivals that can have disastrous consequences), it does offer one precarious solution to address the problem of how people experiencing poverty can access medical care.
 
However, at the age of 65 or upon enrolling in Medicare (which could be sooner, if you have a disability), a transition is triggered that can disrupt or even remove access to this transportation program. Medicare provides significantly fewer supports than Medicaid does, so the switch leaves many vulnerable older adults and people with disabilities unexpectedly stranded, and without suitable replacements.
 
The community has sought to address this issue creatively. Local agencies have worked to develop networks of volunteers to drive older adults to their appointments, but this is dependent on a volunteer being available and willing to take the request.  A bus was also introduced to pick seniors up and bring them to run errands, but this is a very time consuming process, and some individuals have reported being left behind by the bus. Furthermore, if you need to see a specialist out of Hanover or Boston, these solutions are not appropriate. The bus can’t take you there, and the volunteers often won’t (besides, their program limits rides to within 60 miles of their home base). 
 
One LRCD resident had a long-standing provider based out of Dartmouth Hitchcock in Lebanon. When they became unable to drive, they had to find another way to get themselves there. Despite efforts to find appropriate transportation resources, this resident was unable to get to Dartmouth to see their provider. Losing this support resulted in decompensation and ultimately, long-term hospitalization. Another resident needed to get to an appointment with a specialist in Concord. There was no bus to take them to this appointment, so they contacted an agency to request a volunteer driver. The morning of the appointment, they were alerted that there was no volunteer available. The appointment was cancelled. Due to the lack of reliable transportation, the resident did not reschedule.
 
People on Medicare are people over the age of 65 or people with significant, life limiting disabilities – two populations with some of the greatest medical need – and the most likely to be unable to drive. Nevertheless, they have the hardest time accessing appropriate transportation to medical appointments, especially now that Medicare Advantage plans have all but disappeared in New Hampshire.

Melissa Shadden-Cyr, MSW, LICSW
​Resident Services Coordinator