Sentara Health to Drop Medicare Plans in VA & NC by 2026
Some Sentara Health Plans members in Virginia and North Carolina will be required to change insurers.
VIRGINIA, USA — Starting next year, Sentara Health Plans will no longer offer certain Medicare Advantage plans for members in Virginia and North Carolina.
Sentara Health Plans will join UnitedHealth and other major health care insurers as the company tries to balance higher costs and reimbursement pressures.
Sentara Health Plans is eliminating several Medicare Advantage plans on Jan. 1, 2026.
In a statement from the regional health organization, this discontinuation will impact members enrolled in Non-Dual Medicare Advantage, Medicare Advantage Prescription Drug HMO, and Chronic Condition Special Needs Plans.
The Chronic Condition Special Needs Plan is for people who have severe or disabling chronic conditions like diabetes, chronic heart failure, lung disorders and disabling mental health conditions.
Medicare Advantage Prescription Drug (MAPD) HMOs are a type of health insurance that offers care at often reduced and more affordable costs.
Sentara Health says this change won’t impact Medicaid lines of business, Dual-Eligible Special Needs Plans or Employer, Individual and Family plans.
In addition, this change does not affect the insurance plans accepted by Sentara Health hospitals and medical professionals.
They tell us members enrolled in the affected plans should have received a letter this week with the next steps to take.
The U.S. government has cut back payments on Medicare Advantage since 2024 to reduce spending.
We’re told by Sentara Health that industry-wide market dynamics like reimbursement trends are leading many insurers to reassess their participation in offering Medicare Advantage.
Health experts say now thousands of Sentara Health Plans members in Virginia, North Carolina, and also in Florida will potentially have to choose between new doctors or new health insurance.
Current plans will continue as they are through the end of the year. But when the annual enrollment period opens Oct. 15, members will be required to switch to another insurer.
Sentara spokesperson Dale Gauding tells 13News Now the decision was not made lightly and that the current offerings are no longer financially sustainable.
If help is needed comparing health insurance plans, Sentara asks members in Virginia to call the Virginia Insurance Counseling and Assistance Program (VICAP) at 1-800-552-3402. North Carolina members can contact the Seniors Health Insurance Program (SHIIP) at 1-855-408-1212.
Members can also call 1-800-MEDICARE or visit Medicare.gov for information on Medigap policies and help finding plans available in your area.
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