Humana is exiting Medicare Advantage plans that cover around 600,000 members next year. That's the second year in a row they've pulled back. Aetna is trimming its lineup too. Presbyterian is dropping most of its MA business. Becker's has been keeping a running tally all summer, and the seniors who get the letters by September 30 mostly land right back in traditional, fee-for-service Medicare.
Everyone is covering this like a tragedy. I think it's the best thing to happen to primary care economics in a decade. And I think most health systems are about to fumble it.
Here's the part nobody says out loud in a payer contracting meeting. When Humana walks away from 600,000 chronically ill seniors because the medical loss ratio got ugly, the smartest actuaries in the country are telling you what they think unmanaged chronic patients are worth to carry. They ran the math. They lost money. They quit. That's not a market failure. That's a verdict.
And that verdict should change how you think about every patient coming back through your doors.
For a decade the industry treated Medicare Advantage as the future and fee-for-service as the thing you tolerate until the risk contract shows up. Systems built population health teams around capitation. CFOs modeled shared-savings checks that were always one more performance year away. Everybody wanted to be at risk, because at risk was where the story said the money would eventually be.
Now the payers themselves are unwinding that story. They priced the risk on complex seniors, they couldn't make it work, and they're handing those members back the moment it stopped being profitable. If the risk were the goldmine everyone said it was, Humana wouldn't be mailing 600,000 goodbye letters.
The patients flooding back into traditional Medicare are your most complex ones. Congestive heart failure, diabetes, hypertension, chronic kidney disease, usually several at once. And they arrive with no care wrapper at all, because the plan used to at least pretend to provide one. A senior who drops back to Original Medicare without a supplement has no out-of-pocket cap and no case manager calling to check on her. She has your practice. That's it.
Here's what the doom coverage misses. You don't need the plan to manage these patients. Fee-for-service Medicare already pays you to.
Chronic care management, advanced primary care management, remote monitoring, the annual wellness visit. These are real, current Medicare programs that pay a practice to manage patients between office visits. They pay whether the patient sits in an MA plan or in traditional Medicare. When that patient comes back to fee-for-service, the care management money doesn't vanish. It gets paid to you directly, instead of getting skimmed by a plan that was taking the spread the whole time.
Read that again, because it's the whole point. The payer wasn't funding the care coordination out of generosity. The payer was the middleman on a payment Medicare will make to you directly the second the patient is back on Parts A and B.
I'll be honest about the numbers because I have to be. Medicare pays a practice somewhere in the range of a few hundred dollars a year, per patient, across these programs, and it stacks depending on complexity and how many programs the patient qualifies for. I don't have the exact 2026 rate sheet in front of me, so verify the current per-code amounts before you put a dollar figure in a board deck. But the direction is not in question. The work of managing a chronic patient between visits is billable today, under codes that already exist, with no risk contract required.
Roughly 2.9 million MA enrollees faced forced disenrollment heading into 2026, a rate close to 10 percent, up from around 1 percent in a normal year. That figure is worth confirming against a primary source before you quote it, but even at half that, we are talking about the largest involuntary migration back to fee-for-service Medicare in the program's history. Every one of those people is a billable, manageable patient. Somebody is going to manage them. The only question is whether it's their doctor or nobody.
Let me get ahead of the objection, because I've heard it a hundred times. "We tried chronic care management. It didn't move for us."
Right. Because the codes were never the hard part. The hard part is doing the work. A 78-year-old with heart failure and diabetes needs a nurse calling her between appointments, checking her weight, catching the decompensation on a Tuesday before it becomes an ED visit on Saturday. Your physicians cannot do that inside a 12-minute office visit, and they were never trained to. Most systems don't have the staff to do it either, so the codes sit unbilled and the patients sit unmanaged and everyone concludes the program doesn't work.
The program works. The staffing model most people bolt onto it doesn't. That's a fixable problem, and it's a much cheaper one than the risk you were chasing.
Pull your panel. Find every traditional Medicare patient with two or more chronic conditions. That list is about to get materially longer as the disenrollment letters land this fall. Enroll those patients in chronic care management this quarter. Bill the codes that already exist. Don't stand up a committee. Don't wait for a shared-savings deal that may never close.
At Welby we take that operational risk off the practice. We run the care between visits, staff it, and only get paid when the billing actually works. That's our model and I'll defend it. But even if you never call us, the move is identical: own the patients coming back to you, manage the care between their visits, and get paid for work Medicare is already willing to pay for.
The payers just told you what they think your sickest patients are worth. They think it's a losing bet. They're wrong, and they handed you the patients on the way out the door. Take them.
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