Why are insurance companies like Presbyterian leaving New Mexico's Medicare Advantage market?

Insurance companies exit Medicare markets when medical costs exceed premium revenue. Presbyterian lost approximately $59 million annually on its Medicare Advantage plans — a loss that became unsustainable as healthcare costs in New Mexico rose faster than Medicare reimbursement rates. Rising hospital and drug prices, combined with New Mexico's higher rates of diabetes, heart disease, and other chronic conditions, made the business model unprofitable for carriers serving the state.

How many New Mexico seniors are affected by these plan exits?

Presbyterian alone is affecting about 30,000 Medicare Advantage members statewide, though the company is keeping its Dual Plus Special Needs Plan (D-SNP), which serves roughly 13,000 people with both Medicare and Medicaid. Other carriers (including Humana) have also announced exits. In total, dozens of thousands of New Mexico seniors will need to choose new 2027 coverage during the Annual Enrollment Period.

What are my options if my Medicare Advantage plan ends?

You have three main paths: (1) Choose a different Medicare Advantage plan if one is available in your county (enrollment data shows 29 of New Mexico's 33 counties have at least one MA plan option for 2027); (2) Switch to Original Medicare and add a Medicare Supplement (Medigap) policy plus a stand-alone Part D drug plan; or (3) If you have both Medicare and Medicaid, enroll in a D-SNP (Dual Special Needs Plan). Each option has different out-of-pocket costs, provider networks, and drug coverage.

Will I lose my doctors if my plan is discontinued?

Not necessarily. Many doctors accept Medicare patients under Original Medicare and participate in multiple Medicare Advantage networks. Before enrolling in any 2027 plan, check the plan's provider directory to confirm your doctors are in-network for the coverage you're considering. Use Medicare's Plan Finder at Medicare.gov to verify your doctors are included for each option.

What is a D-SNP and why is Presbyterian keeping only one?

A D-SNP (Dual Special Needs Plan) is a Medicare Advantage plan designed exclusively for people with both Medicare and Medicaid. D-SNPs often include extra services Medicaid members value, like dental or vision. Presbyterian determined that its Dual Plus D-SNP (serving members with both programs) was profitable enough to keep, while its standard Medicare Advantage plans were not. If you have both Medicare and Medicaid, enrolling in a D-SNP may give you more coordinated benefits than Original Medicare.

Senior couple reading an official health insurance letter at their kitchen table, looking worried about plan changes.

News & Trends

New Mexico's Medicare Advantage Market Is Shrinking: 2027 Guide

Insurance carriers are exiting New Mexico's Medicare Advantage market. Here's why, who it affects, and what to do if your plan is ending.

Brian Penner
New Mexico Medicare Help Data Desk
August 10, 2026

The bottom line:

Presbyterian is ending most Medicare Advantage plans affecting ~30,000 New Mexico members for 2027
The company loses $$59 million annually on these plans — a structural problem many carriers face
You have until December 7, 2026 to pick a new 2027 plan (AEP starts October 15, 2026)
Your options: switch to another MA plan, return to Original Medicare + Medigap, or enroll in a D-SNP if eligible
No plan changes are automatic — you must actively enroll during AEP or you'll default to Original Medicare

On this page:

Why Are Carriers Leaving?
Who Is Affected?
Market Impact by County
Your 2027 Options
What to Do Right Now
AEP Timeline

Why Are Carriers Leaving?

In June 2026, Presbyterian Healthcare Services announced it would discontinue most of its Medicare Advantage plans effective January 1, 2027. The reason: the company lost $59 million annually on these plans, making the business unsustainable.

This isn't unique to Presbyterian. Across the United States, Medicare Advantage carriers exit markets when medical costs — driven by hospitalizations, emergency room visits, and expensive drugs — exceed what Medicare reimburses them for each member. In New Mexico, this pressure is acute:

Health Challenge	New Mexico Rate	National Average	Impact
Diabetes (adults 65+)	11.6%	9.2%	Higher drug costs, more ER visits
Heart Disease	5.4%	4.8%	More cardiac procedures, hospital stays
Obesity	33.0%	29.4%	Complication rates drive costs up
Hypertension	33.5%	31.1%	Increased medication, monitoring expenses

Source: CDC PLACES 2023 (Bernalillo County, NM)

These conditions drive predictable medical spending. A Medicare Advantage member with diabetes, heart disease, and obesity may cost an insurer $15,000–$25,000 annually in care, while the carrier receives only $12,000–$14,000 from Medicare. That gap is why Presbyterian — and others — are exiting.

Who Is Affected?

Presbyterian's Exit: Approximately 30,000 Medicare Advantage members across New Mexico must choose new 2027 coverage. However, Presbyterian is keeping its Dual Plus D-SNP plan, which serves roughly 13,000 members who have both Medicare and Medicaid. If you're a Dual beneficiary on Presbyterian's D-SNP today, you can keep that plan in 2027.

Other Carriers: Humana announced in July 2026 that it would also exit certain Medicare Advantage markets, affecting hundreds of thousands of members nationwide. New Mexico counties are among the affected regions. Exact member counts for Humana in New Mexico are not yet public, but you should check your plan cancellation letter to see if you're impacted.

Geographic Spread: While New Mexico has 33 counties, only 29 currently have at least one Medicare Advantage plan available. That means seniors in smaller, rural counties have fewer MA options to begin with — and plan exits narrow those options further.

Market Impact by County

Presbyterian's service area has historically covered Bernalillo (Albuquerque), Sandoval (Rio Rancho), Santa Fe, San Juan (Farmington), and Doña Ana (Las Cruces) counties, plus surrounding rural areas. All of these counties now face reduced plan availability for 2027.

30,000

Presbyterian members losing 2027 coverage

13,000

Dual-eligible members keeping D-SNP

29/33

NM counties with at least one MA plan available

For seniors in Bernalillo County (the state's largest), multiple Medicare Advantage plans remain available for 2027 from carriers like Cigna, Bright Health, and others. But if you live in a smaller county — or if your current carrier is exiting — your options narrow significantly. That's why it's critical to check what's available in your specific county before AEP ends.

Your 2027 Options

If your current Medicare Advantage plan is being discontinued, you have three main paths:

Option 1: Switch to Another Medicare Advantage Plan

If your county has other Medicare Advantage plans available, you can enroll during AEP (Oct 15–Dec 7). Before you choose, verify that:

Your doctors are in-network for the new plan
Your current prescriptions are covered on its drug formulary
The premium, deductible, and out-of-pocket cap fit your budget

Use the Medicare Plan Finder at Medicare.gov/plan-compare to compare plans side-by-side.

Option 2: Return to Original Medicare + Medigap + Part D

When your Medicare Advantage plan ends, you qualify for a guaranteed-issue right to purchase Medigap (Medicare Supplement) coverage with no health underwriting. This means insurance companies cannot deny you or charge more based on pre-existing conditions.

In 2026, Medigap Plan G (the most popular) costs $100–$200+ per month depending on your age and the carrier. Add a stand-alone Part D drug plan (average base premium: $40–$60/month) and Original Medicare Part B ($$202.90/month in 2026). Your total monthly cost may be $300–$500 before deductibles and copays. However, Original Medicare typically costs less than Medicare Advantage if you're generally healthy with few doctor visits.

The tradeoff: no network restrictions, but higher out-of-pocket costs if you need significant care.

Option 3: Enroll in a D-SNP (If You Have Both Medicare and Medicaid)

If you qualify for both Medicare and Medicaid ("dual eligible"), you can enroll in a D-SNP. These plans coordinate benefits between the two programs and often include extras like dental, vision, or hearing that standard Medicare Advantage doesn't cover. Presbyterian is keeping its Dual Plus D-SNP, and other carriers offer D-SNPs across New Mexico.

Dual eligible seniors also get monthly enrollment windows (not just AEP), so you can switch D-SNPs each month if you need to. Learn more at Medicare.gov/SNP.

What to Do Right Now

Check your mail: Your current plan should send a "notice of discontinuation" explaining when coverage ends and your enrollment deadlines. Keep this letter handy.
Log into Medicare.gov: Use the Plan Finder to see which plans are available in your county for 2027. Filter by your doctors and prescriptions.
Confirm your doctors and drugs: Call each new plan's customer service line and verify your doctors are in-network and your medications are on the drug formulary. Don't assume.
Check if you qualify for guaranteed-issue Medigap: Your plan cancellation letter should confirm this right. If not, call Medicare at 1-800-MEDICARE to ask.
Mark your calendar for AEP: Oct 15–Dec 7, 2026. Enroll before Dec 7 or you'll default to Original Medicare on Jan 1, 2027 (and cannot switch back to MA until Jan 1, 2028).
Get free help: Call New Mexico Medicare Help at (505) 578-0376 to talk through your options. There's no charge and no obligation to enroll.

AEP Timeline for 2027 Enrollment

Oct 15, 2026: AEP begins. You can enroll in any 2027 Medicare plan.
Dec 7, 2026: AEP ends. Your new plan (or default) begins Jan 1, 2027.
Jan 1, 2027: Your 2027 plan coverage starts. If you did not enroll, you default to Original Medicare.
Jan 1, 2028: Next opportunity to switch Medicare Advantage plans (if you defaulted to Original Medicare).

Important: There is no "second chance" enrollment after Dec 7. If you miss AEP and want to switch plans in 2027, you must qualify for a Special Enrollment Period (SEP) due to a qualifying life event (moving, losing employer coverage, etc.).

Interactive tool · live data

Medicare Plan Finder

See every Medicare Advantage plan in your area, ranked from public CMS data.

Confused about your options? Schedule a free, no-pressure conversation with Brian Penner to compare your 2027 Medicare Advantage, Medigap, and D-SNP choices. New Mexico Medicare Help serves all 33 counties.

Schedule Your Free Strategy Call

Data Desk note: This post covers carrier exits and market conditions as of August 2026. Medicare Advantage enrollments, carrier decisions, and plan availability change annually. Every figure citing 2026 Plan costs or 2027 enrollment windows reflects current federal Medicare rules and CMS announcements. For the most up-to-date plan data and your county-specific options, visit Medicare.gov or call Medicare at 1-800-MEDICARE.

Frequently Asked Questions

Is New Mexico Medicare Help connected to Presbyterian or the government?

No. New Mexico Medicare Help is a licensed independent insurance agency. We are not connected with or endorsed by Presbyterian, the U.S. government, or the federal Medicare program. We're paid by the insurance carriers (not by you), and comparing your options is always free with no obligation to enroll.

Will I pay a penalty if I don't enroll by December 7?

If you miss AEP and later enroll in Part D (a drug plan), you may face a lifetime late-enrollment penalty of approximately 1% per month for each month you were without creditable coverage. Medicare Advantage enrollment doesn't have a per-month penalty, but you'll be defaulted to Original Medicare and cannot switch back to a new MA plan until the next AEP (Jan 1, 2028).

Can I keep the same doctor under a different plan?

Only if your new plan's network includes your doctor. Every plan has its own provider network. Before enrolling, check the plan's online directory or call the plan's customer service line to verify your doctors are in-network. If a key doctor is not in any available MA plan, Original Medicare + Medigap may be your best option, as every doctor who accepts Medicare will see you.

What happens to my prescriptions if I switch plans?

Each plan has its own drug formulary (list of covered medications). Before you switch, confirm your medications are on your new plan's formulary in the same tier (copay level). If your plan changes your drug's tier or removes it entirely, you have appeal rights called an "exception" — ask the new plan for the process.

Sources & Resources

Ready to Understand Your 2027 Options?

New Mexico Medicare Help is a licensed independent insurance agency serving all 33 New Mexico counties. We help you compare Medicare Advantage, Original Medicare + Medigap, and D-SNP plans — free and with no pressure.

Call (505) 578-0376 or schedule a free 15-minute strategy call to go through your 2027 choices step-by-step.

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. New Mexico Medicare Help is a licensed independent insurance agency. Not connected with or endorsed by the United States government or the federal Medicare program. This is education, not advice — confirm plans, costs, and eligibility with a licensed agent or Medicare.gov.