Samaritan Health Plans has announced it will exit the stand-alone Medicare Advantage market in 2026, affecting nearly 14,000 members across Oregon.
It will continue to serve dual-eligible beneficiaries through its D-SNP offering.
The Oregon-based insurer joins a growing list of major carriers scaling back Medicare Advantage coverage. UnitedHealthcare, Aetna, and others have also announced exits in 2026, affecting hundreds of thousands of members nationwide.
Here’s what you need to know.
What’s Happening
Samaritan Health Plans will exit the Medicare Advantage market for 2026, discontinuing three major plans:
- Samaritan Advantage Premier
- Samaritan Advantage Premier Plus
- Samaritan Advantage Valor
This decision affects approximately 13,881 Medicare Advantage members across Lincoln, Benton, and Linn counties in Oregon, including 4,964 members in Lincoln County alone.
The company will continue offering its D-SNP plan for dual-eligible beneficiaries (those with both Medicare and Medicaid).
Bruce Butler, CEO of Samaritan Health Plans, explained the decision:
“This was not made lightly, and it is disheartening, to say the least, but we simply cannot continue to offer these plans at a loss.”
Why the Exit?
This decision comes at a time of significant financial pressure on Medicare Advantage insurers, driven by rising healthcare costs and insufficient reimbursement rates from the government, which have not kept pace with member utilization.
Here are the general factors at play:
- Member Utilization Outpacing Revenue: Steady increases in how much members use their plan benefits continue to outpace premium revenue, including payments from CMS to administer the plans.
- Rising Care Costs: Healthcare costs are increasing faster than reimbursement rates, making it impossible to break even while maintaining competitive premiums.
- Provider Payment Pressures: Reimbursing healthcare providers at rates comparable to traditional Medicare has become increasingly challenging.
- Changing Member Health Profiles: Changes in the demographics and health conditions of enrollees require higher levels of care, further straining finances.
What Are Medicare Advantage Plans?
Medicare Advantage plans (also called Medicare Part C) are an alternative way to get Medicare benefits through private insurance companies approved by Medicare.
Instead of having Original Medicare (Parts A and B) plus a separate prescription drug plan, Medicare Advantage plans often bundle everything together into one plan.
These plans may include:
- Hospital coverage (Part A)
- Medical coverage (Part B)
- Prescription drug coverage (Part D)
- Additional benefits like dental, vision, or hearing aids
Samaritan’s Advantage plans were particularly popular because they included vision and dental coverage, plus a benefits card that accumulated funds for out-of-pocket medical costs and over-the-counter purchases.
The key difference is that with Medicare Advantage, you’re getting your Medicare benefits through a private insurance company rather than directly through the government.
Need Help With Medicare?
If you have any questions about this situation (or Medicare in general), our licensed insurance agents are standing by.
Simply call us at +1 877-360-6565 (TTY: 771) or click the button below to schedule an appointment.