Sentara Health Plans has announced it will no longer offer Medicare Advantage (MA), MA prescription drug HMO, or Chronic Condition Special Needs Plans (C-SNP) in Virginia, North Carolina, and Florida in 2026, impacting approximately 28,961 members statewide.
The company will also lay off about 220 employees as part of the move.
Here’s what you need to know.
What’s Happening?
Humana continues to face financial pressures in the Medicare Advantage market, Sentara Health Plans will exit several Medicare Advantage markets starting in 2026. The Hampton Roads, Virginia-based insurer said the change will affect 28,961 health insurance members statewide, including 18,097 members in the Greater Hampton Roads region.
If you are enrolled in one of the affected plans, coverage will end December 31, 2025. Members will need to pick new coverage during Medicare’s Annual Enrollment Period (AEP), which runs from October 15th to December 7th.
As part of the shift, Sentara will cut about 220 jobs, including 127 positions in Virginia and 80 at its AvMed subsidiary in Florida.
Why It Matters
Sentara’s exit reflects the growing financial pressure on Medicare Advantage insurers nationwide. The company joins a growing list of insurers scaling back coverage, including UnitedHealthcare, Humana, Samaritan Health Plans, and UCare.
The company cited unsustainable operating conditions driven by:
- Industry-wide headwinds including reduced reimbursement rates from the federal government
- Regulatory changes that have made these products financially unviable
- Rising healthcare costs that outpace payment rates
“These products are no longer financially sustainable in the current environment. Industry-wide headwinds and market dynamics, including reimbursement trends and regulatory changes, are leading many insurers to reassess their participation in Medicare Advantage,” a Sentara spokesperson said.
The decision was made following an extensive review and aligns with the company’s commitment to operational excellence and financial stability.
What Are Medicare Advantage Plans?
Medicare Advantage (also called Medicare Part C) plans are an alternative to Original Medicare, offered by private insurers approved by Medicare. These plans often bundle:
- Hospital coverage (Part A)
- Medical coverage (Part B)
- Prescription drug coverage (Part D)
- Potential additional benefits such as dental, vision, or hearing
With Medicare Advantage, your coverage is administered by a private insurer rather than directly through the government. These companies receive payments from Medicare to provide your benefits.
It’s important to know that most Medicare Advantage plans operate with networks of doctors and hospitals, and some may require referrals to see specialists. However, they can offer lower monthly premiums and additional benefits that Original Medicare doesn’t include.
Medicare Advantage has grown significantly in popularity, with over 32 million beneficiaries enrolled in 2024, making up roughly 54% of all Medicare participants.
What Sentara Health Plans Will Continue Offering
Sentara will remain active in other markets, including:
- Dual-eligible Special Needs Plans (D-SNP) for members with both Medicare and Medicaid
- Employer-sponsored plans
- Individual and family plans
- Medicaid lines of business
Important: This change does not affect which insurance plans are accepted at Sentara Health hospitals and medical facilities.
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