SCAN Health Plan expanding Medicare Advantage footprint into Washington

SCAN Health Plan will expand its Medicare Advantage footprint to a new state, offering MA plans in Washington State for the first time, and will also be broadening its presence in California and Texas.

Pending approval from the Centers for Medicare and Medicaid Services, SCAN will offer plans in Pierce, Spokane and Thurston counties in Washington; Sacramento, Placer, Yolo, San Joaquin, Kings and Tulare counties in California; and Fort Bend and Montgomery counties in Texas, beginning Jan. 1, 2026.

The move bucks a current trend of MA providers exiting certain markets. Centene said last year that it would be exiting the MA market in at least six states this year – Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont. 

Earlier this summer, UnitedHealthcare said it would exit certain MA plans, citing higher-than-expected medical costs, but stopped short of providing details of which markets would be affected. The company is taking similar approaches for its Medicare supplement, Group Medicare Advantage and standalone Part D pricing for next year

Through the expansions, SCAN said it would offer plans to nearly 9 million Medicare-eligible seniors in its new service areas, while continuing to serve more than 310,000 members in 33 counties across California, Arizona, Nevada, New Mexico, Texas and Washington.

WHAT'S THE IMPACT

Nationwide, financial pressures and shifting reimbursement rates have led many MA plans to reduce service areas or terminate offerings. KFF analysts estimate more than 1 million seniors may need to seek new coverage, and up to 1.8 million could be affected by plan closures or consolidations.

Zack Myers, national general manager at SCAN Health Plan, said Medicare Advantage works best when it's rooted in community.

"We are entering these new markets with partners who share our values and our commitment to ensuring seniors have access to care that listens to them, meets their needs and honors their life experience," said Myers. "This includes addressing health disparities and creating benefit designs that meet the cultural and social needs of the people we serve."

Other recent efforts from SCAN include a collaboration with Sutter Health to expand coordinated care across Northern California, as well as the opening of SCAN Central, the organization's first storefront in Henderson, Nevada. The storefront is designed to give seniors direct access to in-person guidance, enrollment support and community engagement.

"This is more than a geographic expansion; it's a reaffirmation of our mission to meet the needs of seniors at every stage of their aging journey," said Karen Schulte, president of Medicare at SCAN Health Plan.

THE LARGER TREND

A March report from Chartis and Healthscape Advisors showed decelerating growth for Medicare Advantage plans. Analysts said the market is undergoing a period of correction, following rapid growth in the early 2020s.

The Medicare Advantage market grew by 1.3 million beneficiaries, or 3.9%, in 2024. This is down from 7% growth in 2023 and 9.4% in 2022. 

Recent headwinds confronting MA plans include declining payment rates, medical cost pressures, regulatory burden and less favorable star ratings.

Several plans exited the market, including Premera and Blue Cross Blue Shield Kansas City, and others reduced their service areas, such as Aetna and Humana, according to the report. Prior to the annual enrollment period, many for-profit health plans signaled their intent to slow growth or even contract membership due to the pressures. This has resulted in a flattening of MA plans available nationally, the Chartis report said.

For-profit insurers control nearly three-quarters of the Medicare Advantage market. Meanwhile, Blues, nonprofit and provider-sponsored health plans continue to see marginal market share erosion, despite notching overall enrollment growth, the report said.