Health plans and New York delegation call on Congress to protect older adults in upstate New York

Several not-for-profit health plans are calling on Congress to protect older adults in upstate New York. Univera Healthcare, CDPHP and MVP Health Care have come together to urge elected officials to pass bipartisan legislation that will protect Medicare Advantage benefits and access to care for hundreds of thousands of members.

Without relief, nearly 450,000 Medicare Advantage members in upstate New York may face increased premiums, higher out-of-pocket costs, and fewer choices as health plans battle the financial effects of unprecedented changes to the Medicare wage index.

“We remain grateful for the support and leadership of those in Congress who continue to fight for older adults in our communities,” said Jim Reed, president and CEO of the Rochester-based health plan that does business in Western New York as Univera Healthcare. “We have faith that New York’s congressional delegation will find a solution to avoid catastrophic consequences for nearly 450,000 Medicare Advantage members with not-for-profit health plans in upstate New York.”

What’s at stake?

A 2023 change in how the federal government sets hospital reimbursement rates for Medicare has resulted in significant financial losses for not-for-profit health plans in upstate New York.

Changes to the Medicare wage index resulted in $1 billion in new federal funding for upstate New York hospitals. However, the federal government did not give health plans a corresponding premium increase, leaving the not-for-profit plans to absorb hundreds of millions of dollars in losses. The plans cannot sustain these growing losses, especially as they also struggle with the escalating costs of health care.

“We applaud the Trump administration and leaders at CMS for acknowledging the rising cost of care in the 2026 Medicare Advantage Rate Notice released on Monday,” said Brian O’Grady, president and CEO of CDPHP. “While the rate notice included more funding to help health plans with the rising costs of care, it did not address the financial shortfalls caused by changes to the Medicare wage index.

“Our local, not-for-profit plans will continue to battle the effects of the wage index, which has left the future of our great health plan – and the 75,000 older adults who entrust us with their care – in jeopardy.”

About the reintroduced legislation

Last May, Congresswoman Claudia Tenney (NY-24), alongside several members of Congress, introduced bipartisan legislation to strengthen Medicare Advantage plans in upstate New York.

Since Congress did not act on this legislation or a broader package of health care policies before the end of the previous Congress in December 2024, the legislation is being reintroduced by Rep Tenney as well as Congressman Tim Kennedy (NY-26), Congressman Nick Langworthy (NY-23), Congressman Mike Lawler (NY-17), Congressman John Mannion (NY-22), Congressman Joe Morelle (NY-25), Congressman Josh Riley (NY-19), Congresswoman Elise Stefanik (NY-21) and Congressman Paul Tonko (NY-20).

Additionally, Congresswoman Tenney and members of the upstate New York delegation have co-signed a letter to the Centers for Medicare and Medicaid Services (CMS) asking it to make this correction using its existing statutory authority.

The legislation would adjust the amounts reimbursed to health plans to ensure regional, not-for-profit Medicare Advantage plans remain viable and members maintain access to robust benefits and access to quality care.

"We thank Congresswoman Tenney and our bipartisan Congressional delegation for supporting this imperative legislation,” said Chris Del Vecchio, CEO of MVP Health Care. “This bill will authorize CMS to make a region-specific Medicare adjustment to level the playing field for local, not-for-profit, community-based plans. It will ensure that MVP can continue to innovate with our community provider partners and provide critical benefits to our Medicare members."