Clear Spring Health Left Medicare Advantage in 2026: Where Former Members Stand and What to Do at Open Enrollment
Clear Spring Health stopped offering Medicare Advantage coverage on May 31, 2026. Members got a Special Enrollment Period that ran through July 31, 2026 to pick a new plan. Anyone who didn’t choose one was moved to Original Medicare and enrolled in the $0-premium Humana Basic Rx prescription drug plan.
That window has closed. If you were a Clear Spring member, you’re now in one of a few situations, and the big question is whether that coverage still works for you heading into 2027. The good news: Medicare Open Enrollment runs October 15 to December 7, 2026, and anyone can change plans then.
I’m a researcher, not a licensed insurance agent, and I don’t sell plans. The dates and rules below come from Clear Spring Health’s own FAQ documents, a hospital notice to Clear Spring patients, and Medicare.gov, all linked below. For advice on your situation, your free State Health Insurance Assistance Program (SHIP) is the best unbiased source.
What happened to Clear Spring Health
Clear Spring Health told agents in May 2026 that, “after careful consideration,” it had decided to exit the Medicare Advantage business. Members were notified by mail between May 6 and May 11, with phone calls starting May 6. Coverage ended on May 31, 2026. Those details are from the company’s agent FAQ, which OCi Services posted for brokers.
The exit covered every state where Clear Spring offered Medicare Advantage. In Illinois, UI Health warned its Clear Spring patients that appointments after June 1 could be canceled unless they moved to a plan the hospital accepted.
People who had just signed up for a Clear Spring plan starting between June 1 and August 1, 2026, were told their coverage would never take effect.
Earlier versions of this article cited a figure of “12,000 seniors” affected. I couldn’t confirm that number from Clear Spring, CMS or any primary source, so I’ve removed it.
The deadlines that have already passed
Three deadlines came and went over the summer. It’s worth knowing which ones, because they affect what you can do now.
| Deadline | Date | What it allowed |
|---|---|---|
| Special Enrollment Period (SEP) | June 1 to July 31, 2026 | Choose any Medicare Advantage plan, or Original Medicare with a Part D plan |
| Medigap guaranteed issue | About 63 days after coverage ended (early August 2026) | Buy certain Medigap policies with no health questions |
| Continuity of care | 90 days of active care plans | New plan honors ongoing treatment, even out of network |
The one that hurts most to miss is Medigap guaranteed issue. Under federal rules, when your Medicare Advantage plan leaves Medicare or stops serving your area, you can buy Medigap Plan A, B, D, G, K or L (and C or F if you were eligible for Medicare before 2020). The insurer can’t turn you down or charge more for health conditions. That right runs from 60 days before your coverage ends to 63 days after it ends, as Medicare.gov explains.
For Clear Spring members, that window closed in early August. After it closes, in most states a Medigap insurer can review your health history and decline you or charge more. A handful of states give extra rights, like year-round or birthday-month switching. Ask your SHIP what your state allows.
Figure out what coverage you have right now
Before you change anything, confirm what you’re enrolled in. Plenty of people aren’t sure, especially if a family member or agent handled the switch over the summer.
- Log in to your account at Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). Either will show your current health and drug plans.
- Check your wallet. You should have a red-white-and-blue Medicare card. If you joined a new plan, you’ll also have that plan’s card. If you were auto-enrolled, you’ll have a Humana Basic Rx card.
- Look at your mail since June. A new plan sends a welcome kit and, by September 30, an Annual Notice of Change for 2027.
If you did nothing: Original Medicare + Humana Basic Rx
This is the default most people worry about, but it’s not a bad spot. You have full Original Medicare: any doctor or hospital in the country that takes Medicare, no referrals, no prior authorization for most services. Part B pays 80% of approved costs after the $283 deductible in 2026.
The catch is the other 20%. Original Medicare has no out-of-pocket maximum, so without a Medigap policy, a serious hospital stay or cancer treatment can get expensive. The Part A hospital deductible alone is $1,736 per benefit period in 2026.
The Humana Basic Rx plan is a standalone Part D drug plan. It has a $0 premium in many areas, but a basic plan may not cover your specific drugs well or use your pharmacy as a preferred one. Plug your drug list into Medicare’s Plan Finder before you assume it’s the right fit for 2027.
If you joined another Medicare Advantage plan
Your plan should have mailed a 2027 Annual Notice of Change by September 30. Read it for changes to premiums, copays, drug coverage and networks. Many Medicare Advantage plans are trimming benefits and service areas for 2027, so don’t assume next year looks like this year.
If you bought a Medigap policy during the guaranteed-issue window
You did the hardest part. Medigap policies are guaranteed renewable, so the insurer can’t cancel you for health reasons as long as you pay the premium. At Open Enrollment, just shop your Part D plan.
Old claims and bills from your Clear Spring months
Clear Spring said it would keep processing claims after the exit. Its agent FAQ notes the company had “restored” its systems and was working through a backlog. If you got care before June 1, here’s what to watch:
- Keep every Explanation of Benefits and bill from January through May 2026.
- If a provider bills you for something Clear Spring should have paid, ask the provider whether the claim was submitted and denied, or just never paid.
- If a claim was denied, you still have appeal rights. My guide to appealing a Medicare denial explains the deadlines and levels.
- If you can’t get an answer, call 1-800-MEDICARE and ask to file a complaint about the plan.
How to use Open Enrollment (Oct. 15 to Dec. 7)
Open Enrollment is your reset button. Any change you make takes effect January 1, 2027. Here’s how I’d approach it as a former Clear Spring member.
1. Write down your must-haves. List every prescription with its dose, your doctors and your pharmacy. Note any treatment you expect next year, like a joint replacement or regular specialist visits.
2. Compare plans in Medicare Plan Finder. Enter your drugs and pharmacy, and sort by total estimated cost, not just the premium. My step-by-step on finding the best Medicare plan in your area walks through the tool.
3. Know the 2027 drug numbers. The standard Part D deductible rises to $700 in 2027, and the out-of-pocket cap on covered drugs rises to $2,400. My Part D 2027 guide covers what’s changing.
4. Decide between Medicare Advantage and Original Medicare. If you liked Clear Spring’s extras, like dental or a low premium, another Medicare Advantage plan may suit you. Choose a carrier with a long track record in your county. If Clear Spring’s exit shook your confidence, Original Medicare gives you the widest choice of doctors. But keep in mind that a Medigap policy may now require health questions. My comparison of Medicare Advantage vs. Original Medicare lays out the tradeoffs.
5. Check for help paying. If your income is limited, you may qualify for Extra Help with Part D costs or a Medicare Savings Program that pays your Part B premium. People with either kind of help have more chances to switch plans during the year.
Lessons from a mid-year plan shutdown
Clear Spring wasn’t the first Medicare Advantage plan to leave mid-year, and it won’t be the last. A few takeaways apply to anyone in a smaller or newer plan:
- Read every letter from your plan. Clear Spring members had only a few weeks’ notice before coverage ended.
- Know that a plan exit gives you rights. Losing your plan triggers a Special Enrollment Period and, if you act fast, a Medigap guaranteed-issue right. See my guide to Medicare Special Enrollment Periods.
- Ask the hospitals you rely on which plans they accept before you enroll.
- Call your SHIP at shiphelp.org for free, unbiased help. SHIP counselors don’t sell anything.
FAQ
Is Clear Spring Health still offering Medicare plans?
No. Clear Spring Health exited the Medicare Advantage business, and its coverage ended May 31, 2026.
What happened if I didn’t choose a new plan?
You went back to Original Medicare and were enrolled in the Humana Basic Rx prescription drug plan, which has a $0 premium in many areas.
Can I still switch plans?
Yes, during Medicare Open Enrollment, October 15 to December 7, 2026. Changes take effect January 1, 2027. People with Medicaid or Extra Help may have more chances during the year.
Can I still buy a Medigap policy without health questions?
The federal guaranteed-issue window from Clear Spring’s exit closed in early August 2026. You can still apply, but in most states the insurer can review your health. Some states have extra protections, so check with your SHIP.
Will Clear Spring still pay claims from before June 1?
Clear Spring said it would continue processing all claims. If you’re billed for care from your Clear Spring months, keep your paperwork, ask the provider about the claim’s status, and appeal any denial.
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