Presbyterian Health Plan members in New Mexico are getting two different messages about their Medicare Advantage coverage, and the timing is what matters most. Nothing changes before January 2027 — same doctors, same drug coverage, same premiums for the rest of this year. But starting with the 2027 plan year, Presbyterian is dropping most of those plans for roughly 30,000 members, a move it has tied directly to a $59 million loss on its Medicare Advantage business. For those households, the deadline that actually matters isn’t January 1 — it’s this fall’s Medicare enrollment window, when they’ll need to line up something new. It’s also a reminder that even a large, decades-old nonprofit health system isn’t immune to the financial pressure squeezing Medicare Advantage plans nationally.
2026 Coverage Holds — the Real Deadline Is This Fall’s Enrollment Period
Presbyterian has been direct with current members about what stays the same in the short term. The health plan is not changing anyone’s doctors, drug coverage or costs before the calendar turns to 2027, and it says people can keep using their benefits exactly as they do today for the rest of the year.
That stability doesn’t reset the clock on the bigger transition, though. Presbyterian confirmed in a June 5 notice to members that “there are no changes to your current coverage, provider network or prescription drug coverage at this time,” while also flagging that most Medicare Advantage plans won’t exist in 2027. Because of that, affected members will need to pick a different plan during Medicare’s Annual Enrollment Period, which runs October 15 through December 7 — the same window every Medicare enrollee already uses to review coverage for the year ahead. Anyone who lets that window close without acting risks defaulting into Original Medicare with no drug coverage attached.
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A $59 Million Medicare Advantage Loss Inside a $568 Million Hole
Presbyterian has been specific about the math behind the decision. The Medicare Advantage plans being discontinued accounted for more than $59 million in losses in 2025 alone, the health system told Healthcare Finance News, on top of what it has described as years of weak operating performance in the Medicare Advantage market.
That single-year figure sits inside a far larger financial picture. Presbyterian Healthcare Services, the nonprofit parent that runs the health plan, reported an annual operating loss of $568.2 million in a December financial disclosure, and Presbyterian Health Plan Chief Operations Officer John Johnson told New Mexico lawmakers in a June hearing that staying in the Medicare Advantage market “was financially unsustainable for us to continue as an organization.”
150 Health-Plan Jobs Cut While Presbyterian Hires 870 Clinicians
The Medicare Advantage exit comes with about 150 job cuts, but Presbyterian has drawn a sharp line around who is affected. According to Presbyterian’s statement to Becker’s, the reductions are limited to health plan and administrative roles, and direct patient care positions are untouched. At the same time, the health system says it is actively hiring for roughly 870 open clinical jobs across its hospitals and clinics — a sign that the financial strain sits inside the insurance arm, not the day-to-day care its hospitals and clinics provide. Presbyterian has not said which specific health-plan departments absorb the cuts, but it is framing the move as a business-line closure rather than a broader retreat from New Mexico health care.
The Dual Plus Plan Survives for 13,000 Dual-Eligible New Mexicans
One Medicare Advantage plan is staying put. Presbyterian will keep offering its Medicare Advantage Dual Plus Special Needs Plan, which serves about 13,000 New Mexicans who qualify for both Medicare and Medicaid. Those members, among the state’s lowest-income and highest-need retirees, will not need to shop for new coverage during the fall enrollment window. Everyone else on a standard Presbyterian Medicare Advantage plan will, and they should still expect the usual Annual Notice of Change mailing spelling out what’s ending and by when.
New Mexico Isn’t the Only State Losing Medicare Advantage Options
Presbyterian’s exit is part of a broader retreat by regional health plans from Medicare Advantage. Oregon-based Providence Health Plan recently announced it was ending most of its health insurance business beginning in 2027, citing similar financial pressure, though it says it’s working on an agreement that could let some Medicare Advantage members keep a plan next year. Not every insurer is pulling back — national carriers with more scale, including Humana and Clover Health, have reported Medicare Advantage membership growth this year — but for New Mexicans losing their Presbyterian plan, the local replacement options for 2027 may be thinner than they’ve grown used to.
What Presbyterian Says Comes Next, and When
Presbyterian has committed to a specific timeline for filling in the details members are still missing — which providers, drug formularies and costs will exist once their current plan ends. The health system says it will share information about next steps and important dates in early October, ahead of the December 7 deadline to enroll in whatever plan replaces it. For members weighing whether to wait for Presbyterian’s own replacement options or start comparing other insurers now, that October timeline is the practical trigger: plans typically publish their 2027 provider networks and drug formularies alongside their enrollment-period marketing, leaving only a few weeks to compare before the cutoff. For a nonprofit that disclosed a $568.2 million operating loss months earlier, walking away from a $59 million money-losing product line was, in Johnson’s own words to lawmakers, simply what the numbers required.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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