If you are a Medicare beneficiary in Illinois, Georgia, or Colorado, you need to check your mail, and your insurance card, immediately.
Clear Spring Health has officially announced its complete exit from the Medicare Advantage market in these three states. This isn’t a “next year” problem; it is happening right now. Coverage for every single enrolled member will officially end at midnight on May 31, 2026.
At Total Benefit Solutions Inc, we know how stressful it is to hear that your health coverage is vanishing mid-year. As your health insurance advocates, we are here to ensure you don’t fall through the cracks of this transition. You have less than three weeks to secure new coverage before you revert to Original Medicare and lose the extra benefits you’ve come to rely on.
What Happened? The Clear Spring Health Exit Explained
Clear Spring Health, headquartered in Park Ridge, Illinois, has struggled with regulatory compliance and star ratings for several years. Recently, the Centers for Medicare & Medicaid Services (CMS) (the federal agency that runs Medicare) fined the parent company, Group 1001, for multiple violations, including overcharging members and failing to track out-of-pocket maximums correctly.
Following these challenges, Clear Spring Health decided to shut down all remaining Medicare Advantage Prescription Drug (MAPD) plans in Illinois, Georgia, and Colorado. While this move might help the company’s bottom line, it leaves thousands of seniors in a lurch.
Who is Affected by This Exit?
This market exit affects two specific groups of people:
- Current Members: Anyone currently using a Clear Spring Health Medicare Advantage plan in IL, GA, or CO. Your coverage ends May 31, 2026.
- Pending Members: If you recently signed up for a plan that was supposed to start between June 1 and August 1, 2026, those enrollments are now void. You will not have the coverage you were expecting.
If you fall into either of these categories, you are currently facing a “coverage cliff.” Without taking proactive steps, you will be automatically moved back to Original Medicare (Part A and Part B) on June 1st.
The Real Risk: What You Stand to Lose
Many people assume that reverting to Original Medicare is “fine,” but for most, it creates a massive financial and medical gap. Medicare Advantage plans (also called Part C) are popular because they bundle services that the government doesn’t cover.
If you default back to Original Medicare on June 1st, you will likely lose:
- Prescription Drug Coverage (Part D): Original Medicare does not include a drug plan. You would have to purchase a standalone Part D plan separately or risk paying full price at the pharmacy.
- Dental, Vision, and Hearing: These “extras” are not part of the standard government program.
- Out-of-Pocket Maximums: Original Medicare has no cap on what you might pay in a year. Medicare Advantage plans legally must have a limit on your financial exposure.
- Transportation and Wellness Benefits: Any gym memberships or transportation to doctor appointments will vanish.
Meet Dr. Ben E. Fitz: Your Special Enrollment Guide
Navigating these rules can feel like learning a foreign language. That’s why we’ve brought in our resident expert, Dr. Ben E. Fitz, to explain the “silver lining” in this situation.
“Hello there!” says Dr. Ben E. Fitz. “I know the word ‘exit’ sounds scary, but in the world of Medicare, it actually opens a special door for you. Because Clear Spring Health is leaving the market, you have been granted what we call a Special Enrollment Period (SEP).”
“An SEP is a designated window of time where you are allowed to change your plan outside of the usual fall Open Enrollment season. Usually, you’re ‘locked in’ to your plan for the year, but because your carrier left you, the government gives you a ‘get out of jail free’ card. You can choose a new Medicare Advantage plan or a Medicare Supplement plan with a standalone drug plan, and you won’t be penalized for making the switch!”
“The most important thing to remember,” Dr. Ben E. Fitz adds, “is that you need to act before June 1st to ensure you don’t have a single day without coverage. We are here to make that transition seamless.”
Why You Need an Advocate Right Now
When a carrier exits, they often send out confusing letters or automated phone calls. They might give you a generic 1-800 number to call, where you’ll wait on hold for hours only to speak with someone who doesn’t know your local doctors or your specific prescriptions.
At Total Benefit Solutions Inc (www.totalbenefits.net), we do things differently. We are independent advocates and consultants. We don’t work for Clear Spring, and we don’t work for the government. We work for you.
Our “Never Accept No” philosophy means we don’t just look for the easiest replacement plan; we look for the right one. We shop around across all major carriers in Illinois, Georgia, and Colorado to find a plan that:
- Includes your current doctors and specialists.
- Covers your specific list of medications at the lowest cost.
- Protects your dental and vision benefits.
Step-by-Step: What to Do Before June 1st
Time is your most valuable asset right now. Follow these steps to protect your health and your wallet:
1. Locate Your Current Medication List
Write down every prescription you take, including the dosage and frequency. We will need this to ensure your new plan covers your drugs without interruption.
2. List Your Doctors
Make a list of every physician, specialist, and hospital you use. We will cross-reference this list with available plans in your county to keep your care team intact.
3. Don’t Wait for the “Official” Call
Clear Spring started making calls on May 6th, but they have thousands of members to reach. If you wait for them to call you, you might only have days left to make a decision. Call us today so we can start the comparison process immediately.
4. Understand the “Guarantee Issue” Right
In many cases, an involuntary loss of coverage (like this one) gives you a “Guarantee Issue” right for a Medicare Supplement (Medigap) plan. This means a private insurer cannot turn you down for coverage or charge you more because of pre-existing conditions. This is a rare and valuable opportunity to upgrade your coverage.
Our Commitment to Your Health
At Total Benefit Solutions Inc, we specialize in helping individuals navigate the complex maze of health insurance regulations. We understand the state and federal grants, the foundational loans, and the “red tape” that often stops people from getting the benefits they deserve.
We act as the intermediary between you and the massive insurance bureaucracy. If an insurance company tries to deny a claim or a transition, we fight back. We are advocates in the truest sense of the word.
Contact Us Immediately
The deadline of May 31st is approaching fast. Don’t risk waking up on June 1st to find out your prescriptions aren’t covered or your favorite doctor is suddenly “out of network.”
Let us handle the paperwork and the comparisons for you. We provide personalized advocacy and consulting to ensure you never have to navigate the healthcare system alone.
Total Benefit Solutions Inc
Website: www.totalbenefits.net
Phone: (215) 355-2121
Email: info@totalbenefits.net
We work for your benefit. We never accept “no” for an answer when it comes to your rights.
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Disclaimer: Total Benefit Solutions Inc is an independent insurance agency and is not affiliated with or endorsed by the government or the federal Medicare program. We are advocates helping you navigate your options.