Park Ridge-based Clear Spring Health is backing out of the Medicare Advantage business and will end coverage for its remaining plans on May 31, 2026. The move will force thousands of beneficiaries to pick new coverage before the June plan year, with CMS enrollment files and trade reporting indicating the carrier had roughly 12,000 Medicare Advantage members as of April. Clear Spring says benefits remain active through the end of May and that it will help members through the transition.
Members told coverage remains active through May 31
Clear Spring’s site says members will receive mailed notices and phone support and that “Your benefits remain in full effect through May 31, 2026,” according to Clear Spring Health's website. Trade coverage reports that the plan began outreach this week and that CMS enrollment files showed more than 12,000 enrollees as of April, which means many members will need to find replacement plans or return to traditional Medicare. As reported by Becker's, Clear Spring told brokers that claims will be processed through May 31 and that member calls were already underway.
CMS penalty found system errors that overcharged members
Federal auditors found systemwide claims-configuration failures that led to incorrect payment rates and to some enrollees being charged more than the annual maximum out-of-pocket limit. According to a notice from CMS issued May 1, those findings prompted a civil money penalty of $84,190 against Group 1001, the holding company that oversees Clear Spring’s contracts. Group1001 identifies Clear Spring Health as one of its affiliates, per the company’s corporate materials.
Regulatory history points to persistent problems
This is not the first time regulators have stepped in. In October 2023, CMS moved to terminate a Clear Spring Part D contract after determining the plan had “failed to achieve a Part D summary plan rating of at least three stars for three consecutive years,” according to a separate CMS enforcement notice. That 2023 action came with intermediate sanctions such as suspension of enrollment and marketing for the drug plan, highlighting recurring administrative and performance shortfalls. The new penalty and the decision to exit Medicare Advantage land on top of that enforcement history and growing regulatory scrutiny.
What this means for members and the market
For local members, the impact is immediate: when a small regional carrier exits Medicare Advantage, beneficiaries often have to scramble for alternatives. Researchers estimate roughly 2.9 million Medicare Advantage enrollees nationwide could be forced to find new plans in 2026 as insurers pare back offerings, and small plans are disproportionately affected, according to analysis from the Johns Hopkins Bloomberg School of Public Health. Clear Spring directs members to its MAPD line at (877) 364-4566 and to mailed notices for next steps, and beneficiaries can also consult their State Health Insurance Assistance Program or Medicare.gov to weigh plan options.
Legal implications
CMS’s enforcement documents state that additional remedies are available if problems continue, including “contract termination, intermediate sanctions, penalties, or other enforcement actions,” language that raises the stakes for Group1001 as it works through the wind-down. The company has a procedural window to appeal the civil money penalty, but regulators note that future missteps could trigger stronger contract-level consequences.
Clear Spring says it will call members, provide plan documents, and offer customer support during the transition; see Clear Spring Health's website for plan materials and contact details. Members needing help can also visit Medicare.gov or contact their state SHIP office for enrollment assistance and to learn about special enrollment rules.
