Hospitals Are Dropping Medicare Advantage: What to Do Next

Why Hospitals Are Dropping Medicare Advantage Plans

Hospital systems in many states have ended or scaled back their contracts with Medicare Advantage insurers, citing payment disputes and delays caused by prior authorization requirements. If your hospital or health system sent you a letter about network changes for 2027, you are not alone, and the timing is not a coincidence.

Industry coverage from outlets such as Becker's Hospital Review and KFF has documented this trend across numerous health systems nationwide, and CMS.gov publishes information on Medicare Advantage plan and network changes as well.

These disputes typically center on how much and how quickly insurers reimburse hospitals, along with frustration over claim denials. The trend has touched large academic medical centers as well as smaller regional and rural hospitals, so plan size or hospital size does not guarantee protection from a contract termination.

Reported disputes have included health systems such as BJC/WashU, Lee Health, and Kettering/Sentara clashing with insurers like Aetna, Anthem, and UnitedHealthcare, according to industry coverage from Becker's Hospital Review and KFF. Check with your own hospital and insurer directly, since specific contract disputes change frequently and vary by region.

How This Trend Could Affect Your Coverage

One confusing part of these network exits is timing. Your Medicare Advantage plan's provider directory may still list your hospital as in-network even after the contract has actually ended, because directories are not always updated the moment a change takes effect.

If you receive care at a hospital that has left your plan's network, the cost difference can be significant. Depending on your plan type, out-of-network care may come with much higher cost sharing, or in some cases no coverage at all outside of emergencies. For anyone managing an ongoing condition, a sudden network change can also disrupt care with a specialist or treatment team you have worked with for years.

HMO vs. PPO: Does Your Plan Type Change the Risk?

Your plan type changes how exposed you are to a network exit. The table below contrasts how each plan type handles cost-sharing and access when a hospital leaves the network.

• HMO plans, access: Generally require you to use in-network providers except in emergencies, so losing your hospital can mean losing access to it entirely under that plan.

• HMO plans, cost-sharing: Out-of-network care is typically not covered at all outside of emergencies.

• PPO plans, access: Allow you to see out-of-network providers, so you retain some access even if your hospital leaves the network.

• PPO plans, cost-sharing: Out-of-network care is usually covered, but at a noticeably higher copay or coinsurance than staying in-network.

How to Check if Your Hospital Is Leaving Your Plan's Network

The most reliable first step is calling your hospital's billing or patient services department and asking directly whether they plan to renew their Medicare Advantage contracts for 2026. Hospital staff who handle insurance contracts usually know about terminations well before they are widely publicized.

You can also review your plan's online provider directory, though you should treat it as a starting point rather than the final word, since directories can lag behind actual contract changes. Watch your mail for official notices from either your insurer or your hospital system, since both are generally required to inform members ahead of a network change taking effect for the new plan year.

• Call your hospital's billing or patient services department and ask directly whether they plan to renew their Medicare Advantage contracts for 2026.

• Call your insurer's member services line and ask whether your hospital is in-network as of the date your coverage would take effect.

• Review your plan's online provider directory, treating it as a starting point rather than the final word since it can lag behind actual contract changes.

• Watch your mail for official notices from your insurer or hospital system about upcoming network changes.

• Check industry coverage from outlets such as Becker's Hospital Review and KFF, as well as CMS.gov, for reports on contract disputes affecting your hospital system.

• Keep copies of any letters, emails, or notices you receive about the network change for your records.

What to Do If Your Doctors or Hospital Are Leaving Your Plan

If you confirm your hospital is leaving your plan's network, start by comparing your current Medicare Advantage plan against other Medicare Advantage plans available in your area that still include that hospital. Plan networks vary by county and by insurer, so another plan may offer the same hospital access without requiring you to change providers.

It is also worth considering Original Medicare paired with a Medigap policy, since this combination generally allows you to see any provider that accepts Medicare, which can offer more consistent long-term access to hospitals and specialists. Keep in mind that a hospital leaving your network does not trigger a guaranteed issue right for Medigap, so most people switching would need to go through medical underwriting. If you are weighing this option, review how a Medicare Supplement plan compares with your current Medicare Advantage costs and coverage.

Before switching anything, check how your prescription drug coverage would change. Formularies, the lists of covered drugs, vary between insurers, so a plan that solves your hospital access problem could still create a new issue if your medications are not covered the same way.

When You Can Make a Plan Change

For most coverage changes, you will need to wait for the Annual Enrollment Period, which runs from October 15 to December 7 each year, with changes taking effect January 1. If you are already enrolled in a Medicare Advantage plan, you also have the option to make a one-time plan change during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. A network reduction does not automatically qualify you for a Special Enrollment Period outside of these windows. Eligibility depends on specific circumstances, such as whether CMS determines the reduction significant enough to trigger one, and is not guaranteed in every case. You can review the specific qualifying criteria for Special Enrollment Periods on Medicare.gov's Special Enrollment Periods page.

Avoiding Costly Mistakes During a Network Change

Do not assume a scheduled procedure, surgery, or ongoing treatment at your hospital will be covered the same way once a contract ends. Confirm network status with both your hospital and your insurer before the date of service, since coverage decisions are based on whether the contract is active at the time care is provided, not when you originally scheduled it.

Pay close attention to enrollment deadlines so you do not end up stuck in a plan that no longer includes the hospital or specialists you rely on. It is also worth keeping copies of any letters, emails, or notices from your hospital or insurer about the network change, since these records can be useful if a billing dispute comes up later.

💡 Eddie's Pro Tip

Before you assume your plan still covers your hospital, call both your hospital's billing department and your insurer's member services line and ask the same question: is this hospital in-network as of January 1, 2027. Getting the answer from both sides helps you catch any mismatch between what the directory shows and what is actually true.

Getting Help Without the Pressure of a Sales Pitch

A licensed Medicare agent can walk through plan options with you based on your specific hospital, doctors, and prescriptions, rather than asking you to compare plans on your own from a generic list.

A trustworthy comparison should center on your medical needs and budget, not steer you toward a particular insurer for reasons unrelated to your coverage.

You are allowed to take the time you need to review your options.

Understanding your coverage fully before making a change matters more than acting quickly.

Frequently Asked Questions

Your Next Step: Confirm Your Hospital's Network Status Today

Rather than waiting until the Annual Enrollment Period is nearly over, reach out to your hospital or a licensed Medicare agent now to confirm whether your hospital's contract with your plan is changing for 2027. Getting clear, current information early gives you room to compare options without rushing a decision under deadline pressure.