For millions of seniors, choosing a Medicare Advantage plan has often focused on premiums, prescription coverage, dental and vision benefits, and other advertised extras. But there is another question that may be becoming even more important:
Will your doctors and hospitals still accept your Medicare Advantage plan next year?
Across the country, a growing number of hospitals and health systems have ended, or announced plans to end, participation in certain Medicare Advantage networks. Some of the changes involve major regional health systems, academic medical centers, and specialty providers.
For seniors and their families, the message is simple: Do not assume that the Medicare Advantage plan that worked for you this year will provide the same access to your doctors and hospitals next year.
Hospitals Across the Country Are Leaving Medicare Advantage Networks
Recent and announced network changes affect Medicare Advantage plans offered by some of the nation’s largest insurers.
For example, Genesis Healthcare System in Ohio has announced that its Medicare Advantage contracts with Aetna, UnitedHealthcare, Medical Mutual and CareSource will terminate at the end of 2026 unless new agreements can be reached.
Other announced or recent changes around the country involve major providers such as Ohio State University Wexner Medical Center, Mayo Clinic, NewYork-Presbyterian, Mount Sinai, UNC Health, Moffitt Cancer Center, Mass General Brigham, Lee Health, Sentara Health and numerous regional health systems.
Some disputes may still be resolved before their announced termination dates. Others have already resulted in providers leaving particular Medicare Advantage networks. The larger trend, however, deserves the attention of every Medicare beneficiary.
Medicare Advantage Is Not the Same as Original Medicare
With Original Medicare, a beneficiary generally may receive covered care from any doctor or hospital in the United States that accepts Medicare.
Medicare Advantage works differently. Medicare Advantage plans are offered by private insurance companies approved by Medicare. Many operate with provider networks. Depending upon the type of plan, receiving care outside that network can result in higher costs or, in some circumstances, no plan coverage for the service.
Medicare Advantage plans are required to maintain networks sufficient to provide adequate access to covered services. But that does not mean that every hospital or physician a beneficiary wants to use must participate in the plan.
Networks can, and do, change.
Imagine Finding Out Your Hospital Is No Longer In-Network
Consider a 74-year-old Medicare beneficiary who has seen the same cardiologist for years.
Her cardiologist practices through the hospital system where she has received most of her medical care. She is comfortable with her physicians, they know her history, and all of her records are within the same health system. She renews the same Medicare Advantage plan she had last year without reviewing its provider network.
Several months later, she learns that the hospital system and her Medicare Advantage carrier are no longer under contract. She may suddenly have to choose between changing doctors, changing where she receives treatment, or potentially facing substantial out-of-network expenses depending upon her plan.
For someone dealing with cancer, heart disease, neurological conditions, or another serious illness, changing an established medical team can be much more significant than simply finding another doctor’s office.
Medicare Open Enrollment Is the Time to Investigate
Medicare’s annual Open Enrollment Period runs from October 15 through December 7. Coverage changes made during this period generally take effect January 1.
During Open Enrollment, Medicare beneficiaries can switch Medicare Advantage plans, move from Medicare Advantage back to Original Medicare, or make other permitted changes to their Medicare health and prescription drug coverage.
Before automatically renewing a Medicare Advantage plan for 2027, beneficiaries should ask:
- Are my primary-care physician and specialists still in the plan’s network for 2027?
- Is my preferred hospital still in-network?
- Are the specialists and facilities I would likely use associated with that hospital also participating?
- Are my prescriptions still covered by the plan’s formulary, and have their coverage tiers changed?
- Have the plan’s premiums, deductibles, copayments or maximum out-of-pocket costs changed?
- If I am receiving ongoing treatment, could a network change disrupt that care?
Do not rely solely upon what was true in 2026. Verify the network for the coverage year you are selecting. Be Careful Before Dropping Medicare Advantage for Original Medicare as there is another important consideration.
A beneficiary may decide that Original Medicare provides greater flexibility because of its broad provider access. But Original Medicare does not have the same out-of-pocket structure as Medicare Advantage, and many beneficiaries pair Original Medicare with a Medicare Supplement (Medigap) policy.
Do not assume that you can leave Medicare Advantage and automatically obtain the Medigap policy you want. Depending upon your circumstances and state law, you may not have guaranteed-issue rights and could be subject to medical underwriting when applying for certain Medigap coverage. That means the decision to leave Medicare Advantage should be made carefully and, preferably, before cancelling existing coverage.
What If Your Doctor or Hospital Leaves During the Year?
Network changes can also occur after the coverage year begins.
Medicare Advantage plans remain subject to federal network-adequacy, notice, access and continuity-of-care requirements. Depending upon the circumstances, beneficiaries affected by provider-network changes may have additional protections or enrollment options.
Do not simply assume that you have no alternatives because you received a letter saying your doctor or hospital will no longer participate. Contact the plan, Medicare, or a qualified Medicare counselor and determine what rights and options apply to your particular situation.
Your Health Care Providers Should Be Part of Your Medicare Decision
For seniors, health insurance is about much more than the monthly premium.
A plan offering attractive supplemental benefits may not be the right plan for you if it separates you from the physicians, hospitals, cancer center, rehabilitation facility, or specialists upon whom you rely.
Before selecting or renewing a Medicare Advantage plan for 2027, make a list of the providers that matter to you and verify each one.
And don’t ask only:
“Do you accept Medicare?”
Ask:
“Will you be in-network with my specific Medicare Advantage plan in 2027?”
Those are two very different questions.
As Medicare Advantage networks continue to change, taking the time to investigate before Open Enrollment ends can help avoid an unpleasant, and potentially very expensive, surprise when medical care is needed most.
The Woods Law Office PLLC
Elder Law • Estate Planning • Medicaid & Long-Term Care Planning • Probate & Trust Administration
This article is provided for general informational purposes only and is not intended as legal, tax, insurance, or financial advice. Medicare Advantage contracts and provider networks can change, and announced contract terminations may be resolved through subsequent negotiations. Medicare beneficiaries should confirm current provider participation directly with their health care providers and insurance plans before making coverage decisions.
