Concerns for Medicare Advantage Beneficiaries This Fall
Thousands of individuals enrolled in Medicare Advantage are currently facing a significant decision. Should they opt for a new plan or risk losing access to their preferred healthcare providers?
As the Open Enrollment Period for 2026 approaches—running from October 15 to December 7—many seniors are now aware that choosing a plan involves more than just considering premiums and benefits. A pressing concern is whether their current doctors and hospitals will remain in-network.
For many years, the private insurance companies managing Medicare benefits have negotiated quietly with healthcare providers. However, recent developments have brought these tensions to light, prompting patients to weigh the importance of network stability against the allure of benefits and lower costs.
“Historically, such disputes were mainly seen in employer-sponsored insurance,” explained Paul Ginsburg, a health policy professor at the University of Southern California. “What’s changed is that these conflicts are now impacting Medicare Advantage plans, which is quite upsetting for many people.”
For those caught between these negotiations, the fallout can be significant. With rising medical costs already straining many Americans, some may be forced to change doctors, switch insurance plans, or face higher out-of-network expenses, as Ginsburg highlighted.
In Oregon, a notable case involved the Oregon Health & Science University nearly ending its contract with UnitedHealthcare due to reimbursement disagreements. Had this occurred, over 61,400 members relying on Medicare Advantage would have lost in-network access to OHSU facilities.
Ultimately, both parties chose to remain within the network, but only after a public disagreement involving direct mail campaigns and advertisements.
This situation isn’t unique. Nationwide, an increasing number of healthcare systems are disengaging from Medicare Advantage agreements. In fact, 28 health systems canceled their Medicare Advantage contracts in the first half of 2025 alone, according to some reports.
Experts warn that these conflicts could signal more contract cancellations ahead, as hospitals and large physician groups pursue higher reimbursement rates to combat inflation and rising costs for medical supplies and labor.
At OHSU, leaders indicated that securing better reimbursement from private insurers is a vital strategy for enhancing the hospital’s financial situation. Dr. Shareef Elnahar, the new president, mentioned that they successfully negotiated improved rates with UnitedHealthcare and are currently negotiating with Regence Blue Cross Blue Shield and Kaiser Permanente.
Ginsburg, a former vice chair of the Medicare Payment Advisory Commission, noted that growing pressure on providers and heightened demands from health systems are complicating matters. He suggested that more providers might need to reconsider their participation in Medicare Advantage.
These ongoing conflicts are making healthcare access for older adults increasingly unpredictable. It’s challenging to forecast potential disputes when beneficiaries are selecting a plan during the enrollment period.
Currently, most Medicare Advantage members can only switch plans during the annual open enrollment window. If a provider exits a plan’s network mid-year, it doesn’t automatically initiate a special enrollment opportunity. Although the Centers for Medicare and Medicaid Services allows some exceptions for those losing access to critical care providers, these instances are limited.
This enrollment period, some Medicare Advantage beneficiaries might contemplate shifting to traditional Medicare, which typically provides broader access to providers and fewer authorization hurdles.
However, traditional Medicare lacks an out-of-pocket maximum, leading many to rely on supplementary Medigap insurance to help cover costs.
For those transitioning from an Advantage plan to traditional Medicare, obtaining this supplemental coverage can be challenging or even impossible. Medigap insurers may deny applications based on pre-existing conditions—like diabetes or heart disease—or impose higher premiums.
Ginsburg explained that senior citizens typically get one chance to purchase Medigap without medical underwriting when they initially enroll in Medicare. In most states, except for a few like Connecticut, Massachusetts, Maine, and New York, access to Medigap is not guaranteed after this initial window.
