Health Systems Ending Medicare Advantage Plans in January

Several large health systems have decided to stop offering Medicare Advantage plans starting next year.

This shift comes as seniors face rising premiums, with hospitals no longer accepting MA plans due to issues like prior authorization denials and slow payment processes.

Why is it important

Approximately half of Americans on Medicare opt for Medicare Advantage plans. These plans typically provide bundled services and lower out-of-pocket expenses but can create challenges, such as limited access to in-network doctors or the need for prior authorization for treatments.

What you need to know

According to Becker’s Hospital Review, 15 health systems intend to discontinue Medicare Advantage plans by 2026.

Here’s the list:

1. MultiCare in Tacoma, Washington, will terminate its contract with MA PPO plans in 2026.
2. Mayo Clinic will no longer be in-network with most MA plans from UnitedHealthcare and Humana.
3. Providence Clinical Network is withdrawing UnitedHealthcare’s MA for 15 hospitals in California.
4. Mount Sinai in New York City will be out of Anthem MA’s network in 2026.
5. UNC Health has suspended its acceptance of Humana, WellCare (Centene), and Health Care Service Corp. (formerly Cigna) MA plans next year.
6. Lehigh Valley Health Network will drop UnitedHealthcare MA starting January 25th.
7. TriHealth in Cincinnati plans to stop UnitedHealthcare MA in 2026.
8. Centra Health will end its network with Humana MA next year.
9. Most primary care providers at Massachusetts General Brigham will no longer participate in UnitedHealthcare or BCBS Massachusetts MA Plans.
10. St. Luke’s Health System will withdraw from Humana MA in 2026.
11. Montrose Regional Health will exit Humana MA’s network in 2026.
12. Kettering Health has cancelled contracts with Humana and Devoted Health MA for next year.
13. Iowa Specialty Hospitals and Clinics will not accept most MA plans in 2026, except for Aetna, Medigold, UnitedHealthcare, and Wellmark BCBS.
14. White River Health in Arkansas will no longer be affiliated with Aetna MA starting January 31st.
15. South County Hospital in Rhode Island is set to eliminate Aetna MA in 2026.

Chris Fung, a Medicare expert and CEO of Smile Insurance, noted that this trend indicates a struggle between medical groups and insurance companies. He pointed out that the reasons for discontinuation could range from negotiating lower service rates to dissatisfaction with Medicare Advantage constraints. Whatever the cause, it’s ultimately the patients who face the brunt of these changes.

He emphasized the financial burdens hospitals face, with MA plans reimbursing rural facilities at just 90% of traditional Medicare rates. There’s also the significant challenge of prior authorization denials, which are often overturned on appeal. Michael Ryan, a financial expert, echoed this concern, mentioning that many necessary claims get denied initially, causing delays and complexities that can impact patient care.

He further highlighted the dilemma for patients: opting for Medicare Advantage for added benefits like dental and gym memberships only to find that key providers, like Mayo Clinic, are out of network. That means having to either travel far for care or pay out of pocket, which feels like a major letdown.

People’s opinions

Fung remarked that beneficiaries may need to verify their health care providers each enrollment period to ensure they’re still accepted under their plans. If beneficiaries find themselves in this situation, they might be able to make further changes during the Medicare Advantage open enrollment period from January to March.

Alex Bean, a financial literacy instructor at the University of Tennessee at Martin, expressed concerns about the discontinuation of support from hospitals for Medicare Advantage plans, noting that this growing trend reflects systemic issues with the program’s profitability and effectiveness.

Ryan raised a critical point, questioning why insurance companies that heavily advertise Medicare Advantage can’t afford to pay hospitals adequately. This raises important questions about who actually benefits from these plans.

Kevin Thompson, CEO of 9i Capital Group, pointed out that these changes significantly impact beneficiaries. With many seniors enrolled in Medicare Advantage, the withdrawal of providers leads to fewer choices, longer travel times, and potential obstacles to accessing care, especially for those with pre-existing conditions.

What happens next

With so many Medicare Advantage plans being terminated, Bean stated that patients will likely bear the consequences.

He added that Medicare Advantage enrollees are facing challenges as they must seek new healthcare facilities, making the current landscape quite difficult for many.