Insurers Leaving Medicare Advantage Market

In Missouri, NKC Health went out of network with UnitedHealthcare MA plans on Oct. 1. Preferred provider organization members may have benefits, while HMO point-of-service members typically do not and could owe the entire bill.

Insurers Leaving Medicare Advantage Market

Lehigh Valley Health Network is out of network with UnitedHealthcare MA since January. In Michigan, Blue Cross Blue Shield of Michigan is pulling MA plans with drug coverage out of Iowa, North Dakota and South Dakota.

Humana MA plans are affected in the Upper Peninsula, where UP Health System will be out of network after 2026. In Wisconsin, Aspirus Health Plan is leaving the market after CMS suspended its new enrollment in February.

Medicare Advantage Changes: A Guide for Medical Practices

The environment of Medicare Advantage plans is undergoing significant changes, leaving medical practices with a narrow window to adapt. With open enrollment for 2027 coverage set to conclude on December 7, providers have only a few weeks to identify affected patients and ensure seamless care continuity. A recent analysis has revealed substantial exits from the market, including Blue Cross and Blue Shield of Texas, which will no longer offer Medicare Advantage plans after 2026, having previously covered 227 Texas counties.

In Florida, several major healthcare systems, including Lee Health, Sarasota Memorial, and AdventHealth, are at risk of being out-of-network with UnitedHealthcare as of January 1, unless agreements are reached. On a national scale, major insurers such as UnitedHealth Group, Humana, Health Care Service Corp., and Centene are leaving numerous counties, affecting hundreds of thousands of enrollees.

Steps Practices Should Take Now

In several states, including Illinois, Michigan, Wisconsin, Missouri, Pennsylvania, and Indiana, practices will face smaller but still significant changes, necessitating adjustments to their front desk operations and referral processes. To handle these changes, practices can follow a series of steps, beginning with identifying affected patients. This critical first step involves generating a report from the practice management system, sorted by plan, and then matching it against the exits and network changes in the state.

Patients whose plans are ending or will no longer cover the practice or its referred specialists must be flagged and contacted promptly. Practices should inform these patients about the plans they will accept in 2027 and direct them to resources such as the Medicare Plan Finder, 1-800-MEDICARE, or their State Health Insurance Assistance Program for guidance on comparing options.

Another key step is re-verifying every Medicare Advantage patient’s coverage in January. Given the special enrollment period and the MA open enrollment period, patients’ coverage can change multiple times during the first quarter, making it essential to run eligibility checks before every visit and inquire about potential plan changes at check-in.

Additionally, practices that refer patients to specific healthcare systems, such as UCM AdventHealth or Endeavor, need to update their referral guidance for affected plans. For instance, Evanston-based Endeavor Health will be out-of-network with Aetna MA after 2026, and UChicago Medicine remains out-of-network for individual MA and group retiree plans. These changes necessitate verifying payer details before scheduling appointments, confirming plan types, and understanding the distinctions between PPO and HMO point-of-service members.

Tips for Verifying Patient Coverage

In Pennsylvania, the sheer number of Medicare Advantage plans with drug coverage—66 in Lancaster County alone—means practices should anticipate heavier eligibility checks in January. Similarly, in Indiana, although no health system or insurer is listed on Becker’s 2026 split tracker, patients may still be affected by national plan discontinuations by UnitedHealth Group and Humana, which are impacting approximately 390,000 and 600,000 enrollees, respectively.

Patients selecting a plan before December 7 will likely check if their providers are in-network, often relying on plan directories. Under a proposed rule by CMS, released on October 16, MA plans would be required to verify directory information every 90 days starting in 2028. To avoid issues, practices should proactively audit their provider directory listings in every MA plan, checking for accuracy and sending corrections in writing. If a practice is leaving a network, it’s essential to confirm that the plan will remove them for 2027 to prevent misguided patient referrals.

Finally, practices should mark critical Medicare Advantage dates on their calendars, including the end of open enrollment on December 7, the special enrollment period from December 8 to February’s end, and the MA open enrollment period from January 1 to March 31. Additional important dates include November 17 and December 2, by which plans must send termination letters to patients for primary care and other specialties, respectively, and December 15, the deadline for comments on CMS’s proposed provider directory rule. By staying aware of these dates and proactively addressing the changes in Medicare Advantage plans, practices can ensure a smoother transition for their patients and maintain continuity of care.