Major Healthcare Systems Prepare to Limit Medicare Advantage Access in 2026
A growing number of hospitals and health systems across the united States are signaling a significant shift in their participation with Medicare Advantage (MA) plans. these changes, slated to take effect in 2026, could impact your access to in-network care depending on your chosen MA provider. This article breaks down the current situation and what it means for you.
Why are healthcare providers making these changes?
For years, healthcare systems have expressed increasing frustration with the complexities and administrative burdens associated with MA plans. Reimbursement rates, prior authorization requirements, and claim denials are frequently cited as key concerns. Ultimately, many providers feel these issues hinder their ability to deliver optimal patient care and create unsustainable financial pressures.
Which healthcare systems are opting out?
Here’s a look at the major players announcing changes to their MA network participation, as of late 2024:
* UNC Health (north Carolina): They will no longer accept Humana, WellCare, and Health Care Service Corp. (formerly cigna) MA plans.
* Lehigh Valley Health Network (Pennsylvania): This network is ending its contract with UnitedHealthcare MA starting January 25, 2026.
* TriHealth (Ohio): You’ll find TriHealth out-of-network with UnitedHealthcare MA in 2026.
* Centra Health (Virginia): Centra Health is dropping Humana MA coverage beginning in 2026.
* Mass General Brigham (Massachusetts): Most primary care physicians within this system will no longer be in-network with UnitedHealthcare or BCBS Massachusetts MA plans.
* St. Luke’s Health System (Idaho): St. Luke’s will not accept Humana MA plans in 2026.
* Montrose Regional Health (Colorado): They are ending their contract with Humana MA in 2026.
* Kettering Health (Ohio): This system will no longer contract with Humana and Devoted Health MA plans in 2026.
* Iowa Specialty Hospitals and Clinics: They are dropping all MA plans in 2026, with exceptions for Aetna, Medigold, UnitedHealthcare, and Wellmark BCBS.
* White River Health (Arkansas): White River Health will no longer be in-network with Aetna MA, effective January 31, 2026.
* South county Hospital (Rhode Island): You can expect South County Hospital to be out-of-network with Aetna MA in 2026.
What does this mean for you if you have Medicare Advantage?
These changes could mean higher out-of-pocket costs if you currently receive care from one of these systems. Consider these steps:
* Review your plan: Carefully examine your current MA plan’s network directory to see if your preferred doctors and hospitals will be affected.
* Explore other plans: During the annual enrollment period (October 15 – December 7),consider exploring other MA plans that include these healthcare systems in their network.
* Consider Original Medicare: If you’re concerned about limited network access, you might want to explore switching to Original Medicare with a supplemental Medigap plan.
* Contact your provider: Reach out to your doctor’s office or the hospital directly to confirm their participation status with your specific plan.
What’s the bigger picture?
This trend reflects a growing tension between healthcare providers and MA insurers. It’s likely we’ll see more systems re-evaluate their MA contracts in the coming years. Consequently, it’s more significant than ever to stay informed about your plan’s network and make choices that align with your healthcare needs.
Ultimately, understanding these changes empowers you to navigate the complexities of Medicare Advantage and ensure you continue to receive the
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