Medicare Advantage Network Changes Force Patients to Switch Doctors
Medicare Advantage Network changes are forcing many seniors to leave the hospitals and physicians they have trusted for years as major healthcare systems end contracts with Medicare Advantage insurers, raising concerns about disruptions in ongoing medical care.
In California, Providence Clinical Network, which operates 15 hospitals across Los Angeles and Orange County, ended its Medicare Advantage contract with UnitedHealthcare this year. Nationwide, at least 25 major hospitals and health systems—including Mayo Clinic and NewYork-Presbyterian—have either terminated or scaled back their Medicare Advantage agreements.
Hospitals say the growing number of contract terminations stems from frequent prior authorization requirements, insurance claim denials, delayed reimbursements, and lower payment rates. Providers argue that even after treating patients, they often spend months negotiating with insurers over reimbursement, making the contracts increasingly difficult to maintain.
Patients, however, bear the greatest burden.
When a contract between a hospital and an insurer ends, beneficiaries do not automatically lose their Medicare Advantage coverage. Instead, the hospital, physicians, and specialists leave the plan’s provider network.
Patients who receive notice that their hospital will no longer be in-network next year may need to find new primary care physicians as well as specialists such as cardiologists and oncologists. In some cases, CT scans, MRI exams, surgeries, and even ongoing cancer treatments must be transferred to another medical facility.
How Medicare Advantage Network Changes Affect Patients
The impact is especially significant for beneficiaries enrolled in Health Maintenance Organization (HMO) plans. Except for emergencies, out-of-network care is generally not covered, effectively requiring patients to change providers.
Preferred Provider Organization (PPO) members have more flexibility to seek care outside the network, but doing so often results in significantly higher out-of-pocket costs.
Patients living with chronic conditions—including cancer, heart disease, and diabetes—face additional risks. Switching physicians can delay treatment schedules or require new providers to repeat evaluations before continuing care.
Some beneficiaries may qualify for Continuity of Care protections, allowing them to continue treatment with their current providers for a limited time. However, these protections are not automatic, and patients typically must apply for them.
What Medicare Beneficiaries Should Check
Returning to Original Medicare is not always an easy alternative.
For beneficiaries whose guaranteed Medigap enrollment period has expired, purchasing a Medigap policy generally requires medical underwriting in most states. Depending on an applicant’s health condition, coverage may be denied or premiums may be significantly higher. Experts recommend confirming Medigap eligibility before leaving a Medicare Advantage plan.
Beneficiaries should also carefully review their Annual Notice of Change (ANOC), which is typically delivered by Sept. 30. The notice explains whether their current hospitals and physicians will remain in the network, whether the plan will continue to be offered, and whether premiums, annual out-of-pocket limits, or prescription drug coverage will change for the following year.
Experts also recommend contacting a hospital’s insurance or patient financial services department directly rather than relying solely on information from an insurance company. Confirming that contracts remain in place for the coming year can help patients avoid unexpected disruptions in care.
The Medicare Annual Enrollment Period runs from Oct. 15 through Dec. 7, giving beneficiaries an opportunity to compare plans and switch coverage if their current doctors or hospitals will no longer participate in their Medicare Advantage network.
