This year’s contract shifts are changing where you can get care. About 55% of eligible beneficiaries now use medicare advantage, roughly 35 million people. Recent reports show roughly 90 hospitals and health systems have cut some contracts in the last three years, and a JAMA study found about 2.9 million enrollees faced forced disenrollment.

When a major hospital or medical group goes out-of-network for your plan, non-emergency care often moves off your covered list. That can mean new referrals, surprise bills, or having to switch specialists sooner than you expected.

Expect more narrow networks and more frequent disruption heading into the 2026 plan year. If you rely on academic centers or dominant regional hospitals, you could see immediate impact.

Key Takeaways

• Medicare advantage covers about 55% of eligible people—this is a widespread issue, not just local.
• Roughly 90 hospitals/health systems cut contracts over three years; about 2.9 million enrollees faced disruption.
• Out-of-network changes affect people in active treatment and those tied to high-demand systems first.
• You may need to choose between lower-premium plans with narrower access or broader coverage at higher cost.
• Many changes take effect Jan. 1; watch notices and act before scheduled appointments.

What’s happening with Medicare Advantage networks heading into plans 2026

You may keep the same card but not the same access—networks are being redrawn ahead of next year. Annual contract talks force insurers and health systems to renegotiate payment, coverage rules, and prior authorization processes. That means your in-network status can change even if you do not switch plans or move.

Why in-network access is shifting for plans 2026: Insurers are re-pricing contracts and tightening utilization controls to protect margins. Hospitals cite higher labor and operating costs, plus slow payment and denial friction, when they choose to leave advantage plans.

These moves create two common outcomes: a plan may withdraw from a market, or a health system may exit a specific plan. Both can prompt forced disenrollment for some enrollment groups and sudden limits on where you can get care.

• Watch for termination letters, provider directory updates, and referral or authorization flags.
• Access limits are an care delivery issue — they affect how fast you reach specialists and whether treatments are approved.

Driver	Insurer Action	Provider Response
Rising costs and rates pressure	Lower reimbursements, tighter networks	Re-evaluate participation or exit plans
Prior authorization delays	More utilization controls	Stop accepting certain advantage plans
Slow payment performance	Contract renegotiation	Contract termination in some regions
Market re-pricing for plans 2026	Plan design changes and narrower provider lists	Patients face limited local options

Next, we break down the headline system and regional examples so you can see which centers and carriers are involved.

US, 6 Medicare Providers Dropping Out of Networks: the health systems and regions impacted

A wave of contract terminations is altering where you can see specialists in several states. Below is a quick regional snapshot so you can spot if your care might be affected and what to check next.

Mayo Clinic — Midwest changes

The mayo clinic reduced participation across Minnesota, Wisconsin, and Iowa. For many plans run by UnitedHealthcare and Humana, Mayo will be out-of-network in 2026.

This means fewer contracted plans, tougher appointment access, and a higher chance you’ll need to switch coverage or use Original Medicare + Medigap for predictable access.

Mass General Brigham — Boston-area primary care impact

Mass general brigham removed many primary care providers from UnitedHealthcare and Blue Cross Blue Shield MA plans for 2026.

If your PCP is affected, referrals to specialists and hospital services can change, so confirm your primary care status before scheduling.

Scripps Health — San Diego limits persist

Scripps Clinic and Scripps Coastal groups continue to refuse most advantage plans. The system urged patients to consider Original Medicare to keep clinic access stable.

UNC Health — denial-rate concerns reach patients

UNC health listed denials and care concerns as reasons for leaving Humana, WellCare, and Health Care Service Corp plans. Expect more prior authorization friction and possible out-of-network coinsurance exposure for scheduled care.

Mount Sinai — Anthem contract ended in NYC

Mount Sinai terminated its Anthem agreement after payment disputes. Emergency care stays protected, but scheduled services may not be covered in-network.

Lehigh Valley Health Network — Pennsylvania disruption

Lehigh valley health will exit UnitedHealthcare’s network effective Jan. 25, 2026. High-need service lines like cardiology and oncology are most likely to require plan changes or careful timing around procedures.

Region	Health System	Primary Carrier Impact
Midwest (MN/WI/IA)	Mayo Clinic	UnitedHealthcare, Humana
New England (Boston)	Mass General Brigham	UnitedHealthcare, Blue Cross Blue Shield (MA)
Southern California (San Diego)	Scripps Health	Most Medicare Advantage plans
North Carolina (Triangle)	UNC Health	Humana, WellCare (Centene), Health Care Service Corp
New York City	Mount Sinai	Anthem (Elevance Health)
Eastern Pennsylvania	Lehigh Valley Health Network	UnitedHealthcare

At a glance: these six systems are part of a wider trend. Verify your plan’s provider directory and ask your insurer for options if a system you rely on is listed above.

Why providers are exiting Medicare Advantage plans

Hospitals are stepping back from some advantage plans after years of mounting administrative strain. The decision usually stems from a few clear operational pressures that hit systems' bottom lines and daily workflows.

Prior authorizations, denials, and payment delays

Prior authorization volume has surged, creating long queues and added paperwork for clinicians. Claim denials are higher and often overturned on appeal, which wastes staff time.

"Providence found advantage plans were 70% more likely to deny claims for incomplete records and showed a big jump in payment denials."

• More documentation requests mean longer waits for approvals.
• Clinicians spend hours on appeals instead of direct patient care.
• Delays in payment and contested claims create cash-flow strain.

Reimbursement pressure vs. rising costs

When reimbursement falls short or arrives slowly, hospitals must cover rising labor and supply costs. Scripps reported roughly $75 million in annual losses before it left certain contracts, showing how quickly a plan can turn into a financial drain.

Operational pain	Impact
High denial rates	More appeals, rescheduled procedures
Slow payments	Cash-flow stress, administrative burden
Rising operating costs	Unsustainable margins on some contracts

The "sunk-cost" dilemma

Many systems built infrastructure to work with advantage plans. Leaving reduces volume and can disrupt patients. Yet staying may lock systems into ongoing losses and friction with insurers.

Bottom line: exits are often pragmatic. Systems may later contract selectively with plans that match their standards for timely payment and access. For you, that can mean narrower choices, possible higher out-of-pocket costs, and delays in scheduled care.

How these network changes can affect your care, costs, and coverage

Network shifts can change how you get care and how much you pay in ways you may not expect. Start by checking whether a clinician or hospital remains in your plan’s network. Small changes can mean big cost differences and new referral rules.

What “out-of-network” can mean for coinsurance, referrals, and non-emergency services

Out-of-network often means higher cost-sharing, denied coverage for scheduled visits, and a need to change doctors. In some cases, coinsurance for non-emergency care can reach levels that are effectively prohibitive (examples have shown rates near 40%).

Emergency stabilization is usually covered, but elective surgeries, specialist visits, imaging, and follow-ups may not be. Prior authorizations can become harder when a provider leaves your plan.

Comparing medicare advantage vs. traditional medicare for access to specialists and hospitals

Medicare Advantage plans often have lower premiums and extra benefits. But they rely on narrow networks, which can limit access to major systems and certain specialists.

Traditional Medicare typically offers broader provider choice. Many doctors and hospitals accept it, which may protect continuity of care—but switching back can create timing and Medigap underwriting issues for some patients.

• Hidden costs: lost continuity, delays, appeals work, and time spent finding new in-network clinicians.
• Who is hit hardest: patients needing oncology, cardiology, or specialty surgery often rely on large centers that may leave plans.

Balance your priorities: lower premiums and extras versus predictable access to specific hospitals and specialists when you choose a plan.

What you can do next if your provider is out of network

Seeing a contract termination notice? That notice may open a short window to change coverage. Start by confirming the effective date and whether the change applies to your specific plan variant.

Immediate steps

• Write down the names of key clinicians and the services you need.
• Call the billing office and your insurer to confirm dates in writing.
• Keep the termination notice — it may trigger a Special Enrollment Period (SEP).

Using a Special Enrollment Period after a contract termination notice

An SEP usually allows you to switch medicare advantage plans or move to another carrier outside open enrollment. Use the window to compare options and avoid gaps in care.

How to evaluate new plans

Compare monthly premiums, maximum out-of-pocket, and whether your hospitals and specialists are listed in the networks. Ask how referrals and prior authorization work for high-cost services.

Staying with your doctors: Original Medicare, Medigap, and timing

If you prefer to keep specific clinicians, switching to Original Medicare plus Medigap can help. Be cautious: applying for Medigap later may trigger underwriting and higher premiums if you have chronic conditions.

Check	Why it matters	Ask
Prior authorizations	Can delay treatment	Typical turnaround; appeal support
Continuity of care	Protects ongoing treatment	Transition exceptions and duration
Plan network list	Controls access and costs	Confirm providers for your date of service

Final verification: call the provider billing office, call the insurer, and get confirmation in writing that the provider is in network for your planned date of service.

Conclusion

Contract disputes and payment stress are forcing major systems to narrow agreements or walk away. That trend means 2026 plan-year churn can change where you get care, how quickly you are seen, and what you pay.

Review your plan now: confirm your network status, keep any termination notices, and note effective dates before scheduling care. If accessto a specific academic center matters, weigh plans that protect provider choice. If lower premiums and extras matter more, check prior authorization rules closely.

Executives warn this disruption may continue as rates and contract talks play out. Make annual plan review a habit so your coverage matches your health needs through the year.

FAQ

What is happening with Medicare Advantage networks heading into plans 2026?

Insurers and several large health systems are renegotiating or terminating contracts, which is shrinking in-network access for some Advantage plans in 2026. That can change which hospitals and specialists your plan covers, raise your out-of-pocket costs for out-of-network care, and lead to short-term disruption while new contracts or plan enrollments are sorted.

Why is “in-network” access changing for the 2026 plan year?

You’re seeing changes because hospitals and physician groups are pushing back against lower reimbursement, heavier prior authorization rules, and rising labor and operating costs. Carriers are responding by narrowing networks, and some systems are choosing to leave plans they deem financially unsustainable.

Who is most affected by these network changes?

Medicare Advantage enrollees who rely on large academic centers and regional health systems are most affected. If you receive care in high-demand systems—like major teaching hospitals or integrated health systems—your provider’s contract status with insurers will directly affect your access and costs.

Which health systems and regions are experiencing contract terminations or reduced participation?

Several major systems have announced changes affecting distinct regions. Examples include reduced participation from the Mayo Clinic in parts of Minnesota, Wisconsin, and Iowa; contract shifts involving Mass General Brigham in the Boston area; limits at Scripps Health in San Diego; network status changes at UNC Health; Anthem’s contract termination with Mount Sinai in New York City; and UnitedHealthcare disruptions with Lehigh Valley Health Network in Pennsylvania.

How do prior authorization, denials, and payment delays drive providers away from Advantage plans?

When insurers require extensive prior authorization, deny claims more often, or delay payments, your provider faces administrative burden and cash-flow strain. That increases costs for hospitals and clinics, prompting some to stop participating in plans where the administrative and financial trade-offs are unfavorable.

How do reimbursement pressures and rising operating costs factor into these decisions?

You should know that lower reimbursement rates from some Advantage plans, combined with higher labor and supply costs, make certain contracts unsustainable. Health systems are weighing whether participation harms their ability to maintain services and staffing levels.

What does “out-of-network” mean for coinsurance, referrals, and non-emergency services?

If a provider leaves your plan’s network, you may face higher coinsurance, pay full price for non-emergency visits, and need referrals or prior authorization for in-network alternatives. Emergency care rules differ, but routine specialist visits and procedures often cost more out of network.

How does Medicare Advantage compare to Original Medicare for access to specialists and hospitals?

Original Medicare generally lets you see any provider who accepts Medicare, so you typically have broader access to specialists and hospitals. Advantage plans can offer lower premiums and extra benefits, but they rely on networks that may exclude certain major systems.

Can you use a Special Enrollment Period (SEP) if your provider’s contract is terminated?

Yes. If your plan gives a formal contract termination notice affecting your provider, you may qualify for a Special Enrollment Period to switch plans outside open enrollment. Keep documentation and confirm SEP rules with Medicare or your plan.

How should you evaluate new plans if your provider leaves your network?

Compare premiums, network breadth (including your doctors and hospitals), prior authorization rules, covered services, and total expected out-of-pocket costs. Check star ratings, read plan contract termination notices, and call member services to confirm provider participation.

What are your options if you want to stay with your doctors?

You can look for another Advantage plan that keeps your providers in network, switch to Original Medicare and consider a Medigap policy for supplemental coverage, or confirm whether your current plan offers transition-of-care protections for a limited time while you find alternatives.

How soon will these network changes affect your care and enrollment decisions?

Changes typically take effect at the start of the plan year (often January) or sooner after formal notice. If you get a contract termination notice, act quickly to review your options, check Special Enrollment Period eligibility, and compare plans before deadlines.