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By Suzanne Blake
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Several major health systems are dropping Medicare Advantage plans in the new year.
The hospitals are ending their acceptance of MA plans over issues with prior authorization denials and slow reimbursement, as seniors face increased costs on plan premiums.
Why It Matters
Around half of Americans on Medicare opt for the privatized Medicare Advantage plans. While these plans often offer bundled deals and lower out-of-pocket costs, they can also present issues, such as doctors being out-of-network and treatments requiring prior authorization.
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What To Know
According to Becker’s Hospital Review, 15 health systems are dropping Medicare Advantage plans in 2026.
The full list is as follows:
- MultiCare, which is based in Tacoma, Washington, will stop contracting with any MA PPO plans in 2026.
- Mayo Clinic is another health care branch that will no longer be in network with most MA plans under UnitedHealthcare and Humana.
- Providence Clinical Network is also dropping UnitedHealthcare’s MA for its 15 hospitals in California.
- New York City’s Mount Sinai is no longer in network with Anthem MA in 2026.
- UNC Health has suspended its in-network status with Humana, WellCare (Centene), and Health Care Service Corp. (previously Cigna) MA plans for next year.
- Lehigh Valley Health Network is dropping MA from UnitedHealthcare MA starting January 25.
- TriHealth, which operates in Cincinnati, is dropping UnitedHealthcare MA in 2026.
- Centra Health will no longer be in network with Humana MA next year.
- Mass General Brigham will no longer have most of its primary care providers in network with UnitedHealthcare or BCBS Massachusetts MA plans.
- St. Luke’s Health System is leaving Humana MA plans behind in 2026.
- Montrose Regional Health will be out of network for Humana MA in 2026.
- Kettering Health has ended contracts with Humana and Devoted Health MA for next year.
- Iowa Specialty Hospitals and Clinics has ended its acceptance of all MA plans in 2026, except for Aetna, Medigold, UnitedHealthcare and Wellmark BCBS.
- White River Health, which operates in Arkansas, is not in-network with Aetna MA as of January 31.
- South County Hospital, located in Rhode Island**,** is dropping Aetna MA in 2026.
With so many large medical groups dropping various MA plans, Chris Fong, CEO of Smile Insurance and a Medicare specialist, said it’s indicative of the tug-of-war between insurance companies and medical groups.
“The reasons for dropping could be simply attempting to negotiate better rates for medical services, complete dissatisfaction with the limitations under Medicare Advantage, or a consolidation of plans accepted. Ultimately, the patients are the most affected no matter the reason,” Fong told Newsweek.
As MA plans reimburse rural hospitals at 90 percent of traditional Medicare rates and 82 percent of prior authorization denials get overturned on appeal, hospital systems are facing many looming issues with MA plans that are unlikely to go away, said Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com.
“That means one in five requests denied by MA insurers was actually medically necessary. Hospitals knew it, patients needed it, but insurers said no anyway. Then, after appeals paperwork and care delays, magically approved it. Is that cost control or a paperwork tax on patient care?” Ryan told Newsweek.
“Picture this: You chose Medicare Advantage for the dental and gym membership. Now Mayo Clinic is out-of-network. Your choice is drive three hours or pay out-of-pocket for the specialists who saved your life last year. That's bait-and-switch at scale more than ‘advantage.”
What People Are Saying
Chris Fong, CEO of Smile Insurance and a Medicare specialist, told Newsweek: “We have had to double and sometimes triple check providers with each plan this annual enrollment period to ensure their doctors are still accepting the plan they chose. If a beneficiary finds themselves in this situation and they are on a Medicare Advantage plan they might be able to use the Medicare Advantage Open Enrollment Period to make an additional change between January to March.”
Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek: “Unfortunately, the latest string of hospitals and health systems dropping Medicare Advantage support speaks to a growing trend of issues for the once highly touted program. We've seen many insurers exit the program in recent years, as Medicare Advantage proved to not be as profitable for them as anticipated. Those insurers that remain have come into conflict with facilities and systems due to increasing denials for prior authorizations and delayed reimbursements.”
Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek: “When 16 health systems drop MA contracts in one year, and half of seniors are now in MA plans, we've built a healthcare financing model that only works if hospitals accept below-cost reimbursement forever. They won't. They can't. The math doesn't math.
“If MA plans are so profitable for insurers that they spend thousands per day on TV ads, why can't they pay hospitals enough to keep the doors open? The answer tells you everything you need to know about who's winning in Medicare Advantage. Hint, it's not patients or providers.”
Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek: “Beneficiaries are the ones most impacted. With over half of seniors enrolled in Medicare Advantage, provider exits mean narrower networks, longer travel for care, or being forced to change doctors. Many may return to Original Medicare, which does not require underwriting, but Medigap policies often do, unless a guaranteed issue period applies. For those with health conditions, this can mean higher costs or fewer options.”
What Happens Next
As the many MA plans make their way onto hospitals’ chopping blocks, Beene said patients will invariably suffer.
“Sadly, the biggest loser in all this are Medicare Advantage participants, who find themselves having to look for new healthcare facilities to go to in the event their existing coverage is no longer available,” Beene said.
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