In-network cost sharing no longer applies
You may pay out-of-network rates, which are typically much higher — or the plan may not cover the facility at all.
Medicare Advantage Network Changes
What Happens When Your Hospital Leaves Your Medicare Advantage Network?
Hospital contract disputes are disrupting Medicare Advantage coverage across the country. Here is what beneficiaries need to know — and what options are available.
Last verified: October 25, 2026
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How Hospital-Insurer Contract Disputes Work
Hospitals and insurance companies negotiate contracts that determine how much the insurer pays for care. When those negotiations break down, a hospital may leave an insurer's network — meaning your Medicare Advantage plan may no longer cover care at that facility at in-network rates.
These disputes happen every year, but they have become more frequent and more public as hospital systems push back against reimbursement rates they say do not cover the cost of care.
For Medicare Advantage enrollees, a network termination can mean higher out-of-pocket costs, the need to find new providers, or — in some cases — the opportunity to switch coverage during a special enrollment period.
What Changes When Your Hospital Leaves Your Plan
Your primary care doctor may also be affected
Many physicians are employed by or affiliated with hospital systems. If the hospital leaves the network, affiliated physicians may leave too.
Specialist referrals may be disrupted
If your specialist is part of the affected health system, you may need to find a new specialist who participates in your plan.
Emergency care rules still apply
Federal law requires Medicare Advantage plans to cover emergency care at in-network cost-sharing rates, regardless of network status.
Original Medicare is not affected
If you have Original Medicare (Parts A and B), you can receive care at any hospital or physician that accepts Medicare — regardless of insurer contracts.
Your Three Options When a Hospital Leaves Your Network
Option 1: Switch to Original Medicare With a Medigap Plan
Original Medicare allows you to receive care at any hospital or physician that accepts Medicare — approximately 93% of non-pediatric physicians nationwide. You are not restricted to a network.
A Medicare Supplement (Medigap) plan covers most or all of the cost-sharing that Original Medicare does not pay. Plan G covers everything except the Part B deductible. Plan N covers most costs with modest copayments for some office visits and emergency room visits.
The tradeoff: Medigap plans charge a monthly premium, and in most states you must qualify medically unless you have a guaranteed-issue right. Medigap does not cover prescription drugs — you would need a separate Part D plan.
Option 2: Switch to a Different Medicare Advantage Plan
During the Annual Election Period (October 15 – December 7) or a qualifying Special Enrollment Period, you may be able to switch to a Medicare Advantage plan that includes your hospital and physicians in its network.
Before switching, verify that your specific hospital, primary care physician, and specialists are in the new plan's network for 2027 — not just the health system generally. Network directories can be outdated.
Also compare premiums, copayments, maximum out-of-pocket limits, formularies, and prior authorization requirements. A plan with a lower premium may have higher cost-sharing for the services you use most.
Option 3: Stay With Your Current Plan
If negotiations are ongoing, a contract dispute may resolve before your coverage is affected. Many disputes that make headlines are ultimately settled before the termination date.
If your current plan still covers your most important providers and the hospital dispute does not affect your care, staying may be the right choice.
Do not cancel existing coverage before you have confirmed acceptance into a new plan and verified the effective date.
Concerned About Losing Access to Your Hospital?
Speak directly with William. He is licensed in 19 states and can help you compare Original Medicare with Medigap against your current Medicare Advantage plan.
Does a Hospital Network Dispute Create Medigap Guaranteed-Issue Rights?
This is one of the most important and most misunderstood questions in Medicare. The short answer: a hospital leaving your Medicare Advantage network does not automatically create Medigap guaranteed-issue rights.
Guaranteed-issue rights arise from specific triggering events defined by federal law — primarily plan termination, plan nonrenewal, or a plan leaving your service area. A network change within a continuing plan is a different event.
CMS may determine that a network change is significant enough to trigger a Special Enrollment Period for Medicare Advantage, but that SEP does not automatically create a Medigap guaranteed-issue right.
If your Medicare Advantage plan is being discontinued or is leaving your county entirely for 2027, that is a different situation — you may have guaranteed-issue rights to purchase a Medigap plan. See our plan nonrenewal page for details.
In most states, if you do not have a guaranteed-issue right, you must answer health questions to qualify for Medigap. A pre-existing condition can result in a higher premium or denial of coverage.
Why Original Medicare Is Not Affected by Hospital Contract Disputes
Original Medicare (Parts A and B) is administered by the federal government. Hospitals and physicians participate in Medicare directly — they do not contract with a private insurer to accept Original Medicare patients.
When a hospital and a private Medicare Advantage insurer cannot agree on contract terms, that dispute has no effect on the hospital's participation in Original Medicare. The hospital continues to accept Original Medicare patients.
This is the fundamental difference between Original Medicare and Medicare Advantage: Original Medicare is not a network plan. You can receive care at any participating provider anywhere in the country.
Annual Election Period: October 15 – December 7
The Annual Election Period runs from October 15 through December 7 each year. During this window, you can switch Medicare Advantage plans, switch from Medicare Advantage to Original Medicare, or make changes to your Part D drug plan.
Changes made during AEP take effect January 1 of the following year. If you are concerned about a hospital network dispute affecting your 2027 coverage, AEP is the primary window to act.
Note: AEP does not create a nationwide Medigap open enrollment period. If you want to switch to a Medigap plan and do not have a guaranteed-issue right, you must qualify medically in most states.
Verified 2026–2027 Contract Disputes
The following contract disputes have been verified from official hospital-system sources. Only confirmed events are listed. William is licensed in all states listed below.
Virginia & North Carolina
Sentara Health / Anthem Blue Cross Blue Shield
Sentara ended contract negotiations with Anthem on October 5, 2026. Affects Medicare Advantage, Medicaid, and ACA Exchange plans. Transition planning underway.
Full Virginia detailsMissouri
NKC Health / UnitedHealthcare Medicare Advantage
NKC Health announced important changes to UnitedHealthcare Medicare Advantage coverage effective October 1, 2026. Affects the Kansas City Northland area.
Full Missouri detailsFrequently Asked Questions
Can I still go to my hospital if it leaves my Medicare Advantage network?
You can still receive care there, but you may pay out-of-network rates, which are typically much higher. Emergency care is always covered at in-network cost-sharing rates under federal law. For non-emergency care, check your plan's out-of-network benefits before proceeding.
Does a hospital network dispute automatically give me the right to switch to Medigap?
No. A hospital leaving your Medicare Advantage network does not automatically create Medigap guaranteed-issue rights. Guaranteed-issue rights arise from specific events such as plan termination or plan nonrenewal. In most states, switching to Medigap outside of a guaranteed-issue event requires medical underwriting.
What is the difference between a network termination and a plan nonrenewal?
A network termination means a specific hospital or physician group leaves your plan's network, but your plan continues. A plan nonrenewal means the Medicare Advantage plan itself is ending — either the insurer is exiting your county or the plan contract is not being renewed. Plan nonrenewal typically creates guaranteed-issue Medigap rights; a network termination typically does not.
Can I switch Medicare Advantage plans if my hospital leaves the network?
You can switch during the Annual Election Period (October 15 – December 7). CMS may also grant a Special Enrollment Period if it determines the network change is significant. Contact Medicare at 1-800-MEDICARE or speak with a licensed broker to understand your specific options.
Will my doctors also leave the network if my hospital does?
Possibly. Many physicians are employed by or affiliated with hospital systems. If the hospital leaves the network, affiliated physicians may leave too. Check your plan's network directory and contact your specific physicians to confirm their participation status.
Does Original Medicare cover the hospital if it leaves my Medicare Advantage network?
Yes. Original Medicare is not a network plan. If a hospital accepts Medicare — which most do — you can receive care there under Original Medicare regardless of any dispute with a private Medicare Advantage insurer.
What is Medigap Plan G and how does it work with hospital disputes?
Medigap Plan G covers most Medicare cost-sharing, including the Part A hospital deductible, coinsurance, and skilled nursing facility coinsurance. With Plan G and Original Medicare, you can receive care at any Medicare-participating hospital in the country — you are not subject to network restrictions. The only out-of-pocket cost is the annual Part B deductible.
How do I find out if my hospital is in my Medicare Advantage plan's network?
Contact your plan directly or use the plan's online provider directory. You can also call the hospital's billing department and ask whether they are currently in-network for your specific plan. Network directories can be outdated, so direct confirmation is important.
Your Independent Medicare Broker
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Concerned About Losing Access to Your Hospital?
Speak directly with William. He is a licensed independent Medicare broker in 19 states and can help you compare your options at no cost to you.