2027 Medicare Advantage
2027 Medicare Advantage Provider Network Changes: What to Do if Your Doctor or Hospital Leaves Your Plan
Medicare Advantage plans contract with specific doctors, hospitals, and specialists. Those networks can change from year to year. For 2027, several major carriers are adjusting their networks. Here is what you need to know before October 15.
Annual Enrollment Period: October 15 – December 7, 2026. This is your window to switch Medicare Advantage plans or return to Original Medicare for 2027. Coverage changes take effect January 1, 2027. The 2027 Medicare Plan Finder is available now at Medicare.gov.
Why provider networks matter more than premium
A Medicare Advantage plan's premium is visible. Its network is not — until you need a specialist, a hospital, or a procedure and discover your provider is no longer covered at in-network rates.
For HMO plans, using an out-of-network provider typically means no coverage at all except in a genuine emergency. For PPO plans, out-of-network care is usually covered but at a significantly higher cost-share. The difference between a plan that covers your cardiologist and one that does not can be thousands of dollars.
Network changes are one of the most consequential — and least publicized — aspects of the annual Medicare Advantage review process.
What's changing for 2027
CMS released the 2027 Medicare Advantage and Part D landscape data on September 28, 2026. Nationally, plan availability and network composition are shifting across multiple carriers and markets.
UnitedHealthcare has communicated 2027 plan changes to members through its Plan Renewal resource. UHC has indicated a strategic shift toward HMO products in certain markets, which carry stricter network requirements than PPO plans. The specific plans, geographies, and populations affected vary — individual members should review their Annual Notice of Change (ANOC).
Reports indicate Aetna is also adjusting its 2027 network and plan design in certain markets. Substantive claims about Aetna's specific network changes should be verified directly with Aetna or through CMS Plan Finder for your ZIP code and county.
In Ohio, a network relationship change has been reported between certain Humana individual Medicare Advantage plans and providers affiliated with The Ohio State University Wexner Medical Center, including The James Cancer Hospital, in the Columbus/Franklin County area. Individuals enrolled in affected Humana individual MA plans should verify their current network status directly with Humana and their providers. This is an individual Medicare Advantage network matter — it does not apply to group Medicare coverage.
In Virginia and West Virginia, a network relationship change has been reported between Valley Health and UnitedHealthcare plans in certain service areas. Affected individuals should verify directly with Valley Health and UnitedHealthcare.
The applicable plan, provider relationship, enrollment right, and Medigap eligibility must be verified for each individual's circumstances.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
HMO vs. PPO provider rules
HMO Plans
- In-network providers required (except emergencies)
- Out-of-network care typically not covered
- HMO-POS option may allow limited out-of-network use
PPO Plans
- In-network and out-of-network providers covered
- Out-of-network care costs significantly more
- More flexibility if a provider leaves the network
Medicare Advantage HMO plans generally require you to use providers within the plan's network. Except in a genuine emergency or urgent care situation, using an out-of-network provider typically results in no coverage. Some HMOs offer a Point-of-Service (POS) option that allows limited out-of-network use at higher cost.
Medicare Advantage PPO plans cover both in-network and out-of-network providers, but at different cost-sharing levels. Using an out-of-network provider who accepts Medicare is generally permitted, though your out-of-pocket costs will be higher than for in-network care.
If your current plan is an HMO and your primary care physician, specialist, or hospital is leaving the network, the practical impact is more severe than the same change in a PPO. Confirm your plan type before evaluating your options.
How to check your doctors and hospitals
Review your ANOC
Your Annual Notice of Change arrives by September 30 each year. It lists changes to your plan's benefits, costs, and — in some cases — network. Read it carefully.
Use Medicare Plan Finder
Medicare Plan Finder at Medicare.gov is updated for 2027 plans as of October 1, 2026. You can search by ZIP code and filter by whether specific providers participate in a plan's network.
Check your plan's provider directory
Each Medicare Advantage plan maintains an online provider directory. Search your current plan's directory for each of your providers by name. Directories are required to be updated regularly, but confirm directly with the provider as well.
Call your plan
Call the member services number on your insurance card and ask specifically whether each provider — by name and NPI if possible — is in-network for your plan effective January 1, 2027.
Call your provider
Ask your doctor's office, specialist, or hospital billing department directly whether they will participate in your specific plan for 2027. Provider directories can lag behind actual contract status.
Verify hospital and facility participation
Hospital system participation is separate from individual physician participation. A hospital may be in-network while a physician who practices there is not, or vice versa. Verify both.
Why 'accepts Medicare' isn't the same as 'in my MA network'
This is one of the most common points of confusion in Medicare.
With Original Medicare (Parts A and B), beneficiaries can generally use any doctor or hospital that takes Medicare nationwide. A provider who accepts Medicare assignment agrees to Medicare's approved amounts as full payment.
Medicare Advantage is different. MA plans contract separately with providers to form their networks. A provider who accepts Original Medicare is not automatically in a Medicare Advantage plan's network. The provider must have a separate contract with that specific MA plan.
When a provider leaves a Medicare Advantage network, they may still accept Original Medicare. That distinction matters when evaluating your options.
What happens when a provider leaves
When a provider leaves your Medicare Advantage network mid-year, you may have continuity-of-care protections for ongoing treatment. CMS requires MA plans to provide transitional care for certain situations — for example, if you are undergoing active treatment for a serious condition when your provider leaves the network.
For plan year changes effective January 1, 2027, the relevant window is the Annual Enrollment Period (October 15 – December 7, 2026). During AEP, you can switch Medicare Advantage plans or return to Original Medicare.
An ordinary provider departure from a network does not automatically create a Special Enrollment Period outside of AEP. The ability to change plans mid-year depends on whether a qualifying SEP applies to your specific situation.
What counts as a significant network change
Not every provider departure constitutes a significant network change under federal rules. CMS determines whether a network disruption rises to the level of a significant change that triggers special beneficiary protections.
A significant network change is a CMS determination — not a self-assessment by the beneficiary or the plan. The determination considers the scope of the disruption, the affected population, and the availability of alternative providers in the service area.
If CMS determines that a network change is significant, affected beneficiaries may receive notification and may be eligible for an exceptional-circumstances Special Enrollment Period. The applicable rules and procedures are governed by CMS guidance, including the 2027 MA/PD Enrollment and Disenrollment Guidance (updated September 17, 2026).
Federal rule — source: CMS 2027 MA/PD Guidance (Sep 17, 2026)
An ordinary provider departure does not automatically create a Special Enrollment Period. Certain network disruptions that CMS determines are significant may create an exceptional-circumstances SEP for affected beneficiaries.
When a network change may create an SEP
An ordinary provider departure does not automatically create a Special Enrollment Period. Certain network disruptions that CMS determines are significant may create an exceptional-circumstances SEP for affected beneficiaries.
If an exceptional-circumstances SEP applies, affected beneficiaries may be able to switch Medicare Advantage plans or return to Original Medicare outside of the Annual Enrollment Period. The election window and permitted elections are governed by the specific SEP rules.
Whether a specific network change qualifies, whether you are an affected beneficiary, and what elections are available must be verified for your individual circumstances. Do not assume an SEP applies based solely on a provider or hospital announcement.
When network change may affect Medigap rights
The chain — each step requires a specific federal trigger
A provider leaving a Medicare Advantage network is not the same as a plan termination or service-area reduction, and does not automatically create federal Medigap guaranteed-issue rights.
The chain of events matters: an ordinary provider departure does not automatically constitute a significant-network determination by CMS, and a significant-network determination does not automatically create Medigap GI rights. Each step requires a specific federal trigger.
Where a qualifying federal significant-network-change protection exists under applicable CMS guidance, it may create a Medigap GI right for affected beneficiaries. The applicable plan, the nature of the network change, and the individual's enrollment history all affect eligibility.
Never independently determine GI eligibility from a hospital or provider announcement alone. Verify the applicable federal trigger, the CMS determination, and your individual circumstances.
Provider change vs. plan termination
Event A — A doctor or provider leaves your plan's network. Your plan continues. You may need to find a new in-network provider or switch plans during AEP.
Event B — A major network disruption that CMS may determine is significant, potentially triggering an exceptional-circumstances SEP and, in some cases, Medigap GI rights.
Event C — Your entire Medicare Advantage plan is terminated or not renewed. Federal law provides GI rights to enroll in Medigap Plan A, B, C, D, F, G, or K without medical underwriting.
Event D — Your plan reduces its service area and you are no longer in the coverage area. Similar GI protections apply.
Event E — A carrier exits the Medicare Advantage market entirely. GI rights apply to affected members.
This page addresses Events A and B. For Events C, D, and E — plan terminations, nonrenewals, and service-area reductions — see the related resources below.
Original Medicare provider access
With Original Medicare (Parts A and B), beneficiaries can generally use any doctor or hospital that takes Medicare nationwide. This is a fundamental structural difference from Medicare Advantage.
Providers who accept Medicare assignment agree to Medicare's approved amounts as full payment for covered services. Providers who accept Medicare but do not take assignment may charge up to 15% above the Medicare-approved amount — this is called an excess charge.
Original Medicare does not include prescription drug coverage. A separate Part D plan is required for drug coverage under Original Medicare.
Original Medicare + Medigap
Medigap (Medicare Supplement) policies supplement Original Medicare. Provider access under Medigap is therefore generally based on whether the provider works with Original Medicare, rather than membership in a separate Medicare Advantage-style network.
Plan G covers most Medicare-approved costs after the Part B deductible, including excess charges. Plan N covers most costs with small copays for office and emergency room visits and does not cover excess charges. High-Deductible Plan G provides the same benefits as Plan G after meeting the annual CMS-set deductible, typically at lower premiums.
Medigap premiums vary by carrier, ZIP code, age, and gender. An independent broker can compare current rates from multiple carriers for your specific situation.
AEP vs. Medigap OEP
Medicare Open Enrollment (the Annual Enrollment Period) runs from October 15 through December 7 each year. During AEP, you can switch Medicare Advantage plans, switch Part D drug plans, or return to Original Medicare.
Medicare Open Enrollment from October 15 through December 7 does not create a new nationwide Medigap Open Enrollment Period.
Returning to Original Medicare during AEP does not itself guarantee Medigap acceptance. Outside of a federal GI right, a state-specific protection, or your initial Medigap OEP (which runs for six months from your Part B effective date), Medigap insurers in most states can use medical underwriting and may decline coverage or charge higher premiums based on health status.
Federal GI rights, state additional protections, and individual underwriting outcomes are separate considerations. Verify which protections apply to your specific situation.
2027 network review checklist
Is Your Doctor or Hospital Changing Networks for 2027?
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Frequently Asked Questions
Can Medicare Advantage remove my doctor from its network?
Yes. Medicare Advantage plans contract with providers, and those contracts can change from year to year. A provider may leave a plan's network voluntarily or because the plan and provider did not reach a new contract agreement. Plans are required to maintain adequate networks and to notify members of significant changes, but individual provider departures can occur.
Can I change plans if my doctor leaves?
During the Annual Enrollment Period (October 15 – December 7), you can switch Medicare Advantage plans or return to Original Medicare. Outside of AEP, changing plans generally requires a qualifying Special Enrollment Period. An ordinary provider departure does not automatically create an SEP. If you believe a significant network change has occurred, contact your plan or a broker to determine whether an SEP applies to your situation.
Does losing one doctor automatically create an SEP?
No. An ordinary provider departure does not automatically create a Special Enrollment Period. Certain network disruptions that CMS determines are significant may create an exceptional-circumstances SEP for affected beneficiaries. Whether a specific situation qualifies must be verified for your individual circumstances.
Can a network change create Medigap guaranteed-issue rights?
A provider leaving a network is not the same as a plan termination and does not automatically create Medigap GI rights. Where a qualifying federal significant-network-change protection exists under applicable CMS guidance, it may create a Medigap GI right for affected beneficiaries. The applicable plan, the nature of the network change, and the individual's enrollment history all affect eligibility. Do not assume GI rights apply based solely on a provider or hospital announcement.
What's the difference between HMO and PPO networks?
HMO plans generally require you to use in-network providers. Except in emergencies, out-of-network care typically results in no coverage. PPO plans cover both in-network and out-of-network providers, but at different cost-sharing levels — out-of-network care costs more. If your plan is an HMO and your provider leaves the network, the impact is more severe than the same change in a PPO.
Can I see 2027 plans now?
Yes. Medicare Plan Finder at Medicare.gov is updated for 2027 plans as of October 1, 2026. You can compare plans, check premiums and benefits, and search for providers by ZIP code. The Annual Enrollment Period runs October 15 through December 7, 2026, with coverage effective January 1, 2027.
Should I call my doctor to confirm participation?
Yes. Plan provider directories can lag behind actual contract status. Calling your doctor's office, specialist, or hospital billing department directly to confirm 2027 participation in your specific plan is the most reliable verification step. Ask by plan name and, if possible, plan ID.
Is Medicare Open Enrollment also Medigap Open Enrollment?
No. Medicare Open Enrollment (the Annual Enrollment Period, October 15 – December 7) allows you to switch Medicare Advantage or Part D plans. It does not create a new nationwide Medigap Open Enrollment Period. Outside of a federal GI right, a state-specific protection, or your initial six-month Medigap OEP, Medigap insurers in most states can use medical underwriting.
Can I leave Medicare Advantage for Original Medicare for broader access?
Yes. During AEP (October 15 – December 7), you can return to Original Medicare. With Original Medicare, you can generally use any doctor or hospital that takes Medicare nationwide. However, returning to Original Medicare does not itself guarantee Medigap acceptance outside of a qualifying GI right or state protection. Evaluate your options with a broker before making a change.
Does a lower premium mean the network stayed the same?
No. Premium and network are separate plan characteristics. A plan may reduce its premium while also narrowing its network. Always verify your specific providers in the plan's network directory and through Medicare Plan Finder, regardless of whether the premium changed.