Medicare Advantage Friction
- Nineteen major hospital systems have walked away from Medicare Advantage plans this year, creating network gaps for seniors. - Reporters named '19' hospital systems leaving MA networks, citing growing contractual and policy tensions. - Policy analysts say CMS' tougher posture is driving market instability and could disrupt referrals and continuity of care ( )
Hospital systems across the country are cutting ties with Medicare Advantage plans in 2026, leaving some seniors without their usual doctors or hospitals. (beckershospitalreview.com) Becker’s Hospital Review said 19 health systems had dropped or partially dropped Medicare Advantage contracts effective in 2026 as of April 1. The list includes Mayo Clinic, Mass General Brigham, NewYork-Presbyterian, Mount Sinai, Providence Clinical Network and UNC Health. (beckershospitalreview.com) Several of the breaks are tied to named insurers and dates, not broad exits from Medicare. NewYork-Presbyterian and UnitedHealthcare Medicare Advantage are set to go out of network on May 1 without a new agreement, while Moffitt Cancer Center said it was already out of network with Aetna Medicare Advantage and will leave Humana Medicare Advantage in July. (beckershospitalreview.com) Medicare Advantage is the private-plan version of Medicare, and it now covers 34 million people, or 54% of eligible Medicare beneficiaries in 2025, according to KFF. That scale means a contract fight between one insurer and one hospital system can affect access for a large share of older patients in a region. (kff.org) Hospitals have cited two recurring complaints: prior authorization denials and slow reimbursement. Becker’s said those issues were driving many of the 2026 terminations, and patient advocates have warned that out-of-network shifts can interrupt referrals and ongoing treatment. (beckershospitalreview.com, thecarepartnerproject.org) At the same time, federal officials have been tightening oversight rather than loosening it. The Centers for Medicare & Medicaid Services said in its April 2025 payment notice for 2026 that it was updating Medicare Advantage payment policies to protect beneficiaries and taxpayers from waste, fraud and abuse. (cms.gov) Tom Kornfield, chief executive of MAST Health Policy Solutions, said at the Medicarians conference in Las Vegas on April 20 that the agency had taken “a more adversarial posture” toward Medicare Advantage. He tied that shift to scrutiny of overpayments and fraud and to insurer retrenchment in 2026 markets. (medcitynews.com) Medicare’s advisory commission has added to that pressure with new cost estimates. MedPAC said Medicare Advantage payments in 2026 will run $76 billion above what traditional Medicare would have spent for the same beneficiaries. (fiercehealthcare.com, medpac.gov) Insurers and federal officials argue the program still offers coordinated care and extra benefits that traditional Medicare does not package the same way. CMS said its 2026 payment update is meant to keep Medicare Advantage “efficient” and “accountable” while preserving access to care. (cms.gov) For patients, the immediate issue is narrower than the policy fight in Washington: whether their doctor is still in network on their next appointment date. With more than half of eligible Medicare beneficiaries enrolled in Medicare Advantage, each contract deadline now lands directly in seniors’ care plans. (kff.org, beckershospitalreview.com)
