What to Do if Your Hospital Drops Your Medicare Advantage Plan
A health system dropping your Medicare Advantage plan could affect your ability to use certain doctors and/or hospitals. Here’s what to do if it happens to you.
Many, or all, of the products featured on this page are from our advertising partners who compensate us when you take certain actions on our website or click to take an action on their website. However, this does not influence our evaluations. Our opinions are our own. Here is a list of our partners and here's how we make money.
Updated · 2 min read
Written by
Lead Writer & Content Strategist 
Edited by
Managing Editor Twenty-seven health systems dropped contracts with Medicare Advantage plans in the first half of 2025 . That’s according to health care industry trade magazine Becker’s Hospital Review.
If your hospital or health system drops your Medicare Advantage plan, they're no longer in-network for your insurance. That could make it expensive or even impossible to use them for services.
Here are a few potential ways to handle your hospital going out-of-network with your Medicare Advantage plan.
Switch Medicare Advantage plans
If your hospital dropped your Medicare Advantage plan from one company, you could consider switching to another insurance company.
Pros
Keep the same kind of Medicare coverage you already had.
Open enrollment gives an opportunity to switch every year.
Cons
You probably need to wait for open enrollment.
No guarantee that another plan covers all of your providers.
The hospital could drop your new plan, too.
There are two periods each year when you can switch Medicare Advantage plans:
- Medicare open enrollment: Oct. 15 to Dec. 7.
- Medicare Advantage open enrollment: Jan. 1 to March 31.
Outside of those periods, you’d generally need to qualify for a special enrollment period to switch plans.
Switching plans lets you keep Medicare Advantage if that’s your preferred type of Medicare coverage. But you’d need to shop carefully to find a good plan that covers your health care providers. And it’s possible your hospital could drop your new Medicare Advantage plan, too.
» MORE: Best Medicare Advantage plans
Compare Medicare Advantage plans
| Insurance company | CMS Star Rating | States available | Members in high-rated plans | Member experience |
|---|---|---|---|---|
| 4.1 /5 | 48 states and Washington, D.C. | Medium (50% to 84%) | 3.76 (Above average) | |
| 3.61 /5 | 46 states and Washington, D.C. | Low (49% or less) | 3.61 (Above average) | |
| 4.19 /5 | 43 states and Washington, D.C. | Medium (50% to 84%) | 3.88 (Above average) | |
| 3.68 /5 | 29 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | |
| 4.19 /5 | 29 states | Medium (50% to 84%) | 3.66 (Above average) |
Return to Original Medicare
If your hospital dropped your Medicare Advantage plan, you could drop it, too, and go back to Original Medicare.
Pros
No more provider networks.
Fewer prior authorization requirements.
Almost all health care providers accept Original Medicare.
Cons
Significant change to your Medicare coverage.
No cap on out-of-pocket costs unless you get Medicare Supplement Insurance (Medigap).
Might not be able to get affordable Medigap coverage.
Almost all health care providers work with Original Medicare. You wouldn’t have to deal with provider networks, referrals or prior authorizations.
Switching from Medicare Advantage to Original Medicare is a significant change, however. You’d need to buy a stand-alone Medicare Part D plan for prescription drug coverage, for example.
Buying a Medicare Supplement Insurance (Medigap) plan with Original Medicare is a good way to cover out-of-pocket costs. But if you’re switching to Original Medicare outside of your Medicare Supplement open enrollment period, medical underwriting might make it more difficult and/or expensive to get a Medigap plan.
Go out-of-network
You could stick with your current plan, and you might be able to keep using your hospital and/or doctor out-of-network.
Pros
Minimal changes to your Medicare coverage.
The hospital and plan might renegotiate in the future.
Cons
Out-of-network care can be very pricey.
Some providers might refuse to schedule you for non-emergency services.
Getting out-of-network care could help you avoid making unwanted changes to your Medicare coverage. And network changes aren’t necessarily permanent. Your hospital and insurance company might reach a new agreement, bringing the hospital back in-network.
Out-of-network health care can be very pricey, however. And while you can get emergency services, some health systems might refuse to schedule you for planned care if you’re out-of-network.
Shopping for Medicare Advantage plans? We have you covered.
| MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup. | |
| Best for size of network
| Best for Part B Giveback
|
| Best for ratings
| Best for low-cost plan availability
|
| Star ratings from CMS and on a 5-★ scale. | |
Why are hospitals refusing Medicare Advantage plans?
Hospitals mention denied claims and broken down negotiations on payment rates as reasons why they’re dropping Medicare Advantage plans.
Claim denials
The Medical University of South Carolina health system dropped Humana’s Medicare Advantage and Medicaid plans as of June 30, 2025 . It said in a statement that “we remain concerned about the number of denials of necessary treatment plans ordered by our physicians.”
Sanford Health, similarly, cited “delays in patient care, barriers to scheduling and denials of coverage” when it ended its contract with Humana in 2024 .
Medicare Advantage plans denied about 17% of initial claims in 2019, according to a 2025 study published in Health Affairs, a peer-reviewed academic journal . High denial rates can increase administrative costs and reduce health care providers’ revenue.
Payment rates
Brown University Health dropped UnitedHealthcare’s Medicare Advantage Plans as of July 2025 . It said in a statement that “Brown Health aimed to reach an agreement that provided fair reimbursement and less administrative burden for patients. While we made every effort to reach a fair agreement, UnitedHealthcare ultimately chose to end negotiations.”
Medicare Advantage plans reimbursed hospitals about 9.4% less than traditional Medicare in 2023, according to American Hospital Association (AHA) analysis of industry benchmark data . And even traditional Medicare might not cover the full cost of care, according to the AHA.
If hospitals can’t negotiate more favorable rates with a Medicare Advantage plan, they might choose to leave the plan’s network, instead.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
Article sources
NerdWallet writers are subject matter authorities who use primary,
trustworthy sources to inform their work, including peer-reviewed
studies, government websites, academic research and interviews with
industry experts. All content is fact-checked for accuracy, timeliness
and relevance. You can learn more about NerdWallet's high
standards for journalism by reading our
editorial guidelines.
- 1. Becker's Hospital Review. 27 Health Systems Dropping Medicare Advantage Plans. Accessed Sep 15, 2025.
- 2. MUSC Health. MUSC Health's Contract with Humana Medicare Advantage & Humana Healthy Horizons Medicaid Expires June 30, 2025. Accessed Sep 15, 2025.
- 3. Sanford Health. Sanford Health to End Contract with Humana Medicare Advantage. Accessed Sep 15, 2025.
- 4. Health Affairs. Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent. Accessed Sep 15, 2025.
- 5. Brown Health. New Important Information for UnitedHealthcare Medicare Advantage Members. Accessed Sep 15, 2025.
- 6. American Hospital Association. The Growing Impact of Medicare Advantage on Rural Hospitals Across America. Accessed Sep 15, 2025.
AD
Medicare Advantage plan coverage you can count on
<span>UnitedHealthcare provides expert guidance for today and as your needs change.</span>
AD
Get help with your 3 key Medicare decisions
<ul class="list-disc ml-5 [&>li>ol]:ml-4 [&>li>ul]:ml-4 [&>li]:mt-2"><li><div class="mt-0 mb-0"><span><span><span>When to enroll in Medicare<br></span><span></span></span></span></div></li><li><div class="mt-0 mb-0"><span><span><span>How to get the most value from Medicare<br></span><span></span></span></span></div></li><li><div class="mt-0 mb-0"><span>How to keep Medicare working for you</span></div></li></ul>
Mn-Fr 8am - 9pm, Sat 8am - 8pm EST
Speak to a licensed insurance agent on askchapter.org
