Hospitals, doctors drop Medicare Advantage plans, leaving seniors at risk

When a hospital or doctor drops a Medicare Advantage plan, older patients can be left with a brutal choice: stay in the plan and give up a trusted clinician, or change coverage and risk higher costs and new limits. That disruption is becoming more common as private Medicare plans spread across the country.

Medicare Advantage covered 32.8 million people in 2024, or 54% of the eligible Medicare population. In 2025, the average beneficiary could choose among 42 plans, including 34 with prescription drug coverage. But the breadth of choice masks a narrower reality once patients try to use the coverage. KFF found that Medicare Advantage enrollees had access to just 48% of the physicians available to traditional Medicare beneficiaries in their area, on average, using 2022 provider directories.

The pressure point is the network itself. Medicare Advantage organizations are required to maintain an adequate contracted provider network with time-and-distance standards and a minimum number of providers and facility types. Since contract year 2024, applicants for new or expanding service areas have had to prove they meet those standards before approval. Even so, when a physician group or hospital leaves, the damage lands on patients first.

CMS guidance issued in November 2024 said that if a provider termination is deemed a significant network change, the agency will tell the plan, and the plan must notify affected enrollees about special enrollment period eligibility. Plans also must notify affected members of the termination regardless of whether they qualify for a special enrollment period. A CMS model notice says beneficiaries may be able to change coverage in certain cases, including moving out of the service area, joining a 5-star plan, or gaining or losing Extra Help.

The scale of the problem has widened. In the past 15 months, CMS quietly offered roughly three-month special enrollment periods to thousands of Medicare Advantage members in at least 13 states after provider losses. In one case, Fred Neary, 87, of Dallas, faced a split between five doctors at Baylor Scott & White and his Humana Medicare Advantage plan; because the breakup happened during fall enrollment, he was able to switch plans effective Jan. 1.

The churn is not isolated. A 2025 KFF Health News report said at least 41 hospital systems had dropped out of 62 Medicare Advantage plans serving all or parts of 25 states since July, and separations between plans and health systems had tripled over two years, according to FTI Consulting. Becker’s reported that 18 major insurers exited some Medicare Advantage markets in 2025, affecting more than 1.8 million people in plans that would not exist the next year.

The policy debate now centers on whether Medicare Advantage’s cost controls have advanced faster than the safeguards needed to protect continuity of care. KFF said Medicare Plan Finder did not include Medicare Advantage provider network information in 2025, though insurers will be required to submit provider data directly to CMS for online publication beginning in 2027. For many seniors, the system still leaves the hardest decision until after the doctor is already gone.