Thousands of Medicare Advantage beneficiaries are facing a pressing question this enrollment season: whether to select a new insurance plan or risk losing access to their trusted healthcare providers. As the annual open enrollment period for 2026 runs from October 15 to December 7, many seniors are increasingly aware that their choices extend beyond just premiums or additional benefits; they must also consider the network stability of their existing doctors and hospitals.
For years, the negotiations between Medicare Advantage plan sponsors—private insurers managing Medicare benefits—and healthcare providers occurred behind closed doors. However, recent public disputes have escalated, leading to significant decisions for patients who may need to change doctors, insurance plans, or potentially incur higher out-of-network costs at a time when healthcare expenses are on the rise.
Prominent examples highlight the turmoil. In Oregon, for instance, a potential contract breakdown between Oregon Health & Science University (OHSU) and UnitedHealthcare nearly left over 61,400 Medicare Advantage members without in-network access to OHSU’s facilities. Fortunately, an agreement was reached after public negotiations that included direct-mail and advertising campaigns from both sides. Conversely, negotiations earlier this year between Salem Health and Regence BlueCross BlueShield failed completely, resulting in Salem Health’s hospitals and clinics exiting Regence’s network as of January 1, placing added financial burdens on seniors needing care at those facilities.
This trend is not confined to a single region; it is occurring nationwide, with 28 health systems terminating Medicare Advantage contracts in the first half of 2025 alone, according to Becker’s Hospital Review. Experts attribute these disputes to hospitals and large physician groups pressing for higher reimbursements to offset rising costs, including inflation, increased wages for healthcare workers, and surging medical supply prices. OHSU’s leadership emphasized that negotiating better reimbursement rates from insurers is crucial for financial stability, with ongoing talks planned with additional insurers.
The implications of these disputes extend beyond just individual hospitals. Paul Ginsburg, a health policy professor at the University of Southern California, noted that rising pressures on providers and increasing demands from health systems are causing a reevaluation of participation in Medicare Advantage among many providers. The unpredictability introduced by these disputes complicates the planning process for seniors, who have limited options for real-time adjustments to their plans.
Currently, most Medicare Advantage enrollees can only switch plans during the annual open enrollment window. If a provider exits the network mid-year, there is no automatic special enrollment period triggered for affected patients, although the Centers for Medicare and Medicaid Services has allowed special enrollments in limited cases where patients lose access to essential providers.
Some seniors may contemplate reverting to traditional Medicare during this enrollment season. Traditional Medicare generally provides access to a broader array of providers and has fewer authorization hurdles. However, it lacks a built-in maximum out-of-pocket limit, which often necessitates additional Medigap insurance to manage costs. Securing this supplemental insurance post-enrollment can be challenging, as many insurers may deny coverage or offer higher rates based on existing health conditions, leaving those who transition from Medicare Advantage at a disadvantage. Regulations in most states do not guarantee Medigap access once the initial enrollment period concludes, complicating matters further for many beneficiaries.
As the open enrollment period unfolds, Medicare Advantage beneficiaries face a crucial decision-making juncture, balancing the stability of their healthcare network against the complexities of coverage and costs in a changing landscape.
