Twenty-five hospital systems have walked away from Medicare Advantage contracts in 2026, according to an industry tracker that keeps adding names as the year goes on. Each exit follows a similar script: a termination letter arrives, the hospital’s doctors and facilities go out of network, and the beneficiary’s plan card looks unchanged even though the providers behind it are gone. Many retirees assume a disruption of this size opens the same guaranteed switching window and extended treatment protection that comes with a plan’s own year-end exit from Medicare. The federal rulebook draws a sharper line than that assumption allows.
Becker’s Hospital Review Counts 25 Exits, and the List Keeps Growing
Becker’s Hospital Review has tracked hospital-insurer breakups involving Medicare Advantage since 2023, and its running 2026 list documented 25 health systems that had gone out of network with at least one Advantage insurer by late July, a count the outlet has kept updating as new contract breaks landed through the summer. Fort Myers, Florida-based Lee Health, Rochester, Minnesota-based Mayo Clinic, and Chapel Hill, North Carolina-based UNC Health are among the systems that broke with one or more Medicare Advantage insurers this year, citing reasons that range from prior-authorization denials and slow reimbursement to insurers terminating the contracts outright.
The trend has not slowed. Becker’s own running list of 2026 contract breaks has since grown past 25, with Columbus-based Ohio State University Wexner Medical Center and New York City-based NewYork-Presbyterian both facing Oct. 1 exit dates from UnitedHealthcare or Humana Advantage networks absent a new deal. Twenty-five is a documented floor for how many hospital systems have broken with Medicare Advantage plans in 2026, not a final tally.
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Federal Notice Rules Cap Warning at 30 or 45 Days, Not 90
When a hospital system and a Medicare Advantage insurer break a contract, the insurer’s notice obligation to affected members is set by regulation, not by custom. Under 42 CFR 422.111, a Medicare Advantage organization must provide written notice at least 45 calendar days before the termination effective date for a primary care or behavioral health provider, and make a good-faith effort to give written notice at least 30 calendar days before the effective date for other specialists and facilities. That notice must go to enrollees who are currently assigned to the provider or who have been treated by that provider within the past few years, and it applies whether the break was for cause or not. Nothing in that rule extends the warning period to 90 days, no matter how large or well-known the exiting hospital system is.
The distinction matters because several of this year’s exits involve entire specialty groups, not a single physician. When Mayo Clinic went out of network with most UnitedHealthcare and Humana Advantage plans, or when UNC Health dropped Humana, WellCare, and Health Care Service Corp. plans, the same 30-to-45-day clock applied to every affected enrollee at once, leaving a comparatively narrow runway to research alternatives before the change took effect.
Why the 90-Day Rule in 42 CFR 422.112 Does Not Cover a Mid-Year Exit
The confusion around a “90-day protection” traces back to a real federal rule that simply does not apply to this situation. Under 42 CFR 422.112, a Medicare Advantage organization must provide a minimum 90-day transition period, without disrupting or requiring reauthorization of an active course of treatment, for an enrollee who is new to that plan or new to Medicare. That protection is built for someone switching into a plan mid-treatment; it prevents the new plan from cutting off care the beneficiary already started elsewhere.
A hospital system leaving a beneficiary’s current, existing plan is a different event entirely. The beneficiary has not enrolled in anything new, so the 90-day switching-plan protection in 422.112 never activates. A plan may still choose to authorize transitional coverage for an ongoing course of treatment on its own terms, and the termination notice required under 422.111 is supposed to explain how to request it, but that authorization is a plan decision, not a guaranteed 90-day federal floor.
A Special Enrollment Period Is Discretionary Here, Not Guaranteed
Medicare’s own rules reinforce the same gap on the enrollment side. Medicare.gov’s Special Enrollment Periods page lists automatic, guaranteed switching windows for a plan’s own contract termination or non-renewal by Medicare, but a provider leaving a plan’s network falls instead under “other exceptional circumstances,” evaluated case by case when CMS determines a network change is significant enough to warrant one. A termination letter from a hospital system does not, by itself, open that door; the beneficiary has to contact 1-800-MEDICARE and ask whether CMS will authorize it for that specific situation. Absent that approval, the next dependable opportunity to change plans is the Annual Enrollment Period running Oct. 15 through Dec. 7, with new coverage starting Jan. 1.
The money at stake in that gap is not trivial. According to KFF’s 2026 Medicare Advantage analysis, the average in-network out-of-pocket limit this year is $5,421, while the average combined in- and out-of-network limit among PPOs is $9,825. A beneficiary who keeps seeing a now-out-of-network cardiologist or oncologist while waiting for the fall enrollment window can face a ceiling nearly double what the plan’s in-network cap advertised, on top of routine out-of-network care that HMO plans typically do not cover at all outside emergencies.
This article was produced with AI assistance and reviewed by The Financial Wire editorial team.
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Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
