Sentara Health, Virginia’s largest hospital system, has told Anthem Blue Cross and Blue Shield of Virginia it wants a 6.2% blended increase in what the insurer pays for 2027, spanning its commercial, Medicare and Medicaid agreements alike. Anthem’s counteroffer moved the opposite direction: roughly a 1% cut. The gap between those two numbers has pushed the two organizations toward a possible split that could leave Sentara hospitals and doctors out of Anthem’s network for hundreds of thousands of Virginians, including Medicare Advantage enrollees. For an older Anthem member with a Sentara-affiliated doctor, a fight over a single percentage point is really a fight over whether that doctor stays in network past New Year’s Day.
A Blended 6.2% Ask Meets a 1% Counteroffer
Sentara’s request is a blended figure spanning multiple commercial, Medicare and Medicaid contracts, not a single line-item increase. Aubrey Layne Jr., the health system’s executive vice president and chief administrative officer, has said the 6.2% figure is meant to catch up with labor, drug and supply costs that have outpaced the current agreement with Anthem, layered on top of reductions in federal healthcare funding already working through hospital budgets.
Anthem’s counteroffer runs the opposite direction, cutting reimbursement by roughly 1 percent instead of raising it, according to Becker’s Payer Issues. Sentara says a cut of that size would force decisions on staffing, service lines and how many patients its hospitals can take on, given that the health system already operates on a 3% to 5% margin against roughly $14 billion in annual revenue.
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Medicare Advantage Coverage Sits Inside the Same Contract
The agreements at stake are not limited to commercial insurance. Anthem administers Medicare Advantage and Medicaid managed-care products under the same set of contracts now in dispute, and most of the affected commercial and Medicare agreements remain in effect only through Dec. 31, 2026, per the Becker’s reporting on the dispute. That means an Anthem Medicare Advantage member whose primary care doctor, cardiologist or hospital is part of Sentara could be looking at an out-of-network relationship starting the first of the year if the two sides do not reach a new deal.
Sentara has said a lapse would raise out-of-pocket costs, disrupt existing physician relationships and narrow care options for affected Anthem members, and it specifically named seniors, people with disabilities and lower-income families as the groups with the least room to absorb that kind of disruption.
A $105 Million Unpaid-Claims Fight Runs Alongside the Rate Talks
Layered on top of the rate dispute is a separate fight over money Sentara says it is already owed. The health system alleges Anthem has left more than $105 million in claims unpaid for over 90 days, has not paid $12 million tied to a 2025 billing settlement, and has withheld more than $4 million by downgrading the severity of emergency-department visits, according to Becker’s Payer Issues.
Sentara has framed the unpaid claims as part of the same financial pressure behind its rate request, contrasting its nonprofit structure with Anthem parent company Elevance Health’s $5.7 billion in net income on $197.6 billion in operating revenue in 2025. Anthem, for its part, has said its negotiating position reflects a responsibility to keep coverage affordable for the members, employers and taxpayers it serves.
The Clock: Dec. 31 for Most Contracts, Jan. 28 for Medicaid
Sentara issued formal notice on July 31, 2026, that it intends to let the disputed agreements lapse if no new deal is reached, a standard contractual step that both sides say does not by itself end the negotiations. Nearly 380,000 Anthem members across Virginia could be affected, including about 215,000 in the Hampton Roads region.
The contracts do not all expire on the same date. Most commercial and Medicare agreements run through at least Dec. 31, 2026, the Medicaid agreement continues through Jan. 28, 2027, and several other pieces of the relationship expire on a rolling basis through 2027, according to Becker’s. Until any individual contract actually lapses, Anthem members can keep seeing Sentara providers at in-network rates.
Both Sides Say They Still Want a Deal
Anthem has told Becker’s Payer Issues it remains “optimistic we can reach an agreement before the current contract expires.” Sentara’s Layne struck a similar note, saying, “We remain ready to reach a fair agreement — and Anthem must come to the table prepared to do the same.” Neither side had announced a resolution as of this reporting, leaving Dec. 31 as the date that determines whether the dispute reaches Anthem’s Medicare Advantage members directly, per Becker’s ongoing coverage of the negotiations.
Where the help is written down
The programs that lower Medicare costs each run on a different form and a different office, and no single notice lists them together.
The Medicare Cost & Coverage Protection Kit includes a 10-page kit, 51 state Medicare cost-help packs and the new Part D out-of-pocket cap.
See the state cost-help packs in The Medicare Cost & Coverage Protection Kit.
AI assisted in the reporting and drafting of this article, which a human reviewed before publishing.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
