A contract dispute between one of the nation’s largest health insurers and a regional Virginia hospital system is about to change where thousands of older adults can get in-network care. Valley Health, which operates hospitals and physician practices across the Shenandoah Valley and the Eastern Panhandle of West Virginia, will stop being an in-network provider for certain UnitedHealthcare Medicare Advantage plans in the first days of October. The shift arrives just weeks before Medicare’s annual enrollment window opens, giving affected beneficiaries a narrow stretch of time to sort out their options. Both organizations confirm the change is tied to reimbursement negotiations, not to any change in what Medicare itself covers.
Individual and Group Retiree Medicare Advantage Plans Losing Network Status
UnitedHealthcare rejected Valley Health’s proposal to renew the contract covering its individual and Group Retiree Medicare Advantage PPO plans beyond the current termination date of September 30, 2026. As a result, Valley Health’s hospitals, facilities and physicians throughout Virginia and West Virginia become out of network for those plan types beginning October 1, 2026. The two organizations reached a separate agreement extending their Medicaid contract, so that dispute is limited to the Medicare Advantage line of business, though negotiations over commercial employer and marketplace plans were still unresolved as of the notice.
For beneficiaries enrolled in an individual Medicare Advantage PPO, out-of-network benefits generally remain available but carry a higher member cost share than in-network care. Group Retiree PPO members are treated differently: UnitedHealthcare states their cost share for care at an out-of-network Valley Health provider will match what they would have paid in network, though beneficiaries in both plan types are being encouraged to confirm directly with their Valley Health provider whether that provider will continue to see them after the transition.
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Which Medicare Advantage Plans Keep Their Network Access
Not every UnitedHealthcare member with a Medicare connection is affected. According to Valley Health’s own patient notice, Medicare Supplement (Medigap) plans are untouched, since those policies work alongside Original Medicare rather than through a Medicare Advantage network. UnitedHealthcare’s Dual Special Needs Plans, which combine Medicare Advantage with Medicaid coverage for lower-income beneficiaries, are also carved out and will keep full network access to Valley Health on and after October 1. Members can check for a “D-SNP” designation on their insurance card to confirm which category applies to them.
UnitedHealthcare Community Plan members, Complete Dual Complete enrollees, and veterans using Community Care Network benefits are likewise unaffected, since Valley Health and UnitedHealthcare separately extended their Medicaid-related agreement. UnitedHealthcare’s own notice on the dispute confirms the same carve-outs and directs affected members toward its provider directory at myuhc.com to locate an in-network alternative among nearby systems such as Inova Loudoun Hospital or WVU Medicine’s Berkeley and Jefferson medical centers. The distinction matters because a household can easily include one Medicare Advantage enrollee facing the network change and another relative on a Medigap or dual-eligible plan facing none of it, even though both carry a UnitedHealthcare card.
Continuity of Care and CMS’s Special Enrollment Rules
Beneficiaries already receiving active treatment, such as a scheduled surgery, pregnancy care or ongoing treatment for a serious or complex condition, may qualify for continuity-of-care protections that preserve in-network cost sharing at Valley Health for a limited period even after the network status changes. That protection is not automatic; UnitedHealthcare must approve the request, and beneficiaries are directed to call the number on their plan identification card to apply.
A separate option, a special enrollment period allowing a switch to a different Medicare Advantage plan or back to Original Medicare, is sometimes available when a plan experiences a significant reduction in its provider network. Per Medicare.gov’s own guidance on special enrollment periods, these network-related periods are evaluated case by case and must be approved by the Centers for Medicare and Medicaid Services rather than granted automatically to everyone whose hospital system leaves a network. Beneficiaries who believe they qualify can contact 1-800-MEDICARE directly, since eligibility depends on the specifics of the disruption and the individual’s plan.
Beneficiaries who want independent help sorting through those options, rather than relying solely on the insurer or the hospital system for guidance, can also turn to their state’s Medicare counseling program. Virginia’s State Health Insurance Assistance Program, reachable at 1-800-552-3402, and West Virginia’s equivalent program, reachable at 1-877-987-4463, both offer free, one-on-one counseling on continuity-of-care applications, special enrollment eligibility and plan comparisons, at no cost and with no obligation to switch coverage.
Fall Enrollment Deadline and the Shift to Direct Billing
Medicare’s Annual Enrollment Period, which runs October 15 through December 7 each year, gives every Medicare Advantage enrollee a guaranteed chance to switch plans or move to Original Medicare regardless of network disruptions, with any change taking effect January 1, 2027. For Valley Health’s UnitedHealthcare Medicare Advantage patients, that window opens just two weeks after the network change itself takes hold, compressing the decision timeline for anyone weighing whether to stay with a plan that no longer includes their local hospital system.
Roughly 8,000 patients across Virginia and West Virginia are affected, Valley Health officials estimate, according to reporting by the Winchester Star. Craig Connors, Valley Health’s vice president of revenue cycle and payor relations, said the system will continue filing out-of-network claims with UnitedHealthcare on patients’ behalf through December 31, 2026, with those patients responsible only for their out-of-network cost share in the interim. Starting in 2027, Valley Health will bill affected patients directly at Medicare rates for out-of-network services, after which patients will need to submit their own reimbursement claims to UnitedHealthcare. “Impacted patients need to check their benefits plans carefully,” Connors said, “to understand whether they have out-of-network benefits and how their financial responsibilities change when accessing care at out-of-network providers.”
This article was produced with AI assistance and reviewed by The Financial Wire editorial team.
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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.
