Private Medicare Advantage enrollees in the United States are facing growing instability as major hospital systems withdraw from insurer networks. A proposed federal rule intended to ease disruptions has now been set aside, leaving patients with limited recourse for the time being.
The development reflects a broader tension between insurers and healthcare providers, with consequences already affecting tens of thousands of beneficiaries. For many patients, the issue is not only financial but also deeply personal, involving long-standing relationships with doctors. The situation has drawn attention from regulators and industry groups alike, yet no immediate policy solution is in place.
Patients Caught between Insurer Networks and Provider Departures
Across several states, hospital systems and physician groups have begun exiting Medicare Advantage networks, a move that restricts patients to in-network care under most plans. According to reporting by The New York Times, around 65,000 beneficiaries in North Carolina were affected when UNC Health withdrew from multiple Advantage plans, including Humana.
For patients like Amy Trojanowski, the implications are immediate. She had relied on her plan not only for added benefits such as a monthly $200 debit allowance and dental coverage, but also for continued access to a trusted physician. When informed that her doctor would no longer be in-network in 2026, she faced a difficult choice between maintaining coverage or keeping her provider.
Unlike traditional Medicare, which allows patients to see any provider who accepts it, Medicare Advantage plans operate within defined networks. This structure can limit flexibility when contracts between insurers and healthcare systems change. According to The New York Times, such disruptions are becoming more common, raising concerns among patient advocacy groups and medical organisations.
TheAmerican Medical Association and the American Hospital Association have both expressed support for measures that would protect continuity of care. State insurance officials have also backed efforts to simplify plan changes when provider networks shift midyear.
Federal Proposal Withdrawn despite Broad Support
In November 2025, the Centers for Medicare & Medicaid Services (CMS) introduced a proposed rule aimed at addressing these disruptions. The policy included a provision to streamline the process allowing beneficiaries to switch plans if their providers left a network.
According to CMS, the proposal sought to remove existing limitations that required network changes to be deemed “significant” before patients could qualify for a special enrolment period. The intention was to make it easier for individuals to maintain access to their preferred doctors.
The proposal was part of a broader package of reforms for the 2027 contract year, which also included updates to quality ratings and enrolment processes. According to CMS documentation, these changes were designed to improve access to care and reduce administrative burdens while focusing more on clinical outcomes and patient experience.
Despite this, CMS confirmed earlier this month that the rule would not be finalised. A spokesperson stated that the agency routinely reviews public feedback before making decisions, though no specific reason was given for abandoning the measure.
The absence of this policy leaves a gap for patients affected by ongoing network changes. While discussions about future reforms continue, individuals enrolled in Medicare Advantage plans must navigate these disruptions under the current system, with limited flexibility when providers exit networks.
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