A letter arrives at a Medicare Advantage member’s home in late summer: the regional hospital system that has handled her cardiology, oncology, and primary care will leave her insurer’s network at the end of September. The plan card in her wallet still works. The doctors she has seen for years do not automatically come with it. At least 25 U.S. health systems have dropped Medicare Advantage contracts in 2026, and each departure carries the same hidden math problem. An average in-network out-of-pocket ceiling of $5,421 can push toward a combined $9,825 once out-of-network costs enter the picture, and neither continued care nor a new plan arrives automatically.
Why the Advertised Ceiling Doesn’t Hold Once a Hospital Exits
The number printed on a Medicare Advantage plan’s marketing material only covers spending on care received under that plan’s network rules. Once a hospital exits, treatment there falls into a different cost bucket entirely. According to average 2026 figures showing a typical in-network out-of-pocket limit of $5,421 against a combined in- and out-of-network limit of $9,825 on a PPO, the sick-year ceiling does not disappear when a hospital leaves — it very nearly doubles.
The size of that jump depends on plan type. An HMO generally does not cover routine out-of-network care at all, aside from emergency and urgent visits, so a member who keeps seeing a departed hospital’s specialists may owe the full billed amount. A PPO usually continues covering out-of-network treatment, but at higher cost-sharing under the larger combined ceiling. Either way, the protection a retiree budgeted for is not the protection left standing once the contract ends.
Hospitals and insurers typically frame these splits as failed contract negotiations over reimbursement rates, prior-authorization demands, and the rising cost of treating older, sicker patients. Mayo Clinic went out of network with most UnitedHealthcare and Humana Advantage plans on January 1, and regional systems have followed on their own schedules since. Becker’s Hospital Review is tracking at least 25 health systems that have dropped or narrowed Medicare Advantage contracts in 2026, a list that has kept growing through the year.
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The 90-Day Rule Is Narrower Than It Sounds
Medicare Advantage plans generally must give affected members notice before a contracted provider leaves — at least 45 days for a primary care or behavioral health provider, 30 days for other specialists and facilities. That notice is required to explain how to request continuation of ongoing treatment. It does not create an automatic 90-day extension of coverage with every departing doctor, a distinction that trips up members who assume otherwise.
The actual federal 90-day protection, found in 42 CFR 422.112, applies when someone enrolls in a new Medicare Advantage plan after already starting an active course of treatment; it stops the new plan from immediately disrupting that care, even with an out-of-network provider. A hospital or doctor leaving a member’s current, existing plan is a different scenario, and the No Surprises Act’s continuing-care protections do not extend to Medicare Advantage because Medicare programs run under their own separate rules.
A plan may still approve transitional care under its own internal policy, and some state protections can help depending on where a member lives. The termination notice is supposed to explain how to ask, but the request has to be made in writing, and it has to identify every active treatment, prior authorization, and scheduled procedure by name — a plan will not volunteer the broadest possible interpretation on its own.
A Network Exit Doesn’t Automatically Open a Switching Window
A provider departure does not by itself create a Special Enrollment Period. CMS may authorize one when it determines a network change is significant enough, but a member should not assume the termination letter itself opens that door. The notice is required to mention 1-800-MEDICARE and the possibility of requesting consideration for an SEP based on individual circumstances, which means the request, again, falls on the member rather than the plan.
Absent that approval, the next dependable opportunity to switch is the Annual Enrollment Period running October 15 through December 7, with new coverage starting January 1. Returning to Original Medicare is allowed during an applicable enrollment window, but buying a Medigap policy afterward depends on one unforgiving deadline: once the federal six-month Medigap enrollment window — which starts the month someone turns 65 and enrolls in Part B — has closed, insurers in most states may medically underwrite a new application and decline it or price it higher based on health history.
A hospital leaving an Advantage network does not, on its own, create a federal Medigap guaranteed-issue right. A member with chronic conditions who wants to leave Medicare Advantage is generally better off applying for Medigap first and switching plans second, since a rejected underwritten application does not remove someone from their current Advantage plan, but canceling that plan first, before Medigap approval is in writing, can leave a retiree with Original Medicare and no supplemental coverage at all — the least protected position of the three.
This article was produced with the assistance of AI and reviewed by The Money Overview editorial team before publication.
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