Endeavor Health will no longer be in network for Aetna Medicare Advantage plans beginning January 1, 2027, the health system says. Patients with an Aetna plan have until December 7, the end of the annual enrollment window, to review their options if they want to keep seeing Endeavor doctors at in-network prices. After that date, out-of-network care may cost more.
Which Aetna members are affected
Endeavor, the Evanston, Illinois, system, says the change covers Aetna Medicare Advantage plans. Two groups are not affected: State of Illinois retirees in the TRAIL MAPD PPO plan, and anyone with an Aetna PPO ESA plan, because those plans offer broad access to any provider that accepts Medicare.
Traditional Medicare is not changing. Endeavor says it will keep accepting original Medicare, along with Medicare Advantage plans from Blue Cross Blue Shield of Illinois, Essence Healthcare, Humana and UnitedHealthcare. It adds that benefits vary and not every plan is sold in every region. Changes made during annual enrollment take effect January 1.
The scale is not small. CMS projects about 34 million people will be in Medicare Advantage in 2027, roughly 47.4% of everyone with Medicare. Endeavor is one of at least 33 health systems that have ended, or are preparing to end, contracts with a Medicare Advantage insurer, according to a Becker’s Hospital Review tracker cited by Medical Daily.
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For a patient, the question is whether Endeavor doctors and hospitals matter enough to change plans. The choices are staying with Aetna and going out of network, moving to one of the plans Endeavor still accepts, or switching to traditional Medicare, each with a different cost and drug-coverage picture.
What leaving the network can cost
Endeavor’s warning is plain: out-of-network benefits vary by plan, and patients may incur higher costs for out-of-network care. The system says it will still see office and elective patients on affected plans and bill their insurance, so an appointment is not refused, but the bill can be larger.
Emergency care is protected. Endeavor says its emergency department access continues regardless of network status until a patient is stable.
Patients in active treatment may have another route. Endeavor lists post-surgery care, cancer care, dialysis, regular infusions and chronic controlled-substance prescriptions as situations that may qualify for continued in-network care. The request goes through the insurer, which decides case by case.
That puts the decision with Aetna, not the hospital. A patient in the middle of treatment would ask Aetna about continuity of care early, not after the first out-of-network bill arrives.
The December 7 clock
Medicare.gov says open enrollment runs October 15 to December 7, and a plan change made in that window starts January 1. The plan must receive the request by December 7. During the window a person can switch to another Medicare Advantage plan, with or without drug coverage, or move between Medicare Advantage and Original Medicare.
Missing the date does not end every option. Medicare Advantage members get a separate open enrollment period from January 1 to March 31, but only people already in a Medicare Advantage plan can use it, and a change then takes effect the first of the month after the plan gets the request. By then Endeavor will already be out of network.
Medicare.gov also lists a special enrollment period from December 8 to the last day of February, but it applies when a plan’s contract is not renewed and the member would otherwise default to Original Medicare. Endeavor’s notice sends patients to the annual window instead, and a patient who waits for the later period risks starting January out of network.
A plan switch carries its own questions. Drug lists, premiums and the networks of other doctors differ from plan to plan. CMS says the average Medicare Advantage premium for 2027 is $12.00 a month, down from $14.37, but an average hides wide gaps between individual plans.
KFF analysis cited by Medical Daily found about 7 in 10 Medicare beneficiaries did not compare plans during a recent enrollment period. Staying put by default is the common choice, and in this case it is the choice that sends Aetna members out of network at Endeavor on January 1.
Where to get free help
Endeavor lists three phone lines. BenefitsCheck, its transition partner, is at (855) 774-9510. Medicare’s helpline is 1-800-633-4227, and the Illinois Senior Health Insurance Program, known as SHIP, is at (800) 252-8966.
The health system also points patients to Medicare.gov and to an independent insurance broker. Anyone choosing a new plan should check Endeavor’s name against that plan’s provider directory and each prescription against its drug list.
Endeavor’s notice does not say why the contract with Aetna ended. What it does say is that the date is fixed and the enrollment deadline is December 7.
The open question for each patient is whether the Endeavor name on a doctor list is worth a plan change, and what the other plan would cost in drugs and premiums.
Staying with Endeavor Health after January 1?
Aetna members who stay put by default will wake up on January 1 with Endeavor out of network, and a December 7 deadline missed means months of possible out-of-network bills at the doctors they have used for years.
The 2027 Medicare Open Enrollment Decision Kit gives Aetna members a cost calculator spreadsheet that compares plans on cost, drugs and doctors, a prescription-by-plan comparison and a provider call script for confirming whether Endeavor doctors are in network, plus the Open Enrollment calendar showing each date to the December 7 deadline.
Compare plans on cost, drugs and doctors with the Open Enrollment calculator kit →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
