Major Hospitals Are Quietly Dropping Medicare Advantage — Here's Why

Aug 10

5 min read

Older woman reviewing health insurance paperwork at home

If you or a loved one rely on Medicare Advantage, you might have recently heard some unsettling news in the healthcare world. Across the country, major hospital networks and health systems are stepping back, limiting contracts, or entirely dropping certain Medicare Advantage plans.

For many patients, this news brings a wave of worry and confusion. When you have built trust with your doctors, specialists, and hospital care teams over many years, finding out that your insurance plan may no longer be accepted can feel deeply stressful.

I hear from community members every day who are trying to navigate these sudden shifts in their care. For people already living with chronic pain or disability-related challenges, healthcare instability can feel especially frightening. Today, let’s break down why this is happening, what a major local change means for patients, and how you can protect your healthcare coverage.

A Real Example: What’s Happening at OSU Wexner Medical Center

To understand how real and immediate these shifts are, we can look at a significant upcoming change right here in Ohio.

The Ohio State University (OSU) Wexner Medical Center, The James Cancer Hospital, and OSU-affiliated physicians will no longer be in-network with Humana Medicare Advantage and Humana Healthy Horizons Medicaid plans, effective October 1, 2026.

This transition affects thousands of patients in the region who rely on Humana Medicare Advantage plans to cover their specialized care, routine checkups, and treatments at OSU facilities. While emergency services at OSU Wexner and The James will still be covered at in-network rates after the contract ends, routine and specialized outpatient care will face out-of-network restrictions unless patients take action.

This is not an isolated event. Health systems nationwide, including organizations like Mayo Clinic, Johns Hopkins Medicine, Scripps Health, and Kettering Health, have made similar decisions to drop or restrict various Medicare Advantage contracts.

Why Are Major Hospitals Dropping Medicare Advantage?

It is easy to wonder why hospitals, which exist to care for people, would step away from insurance plans that millions of seniors rely on. The reasons usually come down to intense operational friction between health systems and insurance providers.

1. Administrative Burdens and Prior Authorizations

Medicare Advantage plans are managed by private insurance companies rather than the federal government. To get treatments, tests, or specialist visits approved, doctors often have to submit extensive paperwork and wait for prior authorizations. Hospitals report that these approval processes cause frustrating delays in patient care and tie up valuable hospital staff in endless bureaucratic paperwork.

2. Payment Delays and Reimbursement Denials

Another major driving factor is money and timeliness. Hospitals rely on steady, timely reimbursements to keep their doors open, pay nurses and physicians, and upgrade medical equipment. In many cases, Medicare Advantage plans also reimburse hospitals at lower rates than Original Medicare, which puts even more strain on health systems already dealing with rising costs. Health systems frequently report that private Medicare Advantage insurers have high rates of prior authorization denials and delayed payments, forcing hospitals to spend months fighting to get paid for care they have already delivered.

When administrative costs climb, reimbursement rates stay lower, and payments are delayed or denied, hospitals find it increasingly difficult to sustain partnerships with those specific insurance carriers. For some health systems, the math simply no longer works. Many people in healthcare also believe this may be part of a larger turning point, with some predicting that Medicare Advantage could look very different — or even fade significantly — within the next five years.

What This Means for Patients and Families

If you are a Medicare Advantage beneficiary, changes like the OSU Wexner and Humana transition can feel overwhelming. You might be asking: Will I have to find a new doctor? Will my treatments be interrupted?

Fortunately, hospitals and insurers usually put certain safeguards in place during these transitions:

Transitional Care Periods: For patients undergoing active treatment for serious conditions (such as cancer or complex surgeries), insurers often allow a transitional care window, frequently up to 90 days after the contract termination date, where you can continue seeing your provider at in-network rates while you sort out your options.
Emergency Care Protections: Emergency medical care is legally protected under federal rules, meaning true emergencies at your local hospital will still be covered.

However, once the transition or grace period ends, seeing out-of-network doctors at hospitals like OSU Wexner can lead to steep, unexpected out-of-pocket costs. That is why staying informed and proactive is so crucial.

A senior patient having a comforting conversation with a healthcare navigator in a bright, modern consultation room

How to Protect Your Healthcare and Prepare

Navigating insurance changes requires patience, but you are not powerless. Here are practical steps you can take to safeguard your health and your coverage:

Review Your Current Plan Notice

Insurance companies and hospital networks are legally required to send notification letters when provider networks change. Watch your mail for official notices from your insurance provider or hospital system detailing exact effective dates and affected plans. You can also visit helpful community resources and check out our resources page for guidance on finding support.

Mark Your Calendar for Open Enrollment

The annual Medicare Open Enrollment Period runs from October 15 through December 7, with changes taking effect on January 1. If your preferred hospital system is dropping your Medicare Advantage plan, Open Enrollment is your opportunity to switch to a different Medicare Advantage plan that remains in-network with your doctors.

Consider Original Medicare Plus Medigap

Many patients choose to move away from Medicare Advantage altogether during these transitions, opting instead for Original Medicare (Part A and Part B) paired with a Medigap (Medicare Supplement) policy. Unlike Medicare Advantage, Original Medicare is accepted by nearly all hospitals nationwide, including major academic medical centers, giving you greater freedom of choice without worrying about narrow provider networks.

October 2026 calendar with October 15 highlighted and the Medicare Annual Enrollment Period listed as October 15–December 7.

Moving Forward With Confidence

Healthcare shifts can feel discouraging, especially for people already managing chronic pain, a disability, or mental health challenges. This may be part of a bigger shift in the healthcare industry, so it is wise for patients and families to keep an eye on where things may be heading. Please remember that you do not have to figure it all out alone. Take things one step at a time, review your options early, and lean on your support network.

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Disclaimer: Roy Jones is a mental health, disability, and chronic pain support advocate, not a licensed insurance agent, financial advisor, or medical professional. The information provided in this post is for educational and supportive purposes only and should not be taken as formal medical, legal, or financial advice. Always consult with a licensed insurance broker or State Health Insurance Assistance Program (SHIP) counselor before making changes to your Medicare coverage.

If you are feeling overwhelmed by healthcare changes, chronic pain, or life's transitions, you don't have to carry the burden by yourself. Reach out to Roy Jones on Wheels today for compassionate peer support and encouragement. Visit royjonesonwheels.com to connect, share your story, or find the resources you need to keep moving forward with hope.