Hospitals Saying “No” to Medicare Advantage in 2027

What patients and caregivers need to know this Medicare Open Enrollment Season

The annual Open Enrollment season starts October 15 and runs through December 7th. This is the time of year when people aged 65+ can change their Medicare insurance coverage, including switching between Medicare Advantage companies and Original Medicare offered by the federal government.

You will likely see a flood of Medicare Advantage ads — thousands a day by some estimates. But behind the  promises, many hospitals are quietly saying no to these corporate plans. (Note: Government Medicare is not allowed to advertise.) The plans can be attractive: many offer low premiums plus benefits such as dental, vision and hearing coverage.

But this year, there are some important changes to look at before automatically renewing your plan, or switching away from original Medicare.

Hospitals and health systems across the country continue to end contracts with some Medicare Advantage plans.

In 2026 alone, Becker’s Hospital Review tracked more than 30 health systems dropping one or more Medicare Advantage contracts, mainly due to:

• Prior authorization requirements
• Denials of doctor-recommended care and
• Delayed or inadequate reimbursement.

And lately, important new information about care denials has come to light.

A 2026 report from the Department of Health and Human Service found especially high denial rates for care people often need after a hospitalization.

For example, Medicare Advantage plans denied:

• 54% of requests for inpatient rehabilitation
• 65% of requests for long-term care hospital care
• 12% of requests for skilled nursing facility care

Here’s the number that really caught our attention: when skilled nursing facility denials were appealed, 95% were overturned in favor of the patient.

Consider this:  you may be recovering from surgery or a serious illness, still weak and sitting in a hospital bed, when you’re told your Medicare Advantage plan has denied the continued care your doctor recommends. Now you have to figure out how to appeal it and advocate for more care when you feel least able to do so.

No wonder only 18% of denials are challenged!

So, while a 95% reversal may sound promising, what happens to the patients whose denials aren’t appealed?

This doesn’t mean Medicare Advantage is wrong for everyone.
But it does mean it’s worth looking carefully at how your plan works — especially if you have significant health problems or may need rehabilitation or skilled care.

Already have Medicare Advantage? Ask questions!

Check your doctors AND hospitals. Don’t simply ask, “Do you take Medicare Advantage?” Ask whether they will be in-network with your exact plan in 2027. Different plans from the same insurance company can have different networks.

If you see specialists or receive care from a major medical center, check them too. Several well-known systems have recently ended contracts with particular Medicare Advantage insurers, and more changes have been announced for 2027.

Review prior authorization requirements. If you have a serious or chronic condition, ask whether treatments, rehabilitation, skilled nursing, medications or other services you may need require advance approval.

Read your Annual Notice of Change. Look beyond the premium. Check deductibles, copays, drug coverage, maximum out-of-pocket costs, provider networks and supplemental benefits. What worked well in 2026 may be different in 2027.

Considering Original Medicare?

Original Medicare generally lets you see any doctor or hospital in the U.S. that accepts Medicare, and prior authorization is required far less often.

But there is an important consideration: original Medicare has no annual out-of-pocket maximum, so many people purchase a Medigap plan (also called a Supplement.)

Don’t assume you’ll automatically qualify for Medigap if you leave Medicare Advantage. Depending on when you enrolled, where you live and other circumstances, an insurer may be allowed to consider your health history or even decline coverage.

Before making any switch, check your Medigap eligibility first.

If you are considering a Medicare Advantage plan, check first to see if your preferred hospital still takes it, or has narrowed the plans they accept.

Though a growing number of hospitals and health systems have ended contracts with some Medicare Advantage insurers or sharply narrowed the plans they accept, it  does not necessarily mean a hospital has stopped accepting all Medicare Advantage plans. Network participation can vary by insurer, exact plan, location and even physician group.

Before choosing or renewing a plan, ask both your insurer and your health care providers:

“Will my doctors and hospitals be in-network with my exact Medicare Advantage plan in 2027?”

Following are lists of changes you may wish to consider in your decision this Open Enrollement season. Things may still change so always verify directly before making an enrollment decision.

Medicare Advantage Network Changes Already in Effect:

Medicare Advantage Changes Announced for Late 2026 or 2027:

Hospitals reported to be in negotiations with Medicare Advantage Plans:

Hospitals that have restored Medicare Advantage Participation:

Again, confirm with your own research. Change is a constant!

Keep in mind…

A hospital being “out of network” does not always mean you can never receive care there. PPO plans may provide out-of-network coverage, although your costs can be considerably higher. HMO plans generally offer much less flexibility outside their network, except for emergencies and certain protected circumstances. 

Always know: Are you covered by PPO or HMO plan?

And emergency care is different: Medicare Advantage plans must cover emergency services regardless of whether the hospital is in the plan’s network.

The safest approach: Don’t rely only on an insurer’s online directory. Call your doctors and hospitals and your Medicare plan to confirm that each will be in network for your exact plan in 2027.

Q & A: Key to Your Decision – and Peace of Mind  

As hospitals reassess their relationships with Medicare Advantage, patients and families need clear information to make confident decisions. The best defense is awareness — and partnership.

Check your coverage, ask questions, and share what you learn with others who may be confused by advertising noise. By law, tradional Medicare cannot advertise, but that does not mean it’s not a good option! 

When care and insurance policies align according to personal needs, preferences and risk tolerance, patients can feel assured they have access to care with costs covered as they expect — no surprises!

Download your free hospital checklists here!