A retiree in Wisconsin opens a letter from her cardiologist’s office: starting next January, the hospital system will no longer be in-network for her Humana (NYSE: HUM) Medicare Advantage plan. She has been with that cardiologist for nine years. Her first instinct is to switch back to Original Medicare and buy a Medigap policy. That intention is understandable. Whether it works depends on her health, her state, and one unforgiving deadline.
Becker’s Hospital Review is now tracking 25 health systems that have dropped or narrowed Medicare Advantage contracts in 2026, and the list keeps growing. If your plan still covers your doctors and hospital, this article is background reading. If a termination letter has already arrived, or your AEP mailer shows your primary hospital moving out of network, the next 90 days matter more than the premium comparison you were planning to run.
Why Systems Are Walking
Hospitals commonly cite slow reimbursement, payment disputes, prior-authorization requirements, and the administrative cost of dealing with Medicare Advantage plans. In other cases, the insurer terminates the contract. Either way, the negotiations happen across a conference table, and the patient loses a nine-year relationship with her doctor.
When a hospital exits, the plan’s advertised out-of-pocket maximum may stop offering the protection she thought she bought.
The Number That Actually Bites
In 2026, the federal maximum allowable Medicare Advantage out-of-pocket limit is $9,250 for in-network care. For PPOs, the combined in- and out-of-network limit can reach $13,900. Two things about those numbers matter more than the numbers themselves.
First, neither cap includes Part D drug spending. A cancer patient hitting the medical MOOP can still owe up to another $2,100 for covered Part D drugs in 2026.
Second, the protection depends on the type of plan. A PPO generally covers out-of-network care at higher cost-sharing, potentially pushing the patient toward that $13,900 combined limit. An HMO generally does not cover routine out-of-network care at all. When a hospital walks, affiliated doctors, follow-up imaging, infusion services, and surgical teams may follow it out of network. A patient who thought her worst-case year was $9,250 may now face a much larger bill, plus drugs, plus the practical cost of finding new doctors.
The Switch-Back Trap
Original Medicare plus comprehensive Medigap coverage leaves the beneficiary responsible for relatively little Part A and Part B cost-sharing and can be used nationwide with providers who accept Medicare. Wisconsin standardizes Medigap differently from most states, so policies there are not sold under lettered names such as Plan G. On paper, switching back can still look like the obvious move. In practice, it depends on one date.
The federal Medigap open enrollment window is six months long and runs once, starting the month a beneficiary is 65 or older and enrolls in Part B. After that window closes, insurers in most states can medically underwrite Medigap applications and decline or charge more based on an applicant’s health. State protections vary, so check the rules where you live before assuming a policy is available.
Two timing rules can help, but only one may carry a Medigap guarantee. The Medicare Advantage Open Enrollment Period runs January 1 through March 31 and lets any MA enrollee return to Original Medicare, though Medigap underwriting rules still apply outside guaranteed-issue windows.
The federal trial right is narrower. It applies when someone joined Medicare Advantage upon first becoming eligible for Medicare at 65, or dropped a Medigap policy to try Medicare Advantage for the first time. In either case, the right generally lasts 12 months. Simply joining an MA plan for the first time later in life does not automatically qualify.
A major provider-network change may also qualify an enrollee for a Special Enrollment Period, but Medicare evaluates those cases individually. The network change does not automatically create a guaranteed right to buy Medigap.
What to Do Before AEP Closes
The Annual Enrollment Period runs October 15 to December 7. The letter creates a deadline, not a verdict. Three actions carry the weight.
- First, call your primary care physician’s billing office and your main hospital’s insurance verification line and ask which MA contracts they will honor in January. Do not rely solely on the plan directory. Confirm the answer with both the provider and the insurer.
- Second, if you fall inside a trial right or a state guaranteed-issue window, price the Medigap coverage available in your state against your current MA premium plus a realistic sick-year estimate. For Wisconsin residents, compare the state’s standardized policies and optional riders, not Plan G quotes.
- Third, if you are outside any guaranteed-issue window and have chronic conditions, apply for Medigap first and switch out of MA second. Rejection from an underwritten Medigap application does not force you off MA. Cancelling MA before you have a Medigap acceptance in writing can strand you with Original Medicare and no supplement, which is the worst of both worlds.
The systems are still leaving. Do not let auto-renewal choose your doctors for you.
Contact [email protected] for any questions or corrections.
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