10 Medicare Advantage moves practices should make before open enrollment ends Dec. 7

Blue Cross and Blue Shield of Texas is leaving Medicare Advantage after 2026. It offered plans in 227 Texas counties this year. In Florida, Lee Health, Sarasota Memorial and AdventHealth are set to be out of network with UnitedHealthcare on Jan. 1 unless agreements are reached.

Nationally, UnitedHealth Group is leaving 228 counties, Humana 62, Health Care Service Corp. 498 and Centene 359, according to a KFF analysis of 2027 plan data.

Open enrollment ends Dec. 7. That leaves practices about five weeks to find patients whose plan or network is changing and help them avoid starting the year out of network.

Practices in Illinois, Michigan, Wisconsin, Missouri, Pennsylvania and Indiana face smaller changes, but their front desks will still field questions and see new cards in January.

These 10 steps cover what's changing in each of those eight states and the federal rules on notices, directories, continuity of care and what staff may say.

1. Find affected patients and reach them before Dec. 7

Every other step depends on this one. Run a report from your practice management system of every patient with Medicare Advantage (MA) coverage, sorted by plan. Match it against the exits and network changes in your state, and flag patients whose plan is ending or whose plan won't cover your practice, your hospital or the specialists you refer to most.

Then contact them by phone, letter or patient portal message while there's still time to choose a plan for Jan. 1. Tell them which plans your practice will accept in 2027 and point them to the Medicare Plan Finder, 1-800-MEDICARE or their State Health Insurance Assistance Program (SHIP) for help comparing options. Keep the outreach within the marketing rules in No. 6.

Patients who hear from you in November can keep their care in place. Patients who find out in January may already be in a plan that doesn't include you.

2. Re-verify every MA patient's coverage in January

Members of a plan that isn't renewing who don't choose a new one by the deadline go to Original Medicare, according to Washington's insurance commissioner and Bloomberg's report on UnitedHealthcare. Patients who don't realize that may show up in January with an old card that no longer works.

Because the special enrollment period runs through February and the MA open enrollment period runs through March 31, a patient's coverage can change again after the first visit of the year.

Run eligibility checks before every MA visit in the first quarter, not just the first one, and ask patients at check-in whether they've changed plans. Catching a change at the front desk costs far less than reworking a denied claim.

3. Protect patients in the middle of treatment

Patients who switch plans midway through a course of treatment have a federal safeguard. MA coordinated care plans must provide a minimum 90-day transition period for any active course of treatment when a patient enrolls after starting it, even if an out-of-network provider furnishes the service.

During those 90 days, the plan must not disrupt or require reauthorization for the active course of treatment. The rule applies to basic benefits and covers patients new to a plan and patients new to Medicare.

Flag every patient who is actively seeing a clinician for an ongoing course of treatment and whose plan or network is changing.

Document when treatment started, keep current prior authorization approvals on file and send them to the new plan in early January. If a new plan denies or delays care that falls inside the transition period, cite the rule in your appeal.

4. Audit your provider directory listings in every MA plan

Patients choosing a plan before Dec. 7 will check whether you're in network, and many will rely on plan directories to do it. Under a proposed rule CMS released Oct. 16, MA plans would have to verify directory information at least every 90 days starting in 2028.

Enrollees who see an out-of-network provider because of an inaccurate listing would pay no more than in-network cost sharing.

Don't wait for 2028. Search each MA plan's online directory for every clinician and location in your practice now. Check names, addresses, phone numbers, specialties and whether each clinician is accepting new patients, and send corrections to each plan in writing.

If you're leaving a network on Jan. 1, confirm the plan will remove you for 2027 so patients aren't steered to you by mistake. Comments on the proposed rule are due Dec. 15.

5. Confirm when termination letters must reach patients

When a provider leaves an MA network, the plan must notify affected patients. Federal rules require at least 45 calendar days' notice for primary care and behavioral health providers, in writing plus at least one phone attempt.

For other specialties, the requirement is at least 30 days' written notice. For a Jan. 1 termination, that means letters by Nov. 17 for primary care and Dec. 2 for specialists.

If your practice or an affiliated health system is leaving a network, ask the plan when its letters went out and what they say. Patients often call the practice first, so your staff should know the effective date, the plan's member services number and whether any continuity-of-care protections apply before the calls start.

6. Script what your staff can and can't say about plans

Patients will ask your front desk which plan to pick. Federal marketing rules allow providers, when a patient asks, to discuss the merits of MA plans, including cost sharing and benefits.

Staff may also tell patients which plans the practice contracts with, hand out unaltered CMS materials and refer patients to 1-800-MEDICARE or their SHIP, which offers free, unbiased counseling.

The same rules bar providers, during activities a plan asks them to conduct, from urging patients to enroll in a specific plan based on the provider's own financial or other interests, and from collecting enrollment applications.

Write a short script that covers the plans you accept, where to get help and what staff won't do, and make sure everyone answering phones uses it.

7. Missouri, Pennsylvania and Indiana: check plan type and notice letters

In Missouri, NKC Health in North Kansas City went out of network with UnitedHealthcare MA plans, including AARP and Optum plans, on Oct. 1. NKC says preferred provider organization (PPO) members may have out-of-network benefits, while HMO point-of-service members typically don't and could owe the entire bill.

That distinction applies to every split on this list, so have schedulers confirm plan type, not only the insurer's name, before booking.

In Pennsylvania, Lancaster County has 66 MA plans with drug coverage for 2027, more than any other U.S. county, KFF found. More choice means more patients switching, so plan for heavier eligibility checks in January.

Allentown-based Lehigh Valley Health Network has been out of network with UnitedHealthcare MA since January, according to Becker's.

Indiana has no health system or insurer on Becker's 2026 split tracker or its list of insurers leaving MA for 2027. Indiana patients can still be in one of the plans UnitedHealth Group and Humana are discontinuing nationally.

A UnitedHealth spokesperson confirmed about 390,000 members are in discontinued plans, and Humana announced cuts affecting about 600,000 enrollees, Bloomberg reported.

UnitedHealthcare's nonrenewal notices are dated Oct. 2, so ask patients to bring any plan letter they received to their next visit.

8. Illinois, Michigan and Wisconsin: smaller splits, same homework

In Illinois, UCM AdventHealth hospitals and providers will be out of UnitedHealthcare's network for individual MA and group retiree plans starting Jan. 1. UChicago Medicine stays out of network for those plans, and commercial members aren't affected.

Evanston-based Endeavor Health will be out of network with Aetna MA after 2026, according to Becker's. Group 1001, which sells plans as Clear Spring Health, is leaving the market for MA plans with drug coverage in Illinois, Colorado and Georgia, KFF found.

Practices that refer to UCM AdventHealth or Endeavor should update referral guidance for affected plans.

In Michigan, Blue Cross Blue Shield of Michigan is pulling MA plans with drug coverage out of Iowa, North Dakota and South Dakota but keeping them in Michigan, KFF found. Devoted Health is entering Michigan for 2027, so expect some patients to arrive with a payer your billing team hasn't set up yet.

In the Upper Peninsula, Hancock-based UP Health System will be out of network with Humana MA after 2026, according to Becker's tracker.

In Wisconsin, Wausau-based Aspirus Health Plan, which offered MA plans in 21 counties, is leaving the market after CMS suspended its new enrollment in February. Marshfield Clinic's MA plans are also pulling out of some Wisconsin counties, an attorney told WPR.

Ask both plans for the list of affected counties and match it against your patients' addresses.

9. Texas and Florida: find the patients caught in the biggest changes

In Texas, Blue Cross and Blue Shield of Texas will stop offering its MA plans, Blue Cross MedicareRx drug plans and Dual Care Plus HMO special needs plans after 2026. The insurer offered MA plans in 227 Texas counties this year, and its parent, Health Care Service Corp. (HCSC), will keep HealthSpring MA plans in 47 counties, according to Becker's Payer Issues.

Christus Health Plan, in 36 Texas counties, and Memorial Hermann Health Plan, in six, are also leaving MA. Pull every patient on one of those plans first; they are the largest group that must pick new coverage.

In Florida, the big changes are network disputes with UnitedHealthcare. Lee Health is ending its contracts and will be out of network Jan. 1 for UnitedHealthcare employer, individual and MA members.

Sarasota Memorial says renewal of its MA contract "appears very unlikely," which would put its hospitals, outpatient and urgent care centers and First Physicians Group practices out of network for UnitedHealthcare MA members. AdventHealth says UnitedHealthcare terminated its contract, which ends Dec. 31 and covers MA, commercial, individual and Medicaid plans at all of its Florida locations. UnitedHealthcare disputes Lee Health's account and says it wants to reach an agreement.

Elsewhere in Florida, Naples Comprehensive Health will be out of network with Wellcare and HealthSpring MA plans at year end, according to Becker's tracker. Moffitt Cancer Center has been out of network with Humana MA plans since July 1, and HCSC will no longer offer MA plans with drug coverage in Miami-Dade County, KFF found.

Any of these disputes could settle before Jan. 1, so check each system's update page the week you call patients and again before your January schedules go out.

10. Put the Medicare Advantage dates that matter on your calendar

Open enrollment for 2027 coverage ends Dec. 7, and plan changes made by then take effect Jan. 1. Patients whose MA plan is leaving Medicare or their county get a special enrollment period from Dec. 8 to the last day of February.

From Jan. 1 to March 31, the MA open enrollment period lets anyone already in an MA plan switch to another MA plan or return to Original Medicare. That means a patient's coverage can change more than once before April.

Two more dates matter if your practice is leaving a network on Jan. 1. For a Jan. 1 termination, federal notice rules put the deadline for plans to send patient letters at Nov. 17 for primary care and behavioral health providers and Dec. 2 for other specialists (see No. 5).

Comments on CMS' proposed provider directory rule are due Dec. 15 (see No. 4). Put all of these on the calendar your front desk, billing and referral staff share so no one is working from a different set of dates.