Medicare Advantage
When a Medicare Advantage Hospital Goes Out of Network Mid-Year, Federal Rules Offer Little Automatic Relief
As hospital systems continue dropping Medicare Advantage contracts in 2026, the absence of a guaranteed plan-switch window and the limited reach of continuity-of-care rules are receiving increased scrutiny from researchers and consumer advocates.
By the Goodsurance editorial teamAugust 19, 2026
The continued wave of hospital system departures from Medicare Advantage networks in 2026 has highlighted how limited federal protections are for enrollees when their provider leaves mid-year.
At least 25 health systems dropped some Medicare Advantage contracts in 2026, according to tracking by Becker's Hospital Review. In most cases, affected members receive a written notice and then find that their options for immediate relief are narrow.
When a Medicare Advantage hospital leaves the network mid-year, there is no automatic window to switch plans, and continuity protections require a written request to take effect.
Federal regulations require Medicare Advantage plans to give at least 45 days of advance notice when a primary care or behavioral health provider leaves the network, and at least 30 days for specialists and facilities. Enrollees in active treatment for a serious or complex condition may request in-network cost-sharing to continue care through a transitional period, but must initiate that request in writing. The protection is not automatic.
No guaranteed Special Enrollment Period exists when a provider leaves a plan's network. CMS evaluates disruptions on a case-by-case basis. In some situations, such as the Brown University Health departure in Rhode Island, CMS approved a time-limited SEP for affected members. In others, it has not. CMS proposed a rule earlier in 2026 that would have guaranteed a SEP whenever a provider terminates from a plan's network, but the agency declined to finalize it in the April 2026 Medicare Advantage and Part D final rule.
A KFF Health News investigation published earlier this year found that CMS sent network adequacy enforcement letters to just five insurers over a decade following documented network deficiency findings.
Enrollees who believe their plan's network has become inadequate can file a complaint through 1-800-MEDICARE or their state insurance commissioner.
In plain words
When your doctor or hospital leaves your Medicare Advantage plan during the year, it is hard to switch plans right away. There is no automatic right to change plans when this happens. You may be able to keep seeing your doctor at the lower in-network cost for a short time, but you have to ask for this in writing. Your plan does not do it for you. Sometimes Medicare approves a special window to switch plans after a big network change, but not always. A study by KFF Health News found that the rules about plan networks are rarely enforced. If you think your plan does not have enough doctors or hospitals nearby, you can file a complaint with Medicare or your state insurance office.
Understand the basics first
Source: KFF Health News
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