CMS Withdraws Proposal to Ease Medicare Advantage Network Change Rules

The Centers for Medicare & Medicaid Services has withdrawn a proposed rule intended to simplify the process for Medicare Advantage enrollees when provider networks change midyear. The rejected provision, which was scheduled to take effect in 2027, would have granted affected patients a special enrollment period to switch plans or return to traditional Medicare without penalty. By pulling the proposal, the regulator has left millions of seniors facing continued uncertainty regarding access to their preferred doctors and hospitals.

This regulatory shift occurs against a backdrop of increasing friction between insurers and healthcare providers. Recent market shifts include UnitedHealthcare ending its network contract with Johns Hopkins Medicine in August, leaving most facilities out of network for UnitedHealthcare Medicare Advantage patients. When a long-standing doctor or preferred hospital is no longer covered, enrollees are considered out of network and face steep out-of-pocket costs or the necessity of finding a new provider.

The impact of this regulatory vacuum is significant, with data indicating that two of the largest insurers, UnitedHealthcare and Humana, cover approximately 80 per cent of US counties in 2026. This represents a decline from nearly 90 per cent the previous year. Analysis suggests that one in 10 Medicare Advantage enrollees, representing approximately 2.9 million seniors, face forced disenrollment in 2026 as insurer-provider contracts dissolve.

Lindsey Copeland, director of federal policy at the Medicare Rights Center, expressed disappointment that the provision was not finalised to assist enrollees impacted by midyear network changes. She noted that abruptly losing access to a trusted provider is a difficult experience, particularly for people with complex or serious conditions who rely on specific medical facilities. The rejected rule would have permitted enrollees to utilise a special enrollment period to change plans or switch to traditional Medicare when their current provider leaves the network.

Medicare Advantage remains a popular alternative to traditional Medicare for those aged 65 and older, offering benefits such as drug coverage, eyeglasses, dental care, and fitness classes, often with very low or no premium costs. However, unlike original Medicare, participation in these plans limits members to a specific network of doctors and healthcare providers, networks that are ever-changing. The dismissed provision was designed to help people navigate the friction that often stems from requirements for prior authorisation for care, a restriction rarely required in traditional Medicare.

As dozens of hospital systems jettison Advantage plans this year, the absence of the proposed safeguard means that if a plan is terminated by an insurer, enrollees may be forced to sign up for a new Medicare Advantage plan or switch to traditional Medicare for the following year. The key for consumers remains checking if their doctors will be included in any replacement plan they are folded into, a task made more difficult without the regulatory safety net that was recently withdrawn.