This article may contain references to products or services from one or more of our advertisers or partners. We may receive compensation when you click on links to those products or services. Nonetheless, our opinions are our own.
The information presented in this article is accurate to the best of our knowledge at the time of publication. However, information is subject to change, and no guarantees are made about the continued accuracy or completeness of this content after its publication date.
- Hospital Leaving Medicare Advantage? What to Do in 2025 to Keep Your Care
- Why Are Hospitals Leaving Medicare Advantage in 2025?
- What This Means for You as a Medicare Advantage Member
- Medicare Advantage 2025 Plan Changes
- Steps to Take if Your Medicare Advantage Plan Is Ending
- Other Coverage Alternatives
- How to Keep Your Healthcare Stable
- Medicare vs. Medicaid Differences
- What to Keep in Mind About Medicare Changes in 2025
- Checklist for Choosing the Right Medicare Plan in 2025
- Frequently Asked Questions
- Recommended Reads
Hospital Leaving Medicare Advantage? What to Do in 2025 to Keep Your Care
In 2025, many patients are receiving unsettling news: their hospital is leaving the Medicare Advantage (MA) network. This shift can cause confusion, raise concerns about losing doctors, and create unexpected healthcare expenses. But you have options. This page helps explain what these changes mean, what steps to take, and how to transition smoothly without losing the care you trust.
Why Are Hospitals Leaving Medicare Advantage in 2025?
Across the country, hospitals are dropping their Medicare Advantage contracts due to:
- Low reimbursement rates that strain budgets
- Administrative delays in claims processing and approvals
- Lack of flexibility in negotiations with private insurers
These changes may feel abrupt, but hospitals are making them to ensure financial sustainability and better patient outcomes.
What This Means for You as a Medicare Advantage Member
If your hospital exits the MA network, here’s how it may impact you:
- Provider access: Your doctor or specialist may no longer be in-network, resulting in higher out-of-pocket costs.
- Care disruption: You may need to find new providers or request temporary transition coverage for ongoing treatments.
- Plan reassessment: You might need to consider switching Medicare plans or enrolling in Original Medicare with supplemental coverage.
Common Scenarios and Solutions
| Situation | Recommended Action |
|---|---|
| The hospital is no longer in-network | Search for Medicare Advantage plans that include your preferred hospital or providers. |
| Currently in active treatment | Request continuity of care coverage during transition |
| Out-of-pocket costs have increased | Compare new plans with lower copays or annual spending limits |
Medicare Advantage 2025 Plan Changes
In 2025, shifts in provider networks and plan offerings are more widespread than in previous years. Hospitals and insurers are renegotiating, which may lead to significant plan changes.
- Review updated networks: Use the plan’s online directory or Medicare Plan Finder to confirm which providers remain in-network.
- Compare costs: Reevaluate your current premiums, deductibles, and maximum out-of-pocket expenses.
- Explore new plans: If your current plan is no longer viable, review alternatives during Medicare Open Enrollment or a Special Enrollment Period.
2025 Plan Comparison Snapshot
| Feature | Current Plan | Plan A | Plan B |
|---|---|---|---|
| Monthly Premium | $150 | $17 | $0 |
| Primary Care Copay | $20 | $15 | $25 |
| Specialist Copay | $40 | $35 | $50 |
| Out-of-Pocket Max | $5,000 | $5,400 | $6,000 |
Voted "Best Overall Budgeting App" by Forbes and WSJ
Monarch Money helps you budget, track spending, set goals, and plan your financial future—all in one app.
Get 50% OFF your first year with code MONARCHVIP
Steps to Take if Your Medicare Advantage Plan Is Ending
- Assess your needs: Make a list of essential services, medications, and doctors you rely on.
- Compare new plans: Use the Medicare Plan Finder or speak to a licensed broker.
- Know your enrollment periods: Open Enrollment runs October 15–December 7. Special Enrollment may apply if your provider network changes mid-year.
Alternate Plan Options
| Plan Option | Monthly Premium | Deductible | Out-of-Pocket Max |
|---|---|---|---|
| Plan A | $30 | $500 | $3,500 |
| Plan B | $25 | $300 | $3,200 |
| Plan C | $40 | $0 | $4,000 |
Other Coverage Alternatives
If you’re losing Medicare Advantage coverage, consider these other options:
- Original Medicare (Parts A and B): See any provider that accepts Medicare. Out-of-pocket costs may be higher without a supplement.
- Medigap (Medicare Supplement): Helps cover deductibles, copays, and coinsurance. Requires a separate premium.
- Part D (Prescription Drug Plans): In 2025, out-of-pocket spending is capped at $2,000 annually.
- Employer-sponsored plans: If you’re eligible through work or a spouse, these may offer more affordable and stable coverage.
How to Keep Your Healthcare Stable
Follow these steps to avoid losing access to important services:
- Call your doctors and specialists to confirm if they are still in-network.
- Reach out to your insurance provider to understand your options.
- Track enrollment periods to make timely decisions.
- Use SHIP or Medicare-certified advisors for free personalized guidance.
Provider Status Tracker Example
| Provider | Contact | Status |
|---|---|---|
| City Hospital | (555) 123-4567 | In-Network |
| Downtown Clinic | (555) 987-6543 | Out-of-Network |
Medicare vs. Medicaid Differences
Medicare is a federal program for individuals aged 65+ or with qualifying disabilities. Medicaid is a state-administered program based on income. Some individuals qualify for both, known as “dual eligibility.”
What to Keep in Mind About Medicare Changes in 2025
Changes to your Medicare Advantage network can be disruptive, but they don’t have to derail your healthcare. By understanding your rights, comparing plan options, and acting quickly, you can stay covered and in control. Don’t wait for a lapse in care; make your move now to stay protected in 2025 and beyond.
Checklist for Choosing the Right Medicare Plan in 2025
| Factor | Checklist Item |
|---|---|
| Premium Affordability | Compare monthly costs against your budget |
| Provider Network | Ensure your doctors and hospitals are covered |
| Drug Coverage | Confirm that your prescriptions are included |
| Extra Benefits | Look for vision, dental, and wellness perks |
Frequently Asked Questions
-
Why is my hospital leaving medicare advantage?
Hospitals are citing low reimbursements, administrative complexity, and inflexible contracts with insurers. These factors can make it financially unsustainable for hospitals to remain in-network with certain medicare advantage plans.
Can I still see my doctor?
Possibly, but you may pay higher out-of-network rates unless you switch to a plan that includes your doctor or the provider joins a different network. Some patients may qualify for transition-of-care coverage during ongoing treatments.
Can I switch medicare plans mid-year?
Yes, if you qualify for a special enrollment period due to changes like a hospital leaving your plan’s network. This allows you to switch to a plan that fits your care needs without waiting for open enrollment.
Will I face penalties for switching plans?
No penalties apply during open enrollment or special enrollment periods. You are encouraged to review your options and make a timely change to maintain coverage and access to your preferred providers.
Reviewed and edited by Albert Fang.
See a typo or want to suggest an edit/revision to the content? Use the contact us form to provide feedback.
At FangWallet, we value editorial integrity and open collaboration in curating quality content for readers to enjoy. Much appreciated for the assist.
Did you like our article and find it insightful? We encourage sharing the article link with family and friends to benefit as well - better yet, sharing on social media. Thank you for the support! 🍉
Article Title: Hospital Leaving Medicare Advantage? What to Do in 2025 to Keep Your Care
https://fangwallet.com/2025/07/28/hospital-leaving-medicare-advantage-what-to-do-in-2025-to-keep-your-care/The FangWallet Promise
FangWallet is an editorially independent resource - founded on breaking down challenging financial concepts for anyone to understand since 2014. While we adhere to editorial integrity, note that this post may contain references to products from our partners.
The FangWallet promise is always to have your best interest in mind and be transparent and honest about the financial picture.
Become an Insider
Subscribe to get a free daily budget planner printable to help get your money on track!
Make passive money the right way. No spam.
Editorial Disclaimer: The editorial content on this page is not provided by any of the companies mentioned. The opinions expressed here are the author's alone.
The content of this website is for informational purposes only and does not represent investment advice, or an offer or solicitation to buy or sell any security, investment, or product. Investors are encouraged to do their own due diligence, and, if necessary, consult professional advising before making any investment decisions. Investing involves a high degree of risk, and financial losses may occur including the potential loss of principal.
Source Citation References:
+ Inspo
There are no additional citations or references to note for this article at this time.
