Twenty-five. That’s how many major U.S. health systems have dropped or narrowed their Medicare Advantage contracts in 2026, according to Becker’s Hospital Review’s ongoing tracker — up from 20 the year before. The list is no longer a collection of small rural clinics quietly bowing out. It now includes Mayo Clinic, Mass General Brigham, Mount Sinai, Providence, UNC Health and Memorial Hermann. For agents who spend their days matching seniors to plans, the names on that list have stopped being surprising. What’s changed is the size of the institutions willing to walk away.
CMS didn’t make the math any easier to defend. In January, the agency proposed a Medicare Advantage payment update for 2027 of just 0.09% — effectively flat. Industry pushback was fierce enough to generate nearly 47,000 public comments. By April, CMS had revised that number up to 2.48%, or roughly $13 billion in additional payments, largely by declining to update the risk-adjustment model with newer, lower-cost data. It was a reprieve for carriers. It did little to change what hospitals were already telling insurers at the negotiating table: the reimbursement isn’t there, and the paperwork isn’t worth it.
Why hospitals are actually leaving
Ask agents why hospitals keep walking, and the answer isn’t mysterious. It’s money, and it’s the hoops required to collect it.
“The flat-out answer is that they can’t afford to,” said Chris Prang, a Medicare agent licensed in Virginia and more than a dozen other states, in a response on Medicare Agents Hub’s Q&A platform, where thousands of licensed agents field questions from the public. Prang said Medicare Advantage plans often negotiate hospital reimbursement at half of the Medicare fee schedule or lower. “They can’t meet their requirements for staffing, for safety, for facilities, for management, for cleanliness. They just can’t do it.”
Nicholas Depke, an agent licensed in Nebraska, Arizona, Florida and 15 other states, put the mechanics plainly: reimbursement rates, the administrative burden of getting paid, and prior authorization requirements are the three recurring complaints. “It’s just gotten overwhelming for a number of hospital systems,” Depke said. “Many of them are actually losing money on some of the Medicare Advantage plans that they are dealing with.”
Some agents describe hospitals using network exit as leverage rather than a final decision. “What happens a number of times is the hospital system that has a contract with the Medicare Advantage plan to be a network… will threaten to leave the network, or they actually will leave the network, and they will use it as a bargaining chip to get more money,” Depke said.
Marnie Applegate, an agent licensed in Tennessee, Alabama, Georgia and Texas, tracked the trend back to its early stages. “There are several hospitals around the country, and at the beginning of 2025, I think the number was at 27 that actually stopped taking Medicare Advantage plans,” she said. “That could be due to financial strain from lower reimbursement rates from the carriers.” Eighteen months later, Becker’s count has nearly doubled.
The field is split on how bad it is
Not every agent sees a crisis. Some describe the exits as real but overstated in the aggregate, and warn clients against treating every headline as a reason to abandon Medicare Advantage.
“It’s not that hospitals are rejecting Medicare Advantage across the board,” said Charise Karjala, an agent licensed in California, Arizona, Colorado, Pennsylvania and Washington. “What’s happening is that some hospitals and health systems have been dropping specific plans, or specific carriers, usually after contract negotiations break down.” Karjala pointed to the same three drivers agents raise again and again: payment disputes, administrative friction over prior authorizations and denials, and local leverage fights between a dominant hospital system and a dominant insurer.
Steven Bleicher, an Arizona-based broker, pushed back harder on the framing. “This is not true,” he said of the idea that hospitals broadly reject Medicare Advantage. “Only the specialty hospitals like the Mayo Clinic’s, Sloan-Kettering in NYC, the Cleveland Clinic, MD Anderson in Houston, the Cancer Centers of America, etc. won’t accept a MAPD as those plans for the most part don’t pay in a timely manner.” His list has gotten harder to defend as a boutique problem — Mayo, Mass General Brigham and Mount Sinai are no longer outliers on the 2026 tracker; they’re representative of it.
Jack Mayer, licensed in California and Nevada, offered the view from an agent who leans on scale. “The main thing is to go with a flagship carrier that has huge networks such as United Healthcare, for example,” he said, noting that most of his clients who enroll with a large national carrier tend to stay put. It’s worth noting that UnitedHealthcare and Humana are also the two carriers most frequently named in this year’s contract terminations, according to Becker’s tracking — the same scale that builds a broad network is also where some of the biggest disputes are playing out.
What this means for the person sitting across the table
Where agents converge is on the practical fallout. A network that looked solid in January can look very different by August, and the annual enrollment period isn’t the only moment that matters anymore.
Tracy Brown, a broker at MedWise Trust licensed across more than 30 states, said her firm doesn’t push Medicare Advantage as a default. “They do work for about 30% of our clients,” Brown said. “We advise that only our healthy clients choose this option. For people who need a lot of care or have costly healthcare needs we explain the benefits of Medigap plans.” Sixty percent of her clients, she said, ultimately choose a supplement instead. Brown named Scripps Health in San Diego and the Mayo Clinic as two systems that don’t accept Medicare Advantage at all — a reminder that for some beneficiaries, the plan’s core promise of low-cost access was never fully on the table.
Angela Tapp, licensed in Texas, Alabama, Arkansas and more than two dozen other states, frames the fix as ongoing vigilance rather than a one-time enrollment decision. “My job is to protect your health and your wallet, which means we will always check to make sure your preferred hospital and doctors are fully in-network before we pick a plan,” Tapp said. “And remember, if you ever want total freedom to see any hospital in the country without network rules, we can look at a Medicare Supplement instead.”
The math hasn’t gotten friendlier for hospitals, and CMS’s improved 2027 rate still trails what many health systems say they need to keep pace with cost growth. Twenty-five contract breaks in 2026, following 20 the year before, isn’t a one-time correction. It’s a pattern. The agents fielding these calls aren’t waiting for Washington to settle the argument between carriers and hospitals. They’re doing what they’ve always done: checking the network, twice a year, before the argument reaches their client’s kitchen table.
