Your Medicare Advantage Plan Can Stay and Still Drop Your Hospital

November 10, 2026Russell Rogers

floridamedicare advantageunitedhealthcaresarasota memorialhospital networksmedicare open enrollmentlee healthadventhealthflorida seniors

Your mom's plan is not going away. That is only half of what she needs to know.

The notices and hospital messages many Florida families have seen this fall describe a different problem. The plan stays. The card still works. What may stop working is the hospital where her cardiologist practices.

Most families check one thing and not the other. They confirm the plan is still being sold next year. They do not confirm it still includes the people who treat their parent.

What Sarasota Memorial is telling patients

Sarasota Memorial Health Care System says it fully expects to be out of UnitedHealthcare's Medicare Advantage network on January 1, 2027. Its contract runs through December 31, 2026, and the system says UnitedHealthcare has rejected its proposals to renew it.

If that holds, all of this becomes out of network for anyone on a UnitedHealthcare Medicare Advantage plan:

Sarasota Memorial Hospital in Sarasota
Sarasota Memorial Hospital in Venice
The system's outpatient and urgent care centers
Every First Physicians Group practice

That last item is the one families underestimate. First Physicians Group is the system's own physician group, so this reaches the primary care doctor and the specialists too.

The system's own announcement, dated October 28, is blunt: "We fully expect to be out of UnitedHealthcare's Medicare Advantage network Jan. 1." A hospital spokesperson told the Venice Gondolier it is "highly unlikely" the system will have a new Medicare Advantage contract when the current one expires.

UnitedHealthcare's side was not quoted in the coverage we reviewed. Its Sarasota page is the place to check for its position and any update.

Original Medicare and standard Medicare supplements, usually called Medigap, are not affected. Sarasota Memorial says it always accepts both. The break is specific to Medicare Advantage.

It is not only Sarasota

Lee Health, which covers Fort Myers and much of Lee County, gave notice on August 26 that its hospitals and physicians will be out of network for UnitedHealthcare employer, individual and Medicare Advantage plans on January 1, 2027. UnitedHealthcare says it is negotiating and that Medicare Supplement members are not affected.

AdventHealth's contract with UnitedHealthcare also ends December 31. UnitedHealthcare's notice lists Medicare Advantage among the plans that would be out of network at AdventHealth if no agreement is reached, and says talks are ongoing. We cover the Central Florida version in our Orlando breakdown.

In Naples, NCH says Cigna and Wellcare Medicare Advantage plans will be out of network starting January 1, with emergency care still available.

Becker's Hospital Review's tracker lists 35 health systems ending contracts with at least one Medicare Advantage insurer in 2026. This is a national story landing hard in Florida.

Why this is harder than a plan leaving

When an insurer stops selling a plan in your county, the system is built to catch you. You get a non-renewal notice and a special enrollment period that runs into late February.

When a hospital leaves a plan's network, none of that is automatic. CMS can grant a special enrollment period when a network change is significant, and it has done so case by case. It has also declined, deciding some plans still had enough other providers. Do not count on one.

So plan around the ordinary window, which closes December 7. That date matters more than the contract date. If your parent does nothing, they keep the same plan and premium and may discover in January that the hospital is out of network. After December 7 they can no longer change their mind through the normal process. If you think your parent may qualify for an exception, SHINE or 1-800-MEDICARE can tell you.

What out of network means in practice

Sarasota Memorial has not published how many UnitedHealthcare Medicare Advantage members use its hospitals and physician group. When the same dispute came up in 2023, the Sarasota Herald-Tribune put the number at about 20,000 people. Whatever the count is now, it is a lot of families.

Out of network does not mean the hospital turns your mother away. Sarasota Memorial says it could not process her UnitedHealthcare card, and that federal rules limit how much it can discount care for a Medicare-eligible patient paying out of pocket. In other words, "we will just pay cash" may not bring the bill down the way families expect.

Emergency care is the exception. Medicare Advantage plans must generally cover emergency services at in-network rates even out of network, with no authorization. If your dad has chest pain on January 2, he should go to the nearest emergency room, including Sarasota Memorial.

What happened in 2023

Sarasota Memorial and UnitedHealthcare were in this exact position at the end of 2023. The contract was set to expire December 31, and a one-year Medicare Advantage agreement was reached in late December, according to Becker's reporting on the Herald-Tribune's coverage. Sarasota Memorial says it made significant concessions that year to stay in network.

Two honest readings come out of that. Last time the dispute resolved at the last minute. But "it worked out last time" is not a plan, and this time the system is saying publicly that it expects no deal.

You are not deciding who is right. You are deciding how much uncertainty your parent can carry for a year. A 78-year-old midway through cancer treatment answers differently than a healthy 67-year-old.

What to check before December 7

The work is small, and it is the part you control.

Search by hospital name, not health system. Directories are inconsistent. Look up "Sarasota Memorial" and "First Physicians Group" separately, and use the 2027 directory.

Check the doctor, not just the building. If your mom sees an oncologist or a cardiologist, look that person up by name. A hospital can be in network while a physician group is not.

Call the plan and ask for the answer in writing. Use the number on the back of the card, ask about the specific hospital and doctors for plan year 2027, and keep the response. Sarasota Memorial, Lee Health and AdventHealth also publish their own insurance pages.

Know which kind of plan your parent has. A PPO may carry some out-of-network benefits. An HMO usually does not, and the bill can be the whole thing.

Ask about continuity of care if treatment is underway. UnitedHealthcare's notice for the AdventHealth dispute describes a process: members in active treatment for a serious condition, such as cancer, can apply to keep in-network benefits for 90 days, and they must be approved. The call goes to the number on the ID card. Sarasota Memorial says state law may also protect patients in ongoing treatment for a serious illness, so ask UnitedHealthcare whether the same process applies to Sarasota Memorial and get the answer in writing.

Check the nursing home list separately. A hospital stay often ends in a rehab stay, and that is a different network list. Start with the facilities near your parent in Sarasota, Venice, Fort Myers or Naples and check each against the 2027 directory.

The trap in "I will fix it in January"

There is a real safety valve, and it is worth knowing how far it goes.

Between January 1 and March 31, anyone already on a Medicare Advantage plan can make one change: switch plans, or drop Medicare Advantage and return to original Medicare. That period exists for situations like this one.

What it does not do is guarantee your parent can buy a supplement.

Medigap guaranteed issue rights are narrow. They cover things like your plan ending or leaving your area, or a first-year trial right if someone joined Medicare Advantage when first eligible at 65. A hospital dropping out of a network is not one of those situations. Outside them, a Medigap insurer can ask about your parent's health and decline to sell a policy, or charge more.

Returning to original Medicare in February without a supplement can leave your parent with no cap on the 20 percent coinsurance original Medicare does not cover. For someone with a serious diagnosis, that is not a safe landing spot.

January is not useless. December just has more options, and the decision is better made while all of them are open.

What the fight is actually about

Sarasota Memorial's chief executive says the fight is about prior authorization and reimbursement, and that UnitedHealthcare wants to weaken patient protections while paying less than original Medicare. We did not find UnitedHealthcare's response to those claims, so treat them as the hospital's account.

The data underneath is not in dispute. A KFF analysis of insurer-reported figures found Medicare Advantage insurers denied 12 percent of standard prior authorization requests in 2025, and UnitedHealth Group denied 17 percent, the highest of the six large insurers examined, against 5 percent at the lowest. Across Medicare Advantage, about two thirds of the denials that were appealed were overturned, though few are appealed.

That is the figure to carry into a hospital room. If your parent is denied a scan or a procedure, appeal it, and ask the doctor's office to file.

What you can actually control

You cannot predict what two organizations will agree to in the last week of December. Anyone telling you otherwise is guessing.

What you can do is know, before December 7, whether the plan your parent is enrolled in still covers the hospital and the doctors who treat them. That is a website and a phone call. If the answer is yes, you have bought a year of certainty for the price of an afternoon. If it is no, you still have time to choose rather than react.

SHINE counselors through the Florida Department of Elder Affairs are free and confidential. Call the Elder Helpline at 1-800-963-5337.

If your parent's plan is leaving the market entirely rather than losing a hospital, the steps are different, and we wrote about those in what to do when your Medicare Advantage plan is non-renewed. If you are trying to work out which counties are affected, that is here.

Start with the hospital. It is the one question in this whole mess with a definite answer today.

Sources: Sarasota Memorial Health Care System, "Why Sarasota Memorial Is Standing Up for Medicare Advantage Patients," October 28, 2026, and UnitedHealthcare and Medicare Enrollment FAQ pages (smh.com); Venice Gondolier, "SMH, UHC at 'impasse' on new Medicare Advantage deal" (2026); Becker's ASC Review, "Sarasota Memorial, UnitedHealthcare strike outpatient Medicare Advantage agreement" (2023); Lee Health notice to UnitedHealthcare (August 26, 2026), as reported by Becker's Hospital Review and WGCU; UnitedHealthcare, AdventHealth contract update and FAQ pages (2026); Naples Comprehensive Health, Medicare Advantage update (2026); Becker's Hospital Review, health systems dropping Medicare Advantage plans; KFF, "Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain" (2026); KFF Health News, "When Medicare Advantage Drops Doctors, Some Members Can Switch Plans"; Florida SHINE, floridashine.org.

Frequently Asked Questions

Will Sarasota Memorial be out of network for UnitedHealthcare Medicare Advantage in 2027?

Sarasota Memorial says it fully expects to be. Its current contract runs through December 31, 2026, and the system says UnitedHealthcare has rejected its renewal proposals. Both hospitals, the outpatient and urgent care centers and First Physicians Group would be affected. Check for updates before December 7.

Is there a special enrollment period if my hospital leaves my plan's network?

Not automatically. CMS can grant one when a network change is significant, and it has done so case by case, but it has also declined. Plan around the standard window that closes December 7, and ask SHINE or 1-800-MEDICARE whether an exception applies.

Is emergency care still covered if the hospital is out of network?

Yes. Medicare Advantage plans must generally cover emergency services at in-network rates whether or not the hospital is in the plan's network, with no authorization. Go to the nearest emergency room.

Can I switch to original Medicare and buy Medigap in January?

You can return to original Medicare between January 1 and March 31, but a hospital leaving your plan's network does not give you a guaranteed right to buy a Medigap policy. Outside guaranteed issue situations, an insurer can ask health questions and decline or charge more.

How do I check whether my parent's plan still covers their hospital?

Call the number on the back of the plan card and ask whether the specific hospital and doctors are in network for plan year 2027. Ask for the answer in writing, and look up each doctor by name in the 2027 provider directory.

When does Medicare open enrollment end for 2027 coverage?

Open enrollment runs October 15 through December 7, 2026, and changes take effect January 1, 2027. Florida's SHINE program offers free, unbiased help at 1-800-963-5337.