Blue Cross and Blue Shield of Texas leaves Medicare Advantage as UnitedHealthcare splits with Florida health systems

Blue Cross and Blue Shield of Texas will stop offering Medicare Advantage (MA) plans after this year. The insurer offered plans in 227 Texas counties in 2026, according to Becker's Payer Issues. Its parent company, Health Care Service Corp. (HCSC), will keep offering HealthSpring MA plans in 47 Texas counties.

Open enrollment for 2027 coverage runs through Dec. 7. Nationally, UnitedHealth Group is leaving 228 counties and entering nine. Humana is leaving 62 and entering four. HCSC is leaving 498 counties and entering none, and Centene is leaving 359 and entering 15.

Those figures come from a KFF analysis of federal plan data published Oct. 9. Each exit means the insurer no longer offers any MA plan with drug coverage in that county.

A UnitedHealth spokesperson confirmed that about 390,000 members are in plans being discontinued, and Humana has announced cuts affecting about 600,000 enrollees, Bloomberg reported.

UnitedHealthcare President Bobby Hunter has said the company is pulling back in markets where preferred provider organization plans, which carry higher operating costs, make up a larger share of its offerings. "We can't ignore the realities facing the healthcare system," Hunter said, according to Newsweek.

On the provider side, Becker's Hospital Review's tracker lists 35 health systems ending contracts with at least one MA insurer in 2026. Systems that drop plans often cite prior authorization denials and slow payment, and in some cases the insurer ends the contract.

KFF counted 193 counties with no MA plan with drug coverage open to general enrollment for 2027, up from 123 this year. None of those counties are in the eight states covered below.

Texas: Blue Cross and Blue Shield of Texas leaves Medicare Advantage

Blue Cross and Blue Shield of Texas will no longer offer its Blue Cross Medicare Advantage plans, Blue Cross MedicareRx prescription drug plans or Dual Care Plus HMO special needs plans for 2027. The insurer said affected members were notified by mail before Oct. 2 and will have a special election period to choose new coverage, Fox 7 Austin reported.

"Like all carriers, Blue Cross and Blue Shield of Texas evaluates its Medicare products annually by market to determine their ongoing viability," the company said in a statement.

Two health system-owned plans are also leaving. Christus Health Plan offered plans in 36 Texas counties, and Memorial Hermann Health Plan offered plans in six. Memorial Hermann confirmed in July that it is also shutting down its commercial business, according to Becker's.

Florida: Lee Health, Sarasota Memorial and AdventHealth face UnitedHealthcare splits

Lee Health is ending its hospital and physician contracts with UnitedHealthcare at the end of 2026. Starting Jan. 1, it will be out of network for UnitedHealthcare's employer-based, individual and MA members.

Lee Health says roughly one-third of its medical necessity denials are tied to UnitedHealthcare MA plans and that the insurer owes it more than $100 million in disputed and underpaid claims, Becker's reported.

UnitedHealthcare disputes that account. "Lee Health unexpectedly issued a notice to end our network relationship at the conclusion of our current contract without any advance notice or discussions," a spokesperson said, according to WINK News. The insurer has since posted an FAQ for members and says it wants to reach an agreement, WINK reported.

Sarasota Memorial Health Care System's MA contract with UnitedHealthcare expires Dec. 31. Without a new deal, its Sarasota and Venice hospitals, its outpatient and urgent care centers and all First Physicians Group practices would be out of network for UnitedHealthcare MA members, including those in the AARP-branded plan.

"At this time, it appears very unlikely our Medicare Advantage contract with UnitedHealthcare will be renewed for 2027," the system says on its website.

AdventHealth says UnitedHealthcare terminated its contract, which ends Dec. 31. Without a new agreement, AdventHealth hospitals and clinicians at all Florida locations would be out of network starting Jan. 1.

The change would affect UnitedHealthcare MA, individual and family, commercial and Medicaid plans, according to AdventHealth. The system says it isn't asking for increases above inflation and is instead seeking terms that address delays, denials and prior authorization requirements.

Naples Comprehensive Health will be out of network with Wellcare and HealthSpring MA plans at year end, according to Becker's tracker. University of Miami Health System also appears on the tracker for a 2027 break with UnitedHealthcare MA.

Moffitt Cancer Center has been out of network with Humana MA HMO and PPO plans since July 1 after Humana terminated the agreement, and it sees Aetna MA patients on an out-of-network basis, Fox 13 reported. HCSC will no longer offer MA plans with drug coverage in Miami-Dade County in 2027, KFF found.

Separately, the Hurricane Isaias emergency declaration has loosened some MA network rules for Florida practices.

Illinois: UCM AdventHealth leaves UnitedHealthcare's individual MA network

Starting Jan. 1, UCM AdventHealth hospitals and providers will be out of UnitedHealthcare's network for individual MA plans and group retiree plans. UChicago Medicine hospitals and providers stay out of network for those plans, UnitedHealthcare says. Commercial members aren't affected.

Evanston-based Endeavor Health will be out of network with Aetna MA after 2026, according to Becker's.

Group 1001, which markets plans as Clear Spring Health and offered them in Colorado, Georgia and Illinois, is leaving the market for MA plans with drug coverage entirely, KFF found.

Michigan: Blue Cross Blue Shield of Michigan narrows, Devoted enters

Blue Cross Blue Shield of Michigan will offer MA plans with drug coverage only in Michigan and Wyoming for 2027. It also offered them in Iowa, North Dakota and South Dakota this year, KFF found.

Devoted Health is entering Michigan as one of five new states, Becker's reported. In the Upper Peninsula, Hancock-based UP Health System will be out of network with Humana MA after 2026, according to Becker's tracker.

Wisconsin: Aspirus Health Plan exits

Wausau-based Aspirus Health Plan, which offered MA plans in 21 Wisconsin counties, is leaving the market. CMS suspended new enrollment in February after the plan's claims processor, UCare, was taken over by Minnesota regulators, Becker's reported.

Marshfield Clinic's MA plans are also pulling out of some Wisconsin counties, WPR reported.

Missouri: NKC Health leaves UnitedHealthcare MA

NKC Health in North Kansas City went out of network with UnitedHealthcare MA plans, including AARP and Optum plans, on Oct. 1, according to the health system.

NKC says PPO members may have out-of-network benefits, while HMO-POS members typically don't and could owe the entire bill.

Pennsylvania: the most choice in the country, and one split

Lancaster County has 66 MA plans with drug coverage for 2027, more than any other U.S. county. The counties with the most options are mostly in Pennsylvania, Ohio and Michigan, KFF found.

Allentown-based Lehigh Valley Health Network has been out of network with UnitedHealthcare MA since January, according to Becker's.

Indiana: no headline split, but plan-level changes

Becker's 2026 tracker of health system splits and its list of insurers leaving MA for 2027 don't include an Indiana health system or insurer. Indiana enrollees can still be affected by the plans UnitedHealth Group and Humana are discontinuing nationally.

UnitedHealthcare sent nonrenewal notices dated Oct. 2, Bloomberg reported.

What the rules say for physicians and patients

Open enrollment ends Dec. 7, and changes take effect Jan. 1. When a plan leaves Medicare or a county, members get a special enrollment period from Dec. 8 to the last day of February.

Members of a nonrenewing plan who choose nothing go to Original Medicare, according to Bloomberg's report on UnitedHealthcare and to Washington's insurance commissioner. The MA open enrollment period, Jan. 1 to March 31, gives members one more chance to switch plans or return to Original Medicare.

Federal rules require MA plans to notify patients at least 45 calendar days before a primary care or behavioral health provider's termination, in writing plus at least one phone attempt.

For other specialties, the requirement is at least 30 days' written notice. For a Jan. 1 termination, that works out to letters by Nov. 17 for primary care and Dec. 2 for specialists.

When patients ask, physicians may discuss "the merits of a MA plan or plans," including cost-sharing and benefits. They may also name the plans they contract with, hand out unaltered CMS materials and refer patients to a State Health Insurance Assistance Program (SHIP) or 1-800-MEDICARE.

During activities a plan asks them to conduct, providers may not urge patients to enroll in a specific plan based on their own financial or other interests, and they may not collect enrollment applications.

Under a proposed rule released Oct. 16, MA plans would have to verify provider directory information at least every 90 days starting in 2028. Enrollees who see an out-of-network provider because of an inaccurate listing would pay no more than in-network cost sharing. Comments are due Dec. 15.

Medicare Advantage members' satisfaction with their plans has fallen for two years running, and most older adults spend less than an hour choosing a plan.

Frequently asked questions

When is the deadline to change Medicare Advantage plans for 2027?

Dec. 7. Changes made during open enrollment take effect Jan. 1, 2027.

What happens if a patient's Medicare Advantage plan is leaving their county?

They can choose a new plan by Dec. 7 for a Jan. 1 start. They also get a special enrollment period from Dec. 8 to the last day of February. Members who choose nothing go to Original Medicare.

Can physicians recommend a Medicare Advantage plan to patients?

Physicians may discuss the merits of plans when patients ask, name the plans they contract with and refer patients to a SHIP or 1-800-MEDICARE. In activities conducted for a plan, they may not urge enrollment in a specific plan based on their own financial or other interests.

How much notice must a Medicare Advantage plan give patients when a physician leaves its network?

At least 45 days for primary care and behavioral health providers, with written notice and a phone attempt. At least 30 days in writing for other specialties.

Will any counties in Texas, Florida, Illinois, Michigan, Wisconsin, Missouri, Pennsylvania or Indiana have no Medicare Advantage plan in 2027?

No. KFF's list of counties without an MA plan with drug coverage open to general enrollment doesn't include any of these states.