For skilled nursing facilities, hospital departures from MA plans can disrupt referral pipelines and shift patient volumes in ways that are hard to anticipate. SNFs should monitor their hospital referral partners’ MA plan relationships closely, since a high-profile contract breakup can trigger mass disenrollment and redirect patients toward traditional Medicare or competing plans.
When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too
At least 41 hospital systems have dropped out of 62 Advantage plans serving all or parts of 25 states since July, according to Becker’s Hospital Review. Over the past two years, separations between Advantage plans and health systems have tripled, said FTI Consulting, which tracks reports of the disputes. Over the last 15 months, the Centers for Medicare & Medicaid Services has quietly offered roughly three-month special enrollment periods allowing thousands of Advantage members in at least 13 states to change plans. They were also allowed to leave Advantage plans entirely and choose traditional Medicare coverage without penalty, regardless of when they lost their providers. But even when CMS lets Advantage members leave a plan that lost a key provider, insurers can still enroll new members without telling them the network has shrunk.
— KFF Health News, April 28, 2025
Jaffe, Susan. “When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too.” KFF Health News, 28 Apr. 2025. https://kffhealthnews.org/news/article/hospitals-abandon-medicare-advantage-plans-members-quit-too/.
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
