Medicare Advantage pullbacks tighten access across Texas and Florida as 2027 enrollment nears
Blue Cross and Blue Shield of Texas is leaving Medicare Advantage after 2026, and several major Florida health systems are preparing to split from UnitedHealthcare. The changes land in a year when open enrollment runs through Dec. 7, forcing beneficiaries to sort through county-level plan exits, network losses and prescription drug coverage changes before coverage decisions lock in.
The pattern is not isolated. It reflects a broader market retreat by insurers and a parallel pushback from hospitals and physician groups over payment, denials and prior authorization delays.
In Texas, Blue Cross and Blue Shield of Texas will stop offering Blue Cross Medicare Advantage plans, Blue Cross MedicareRx prescription drug plans and Dual Care Plus HMO special needs plans for 2027. The insurer had offered Medicare Advantage products in 227 Texas counties in 2026, but those plans will disappear from its lineup next year. Health Care Service Corp., the parent company, will continue offering HealthSpring Medicare Advantage plans in 47 Texas counties, leaving some beneficiaries with a narrower set of options than they had this year.
A separate county-level shift matters just as much as the brand names involved. When an insurer exits a county, it is not a symbolic move; beneficiaries lose access to every Medicare Advantage plan with drug coverage that carrier offered there. KFF counted 193 counties with no Medicare Advantage 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 in this report, but the rise signals how quickly access can contract when carriers decide markets no longer work financially.
Texas beneficiaries face a full plan exit from Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas notified affected members by mail before Oct. 2, giving them a special election period to select new coverage. That detail is important for bedside planning and for the physician office: medication lists, referral patterns and network restrictions can change abruptly once a beneficiary is moved to another plan, especially if the new option does not preserve the same pharmacy or specialist access.
The insurer described the move as part of its annual market review of Medicare products. In practice, that means business viability is driving coverage design more directly than many patients realize. When margins tighten, plans that appear stable on paper can disappear in a single enrollment cycle, and the result is a scramble for alternate coverage in counties that may already have limited choice.
Christus Health Plan and Memorial Hermann Health Plan are also leaving Medicare Advantage in Texas. Christus Health Plan offered plans in 36 counties, while Memorial Hermann Health Plan offered plans in six. Memorial Hermann had already announced that it is shutting down its commercial business, a reminder that payer strategy and health-system finances are increasingly intertwined.
Florida hospitals push back as UnitedHealthcare contracts unravel
Florida offers a different but related disruption: network breakups between UnitedHealthcare and major health systems. Lee Health is ending hospital and physician contracts with UnitedHealthcare at the end of 2026. Beginning Jan. 1, Lee Health will be out of network for UnitedHealthcare employer-based, individual and Medicare Advantage members. The system says about one-third of its medical necessity denials are tied to UnitedHealthcare Medicare Advantage plans, and it says the insurer owes more than $100 million in disputed and underpaid claims. UnitedHealthcare disputes that account and says Lee Health issued notice to end the network relationship without advance notice or discussions.
The dispute is more than a contract standoff. High denial rates and delayed reimbursement can shape whether a system can keep specialists, outpatient services and ancillary care in network at all. For patients, the practical effect is usually delayed authorization, higher out-of-pocket spending or the need to move care to another facility to remain in network. For physicians, the burden shows up as more time spent contesting coverage decisions and documenting necessity in a system already stretched by administrative work.
Sarasota Memorial Health Care System faces a similar split. Its Medicare Advantage contract with UnitedHealthcare expires Dec. 31, and without a new agreement, Sarasota and Venice hospitals, outpatient and urgent care centers, and First Physicians Group practices would be out of network for UnitedHealthcare Medicare Advantage members, including those enrolled in the AARP-branded plan. Sarasota Memorial says a renewal appears very unlikely for 2027. That language leaves little room for ambiguity: patients who assume continuity may find themselves outside the network on Jan. 1 unless they change coverage or accept higher costs.
AdventHealth says UnitedHealthcare terminated its contract, with the agreement ending Dec. 31. If no new deal is reached, AdventHealth hospitals and clinicians across Florida would be out of network starting Jan. 1 for UnitedHealthcare Medicare Advantage, individual and family, commercial and Medicaid plans. AdventHealth says it is not seeking increases above inflation and is instead asking for contract terms that address delays, denials and prior authorization requirements. The focus on prior authorization is clinically significant because delays can slow imaging, procedures and follow-up care even when treatment is medically indicated.
County-by-county plan exits raise the risk of coverage gaps
National insurer retrenchment is moving at the same time hospital systems are refusing contracts they view as unsustainable. 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, based on KFF analysis of federal plan data published Oct. 9. Those numbers do not capture every downstream effect, but they do show how quickly Medicare Advantage footprints can shrink.
County exits also interact with local provider behavior. Becker’s Hospital Review tracks 35 health systems ending contracts with at least one Medicare Advantage insurer in 2026. Systems that drop plans often cite prior authorization denials and slow payment, while in other cases the insurer ends the contract first. Either way, the beneficiary is the one who has to decide whether to stay with the doctor, switch plans or accept a network disruption that may alter referral patterns and prescription coverage.
A few Florida systems remain in flux. Naples Comprehensive Health will be out of network with Wellcare and HealthSpring Medicare Advantage plans at year end. University of Miami Health System also appears on the tracker for a 2027 break with UnitedHealthcare Medicare Advantage. Moffitt Cancer Center has been out of network with Humana Medicare Advantage HMO and PPO plans since July 1 after Humana terminated the agreement, and it sees Aetna Medicare Advantage patients on an out-of-network basis.
The practical consequence is cumulative. Medicare Advantage has long been marketed as a coordinated alternative to traditional Medicare, but coordination depends on stable networks, predictable authorizations and timely claims payment. When those pieces fracture, continuity of care becomes a moving target for older adults managing cancer, cardiac disease, diabetes and other chronic conditions that require repeated specialist contact.
Dec. 7 is the cutoff for many beneficiaries to make enrollment decisions for 2027, and the Florida and Texas changes arrive just before that deadline. The unresolved questions are specific: how many members will move to new plans, how many will lose their preferred doctors, and how many will face interrupted access to prescriptions, procedures and ongoing specialty care once the new year begins.