The Centers for Medicare & Medicaid Services has shelved a proposed rule that would have helped Medicare Advantage patients switch plans when their doctors leave networks. The reversal comes as UNC Health and other major hospital systems nationwide are abandoning private Medicare Advantage plans, leaving 65,000 North Carolina beneficiaries scrambling for alternatives.

Amy Trojanowski, a 60-year-old with a disability, exemplifies the human cost. After nearly a decade with her trusted doctor at UNC Health, Humana informed her the hospital system would exit its network in 2026. Medicare Advantage plans, which cap out-of-pocket costs and offer extra benefits like dental and vision, require patients to use in-network providers. When networks shrink, patients face difficult choices between their doctors and their insurance.

Last November, CMS proposed streamlining the process for patients to change coverage midyear when providers leave plans. The agency would have eliminated the need to determine if network changes were "significant" before allowing special enrollment periods. But CMS officials recently abandoned the proposal without explanation, even as breakups between health systems and insurers accelerate. With 35 million Americans enrolled in Medicare Advantage and federal reimbursement increases failing to match rising medical costs, industry analysts predict further market disruption ahead.