Sarasota Memorial Health Care System says it expects to leave UnitedHealthcare's Medicare Advantage network Jan. 1, 2027, after the two sides reached what the hospital system calls an impasse.

The current contract expires Dec. 31, 2026. Medicare's annual open enrollment period closes Dec. 7, giving affected patients until then to review coverage options for next year.

"At this point, it is highly unlikely we will have a new Medicare Advantage contract when our current agreement expires Jan. 1, 2027," Kim Savage, Sarasota Memorial spokesperson, said in early November, as reported by the Venice Sun. "It appears we have reached an impasse."

An advertisement the health system ran in local newspapers put it more bluntly: "We fully expect to be out of UnitedHealthcare's Medicare Advantage network Jan. 1, 2027."

What it means for patients

If the contract expires without a replacement, Sarasota Memorial's hospitals in Sarasota and Venice, outpatient and urgent care centers, and First Physicians Group (FPG) practices would generally become out-of-network for UnitedHealthcare Medicare Advantage members, according to the health system's website.

Coverage for nonemergency treatment would depend on the patient's specific Medicare Advantage plan and the services involved. Some plans offer out-of-network benefits, but Sarasota Memorial has warned that it may be unable to process UnitedHealthcare claims for those services. Patients should not assume their plans will cover treatment at Sarasota Memorial after Dec. 31 without confirming directly with the insurer and provider.

Patients who are pregnant or undergoing treatment for a serious illness, such as cancer, may qualify for temporary continued access to in-network care through UnitedHealthcare's continuity-of-care provisions. Eligibility depends on individual circumstances and must be confirmed with the insurer.

Emergency services would remain covered under federal Medicare Advantage rules, although patients should verify applicable cost-sharing requirements. Behavioral health services through Sarasota Memorial and FPG would also remain in-network regardless of the contract outcome, according to the health system.

Original Medicare and Medicare supplement insurance, commonly called Medigap, are not affected by the dispute.

Two sides, two stories

Sarasota Memorial said the dispute goes beyond reimbursement rates. The health system has alleged that UnitedHealthcare's use of prior authorization creates barriers to medically necessary care for Medicare Advantage patients.

Dr. Jack Rodman, FPG chief medical officer, wrote in a Sept. 25 letter to providers that "we've seen firsthand how UnitedHealthcare's use of prior authorization and other restrictions create barriers between our Medicare Advantage patients and the care they need," according to earlier Venice Sun coverage.

UnitedHealthcare, in a statement after Sarasota Memorial first notified patients in late September, said it proposed to continue reimbursing the hospital at market-competitive rates. The insurer said Sarasota Memorial is seeking price increases that would raise health care costs and that claims delays are largely due to billing errors and duplicate claims.

"Sarasota Memorial has a history of putting its patients in the middle of contract disputes with health plans, presumably as leverage to obtain price hikes that drive up healthcare costs," UnitedHealthcare stated.

Sarasota Memorial rejected that characterization.

"Higher reimbursement alone cannot resolve the issues we (and other health systems across Florida and the nation) are facing with UnitedHealthcare," the health system stated in its advertisement.

A national pattern

Sarasota Memorial is not alone. At least 34 health systems across the country have ended or announced plans to end relationships with Medicare Advantage insurers in 2026, according to Becker's Hospital Review. In Florida, Lee Health and AdventHealth also face potential network exits with UnitedHealthcare at year's end.

The current Sarasota Memorial agreement was reached in 2023 after what the health system described as "difficult concessions" to remain in the network.

What patients should do before Dec. 7

Sarasota Memorial is urging UnitedHealthcare Medicare Advantage members to review other plan options before Medicare's annual open enrollment period ends Dec. 7 and contact their providers about appointments or procedures scheduled for 2027.

Patients can compare plans at Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Free counseling is available through Florida's SHINE (Serving Health Insurance Needs of Elders) program at 1-800-963-5337.

A list of Medicare Advantage plans Sarasota Memorial and FPG expect to accept in 2027 is available at smh.com/medicare.

Patients considering switching from Medicare Advantage to Original Medicare should also check their eligibility for Medigap coverage. Federal rules do not guarantee that everyone leaving a Medicare Advantage plan can purchase a Medigap policy without medical underwriting, and eligibility protections vary by circumstance.

Before changing coverage, patients should confirm that their preferred doctors, hospitals, medications and other services are included in the new plan.

Sarasota Memorial said it remains hopeful about renewing its separate commercial and exchange plan contracts with UnitedHealthcare before Dec. 31, although agreements have not been guaranteed.

Patients with questions can call Sarasota Memorial at (941) 917-1100, option 2, weekdays from 8 a.m. to 5 p.m.

Key date: Medicare's annual open enrollment period closes Dec. 7, 2026. Coverage changes generally take effect Jan. 1, 2027.