Picture this: You're a senior in Minnesota, relying on the world-renowned Mayo Clinic for your health needs, only to discover that your Medicare Advantage plan might suddenly deem it off-limits. This unsettling scenario is about to become a harsh reality for thousands next year, as major changes shake up access to top-tier care—changes that could leave you facing steep out-of-pocket bills or scrambling for new coverage.
But here's where it gets controversial... Starting in 2026, the Mayo Clinic will no longer be in-network for the majority of Medicare Advantage plans offered by two of America's biggest insurers, UnitedHealthcare and Humana. The Minnesota Star Tribune confirmed these shifts over the past week, though neither the clinic nor the insurers provided any reasons for the move. This means hundreds of thousands of beneficiaries across the state—particularly those enrolled in these plans—will likely have to switch to different coverage if they want to keep visiting the prestigious medical center in Rochester.
To help beginners understand, Medicare Advantage plans are essentially privatized versions of traditional Medicare, offered by private insurers. They often come with lower premiums (the amount you pay each month) but can limit your choices of doctors, hospitals, and clinics through something called a "provider network." If a provider like Mayo is out-of-network, you might end up paying much more out of pocket for services, or in some cases, you won't be able to schedule appointments at all. Imagine needing specialized care and being told your insurance doesn't cover it—that's the risk here.
Officials at Mayo Clinic pointed out that the facility is already out-of-network nationwide with most Medicare Advantage plans. They emphasized that the clinic remains fully available under original Medicare (the government-run program) and serves a significant number of Medicare patients daily. Humana, based in Kentucky, issued a statement highlighting a long-standing issue: the high costs associated with Mayo's services. "When providers demand much higher reimbursement rates than original Medicare allows, it puts extra pressure on our entire health care system," they said.
This isn't happening in a vacuum. As Medicare's annual open enrollment period kicks off—running from October 15 to December 7—more than 1.1 million Minnesotans on Medicare are grappling with big shifts for 2026. That includes an expected average premium hike of nearly 18% for Medicare Advantage plans in the state, according to federal projections. Plus, Minnesota is seeing one of the sharpest declines nationwide in available options: the average beneficiary could face 11 fewer plans next year, per a recent report from the California-based KFF, a health care research group.
And this is the part most people miss... Provider networks are a key feature of Medicare Advantage, but they can feel like a double-edged sword. On one hand, these plans usually cost less than traditional Medicare plus any extra coverage like prescription drug plans (known as Part D) or Medicare Supplements. On the other, they trade that affordability for restrictions—meaning you might not get to see your preferred specialists without hefty fees or referrals. For example, if you're in a Medicare Advantage plan and need an out-of-network hospital visit, you could be on the hook for thousands in additional costs, effectively blocking access to care you might desperately need.
The shake-up specifically affects UnitedHealthcare's individual Medicare Advantage plans starting January 1, though it spares those who get coverage through employer-sponsored group plans for retirees. UnitedHealthcare explained that they've secured a multi-year agreement ensuring Mayo remains in-network for people in their commercial employer plans and Medicare Advantage Group Retiree options. But for others, it's a different story entirely.
Historically, Minnesota seniors in Medicare Advantage could sometimes tap into out-of-network benefits to visit Mayo, but the clinic tightened the reins in 2022 by stopping appointments for such patients. This change has made it even more critical for folks to scrutinize plan networks during open enrollment. "Minnesotans are incredibly attached to Mayo—it's a big deal for them," said Kelli Jo Greiner, Medicare program director at the Minnesota Board on Aging. "We get so many questions about which plans allow access to Mayo. People want to know their options."
Looking at the numbers, five Medicare Advantage plans in Minnesota currently include Mayo as in-network for 2025. Come next year, that drops to just two insurers: Blue Cross and Blue Shield of Minnesota and Medica. Mayo has long drawn criticism for its relatively high costs compared to other Minnesota providers, but the clinic pushes back, arguing that its superior quality actually leads to broader savings—for instance, by reducing complications that could mean more expensive care down the line. They cite sophisticated clients like Walmart as examples of organizations that recognize these efficiencies.
Is this narrowing access really about keeping costs down? Experts say it's too early to pinpoint if rising expenses in Medicare Advantage are directly causing these shifts, but the trends are clear. Jack Hoadley, a retired research professor in health policy at Georgetown University, noted that insurers are under increasing financial strain this year. He pointed to a public dispute between UnitedHealthcare and Baltimore's Johns Hopkins University, another elite medical center, where contract talks have kept providers out-of-network for weeks. Still, UnitedHealthcare's provider directories show that many other high-profile hospitals remain accessible, suggesting negotiations often revolve around pricing, service fees, and requirements for prior authorization (where you need approval before certain treatments).
Insurers are responding to these pressures in various ways. UnitedHealthcare and others are leaning more on Health Maintenance Organization (HMO) plans, which typically require referrals from a primary care doctor for specialist visits, helping to control overuse. They're also shifting more costs onto patients to discourage out-of-network choices. With places like Mayo, Hoadley raised a thought-provoking question: Do patients sometimes chase prestige over necessity, seeking care at high-end clinics for routine issues when equally good—but cheaper—options exist nearby? Original Medicare with a solid Supplement plan lets you make those choices without financial penalty, but plans like these aim to guide decisions.
"Does this mean we're overusing care? Should insurance companies steer us toward more cost-effective options?" Hoadley pondered. It's a debate worth having: are insurers protecting the system, or are they unfairly limiting your freedom?
For now, insurance brokers report a clear pattern: Medicare Advantage plans are shrinking their broad-access options. "Some insurers are phasing out these wide-network plans entirely or pulling them from certain areas," said Joshua Haberman, CEO of Alexander & Haberman in Bloomington. "Others are redesigning them into much narrower networks, restricting choices further."
So, what do you think? Should high-cost providers like Mayo be held accountable for straining the system, or does their quality justify the premium? And is it fair for insurers to restrict your access in the name of affordability? Share your thoughts in the comments—do you agree or disagree, and why? Let's discuss!
About the writer: Christopher Snowbeck is a reporter specializing in health insurers, such as Minnetonka-based UnitedHealth Group, and the operations of hospitals and clinics.
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