The Mayo Clinic will no longer be an in-network provider for certain Medicare Advantage plans offered by UnitedHealthCare and Humana, a change set to take effect on January 1, 2026. The move will impact individuals enrolled in specific plans from two of the nation's largest insurers and is prompting patients to re-evaluate their coverage options.
This development affects Mayo Clinic locations across Minnesota, Wisconsin, and Iowa and arrives during the annual Medicare Open Enrollment period, creating a new layer of complexity for seniors and other eligible individuals managing their healthcare choices.
Key Takeaways
- Starting Jan. 1, 2026, Mayo Clinic will be out-of-network for certain UnitedHealthCare and Humana Medicare Advantage plans.
- The change primarily impacts individual and Dual Special Needs Plans (DSNP), while most employer-sponsored and group retiree plans remain unaffected.
- Insurers cite high reimbursement demands from providers as a factor driving up healthcare costs and premiums.
- Patients are encouraged to review their insurance coverage during the current open enrollment period to ensure future access to Mayo Clinic.
Details of the Network Shift
The upcoming network changes will have specific consequences for members of different plans. UnitedHealthCare confirmed that while it has secured a multi-year agreement with Mayo Clinic for employer-sponsored and group retiree plans, its individual Medicare Advantage and Dual Special Needs Plans will be affected.
"Starting Jan. 1, 2026, Mayo Clinic locations in Minnesota, Wisconsin and Iowa will be out of network for UnitedHealthcare’s Medicare Advantage individual and Dual Special Needs Plans (DSNP)," a statement from UnitedHealthCare explained. The insurer advised members in these plans who wish to continue receiving care at Mayo Clinic to explore their options during the upcoming enrollment period.
Humana also announced that Mayo Clinic would be out-of-network for its Medicare Advantage members beginning in 2026. The company has started notifying affected members and is offering assistance to help them navigate the transition.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies. These plans are regulated by the federal government and must provide the same basic coverage as Original Medicare, but they often include additional benefits like dental, vision, and prescription drug coverage. However, they typically operate with specific networks of doctors and hospitals, which can change from year to year.
The Issue of Healthcare Costs
The decision appears rooted in ongoing negotiations over the cost of medical care. Insurers often build their networks based on reimbursement rates agreed upon with healthcare providers. When these negotiations fail, providers may leave the network.
Humana pointed directly to the financial aspect of the decision, noting the strain that high provider costs place on the healthcare system.
"When providers require significantly higher reimbursement rates compared to Original Medicare, it further strains our healthcare system," Humana stated. "Ultimately, it costs patients more in the end, as seen in the increasing average Medicare Advantage premiums in Minnesota."
For its part, Mayo Clinic stated that while it participates in some Medicare Advantage plans, it is already out-of-network for most. The healthcare provider emphasized its continued participation in Traditional Medicare and Medicare supplement plans.
Patient Advisory: Mayo Clinic encourages patients to confirm their insurance coverage and network access directly with their Medicare Advantage plan provider before enrolling for the upcoming year to avoid unexpected out-of-network costs.
Impact on Patients and Political Reaction
The announcement has raised concerns among patients and lawmakers, particularly for those on fixed incomes who may face difficult choices between keeping their doctors and affording their care. The timing coincides with the Medicare Open Enrollment period, which runs from October 15 to December 7, a critical window for beneficiaries to make changes to their health plans.
Minnesota State Senator Liz Boldon, a nurse by profession, described the situation as personally concerning, having recently helped her own parents navigate the complex insurance system.
"I work in health care. I’ve got access to resources. It took some time for me to navigate that system," Boldon said. "So, I think about what that looks like for other people who don’t have the resources or the background that I have. It is confusing, it is difficult."
The sentiment is bipartisan. State Senator Carla Nelson expressed sympathy for residents who now face tough decisions. "My heart and my thoughts go out to those people who are going to be making those difficult decisions now," she stated. "These are often people on fixed incomes. It’s not like you can just rely on your paycheck."
Nelson identified the broader issue of rising healthcare costs as the fundamental driver behind such network disputes. She argued that the underlying costs of care and reimbursement rates are forcing these difficult outcomes, which ultimately affect patients' access to world-class facilities like Mayo Clinic.
