UnitedHealthcare Medicare Advantage Alert
UnitedHealthcare could remove Sarasota Memorial and First Physicians Group from its network on Jan. 1, 2027.
Three years ago, Sarasota Memorial Health Care System and First Physicians Group made difficult concessions to remain in UnitedHealthcare’s Medicare Advantage network and protect our patients’ access to care.
But now, as we near the end of that agreement, UnitedHealthcare is changing key provisions that protect Medicare Advantage members and their access to the doctors, hospital, specialists, treatments and services they depend on. We have made multiple attempts to renew our Medicare Advantage contract with UnitedHealthcare before it expires on Dec. 31, 2026. The insurer, however, has rejected proposals with fair and reasonable terms that sustain important protections for our patients, health system and community.
Our agreement with UnitedHealthcare remains in effect through Dec. 31, 2026, and we expect UnitedHealthcare to remove Sarasota Memorial and First Physicians Group from its Medicare Advantage network on Jan. 1, 2027.
We are sharing this information now so Medicare Advantage members and Medicare-eligible patients in our community have time to make informed decisions about their health care and insurance options over the next several months, and during this year's Medicare Open Enrollment (Oct. 15-Dec. 7). For more information, we encourage you to review the frequently asked questions below and check this webpage for future updates.
FREQUENTLY ASKED QUESTIONS
Is Sarasota Memorial still trying to reach an agreement with UnitedHealthcare? Could this be resolved in the coming days?
While we are making progress on a separate agreement for Commercial (employer-sponsored) plans, it is unlikely our Medicare Advantage contract with UnitedHealthcare will be renewed before it expires on Dec. 31, 2026.
Medicare Advantage plans have faced growing scrutiny around the nation over policies and practices that delay or deny medically necessary care. 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.
Because the insurer has shown no interest in addressing these issues and reaching a fair, sustainable agreement with us, we must prepare our community for the possibility that United will remove SMH and FPG providers from its Medicare Advantage network on Jan. 1, 2027.
Please note this change does NOT affect patients with original/traditional Medicare plans or standard Medicare Supplemental plans, which typically do not have the same provider network restrictions as Medicare Advantage plans.
Which SMH providers, locations and services are affected?
If we do not have a new Medicare Advantage contract with United by Dec. 31, 2026, SMH-Sarasota, SMH-Venice and our network of outpatient and urgent care centers and First Physicians Group practices all will become out-of-network providers for UnitedHealthcare members enrolled in Medicare Advantage plans, including its AARP-branded Medicare Advantage plan.
That means United members with Medicare Advantage plans will have to pay a higher out-of-pocket cost for services or be forced to find new providers outside of the SMH/FPG network.
There are a few exceptions for emergency care, serious chronic conditions and behavioral health services (see additional information below).
And we continue to remain hopeful that we will reach an agreement before the end of the year on our separate, commercial contract with UnitedHealthcare that covers employer health plans.
Are other UnitedHealthcare plans affected?
In addition to United’s Medicare Advantage plans, we have agreements covering Commercial (employer-sponsored) plans and Exchange plans that also are due to expire on Dec. 31, 2026. We are in active negotiations and optimistic that we will reach a new agreement by the end of the year.
As noted above, Sarasota Memorial and SMH First Physicians Group providers will continue to remain in-network with UnitedHealthcare for behavioral health care, even if our other agreements expire at the end of this year.
What would happen in emergency situations if Sarasota Memorial is no longer in-network with United?
In emergency situations, go to the nearest hospital emergency department, including those at SMH’s two hospitals and our freestanding ERs. No authorization is needed, and a patient’s financial responsibility is usually no higher if they go to an in-network or out-of-network hospital or freestanding ER for emergency care. Medicare Advantage plans generally are required to cover emergency services, including out-of-network emergency care, at in-network levels.
Do I need to reschedule my procedure or appointments?
No. Patients should keep their current appointments and continue scheduling new appointments with SMH and their FPG physicians through the end of 2026.
What if I need continuing care for a serious condition or illness?
There are provisions in state law to ensure continuing care at in-network rates for women who are pregnant and for patients in the midst of ongoing care for a serious illness, such as cancer. Although there are limitations, Sarasota Memorial and FPG will work with patients affected in these circumstances to ensure they receive the care they need. We encourage you to call United at the number on your insurance card to discuss your specific situation.
Will UnitedHealthcare members still be able to seek care at SMH using UnitedHealthcare’s out-of-network benefits?
Not necessarily. If SMH and FPG are removed from UnitedHealthcare network, SMH and FPG will be unable to process your UnitedHealthcare insurance. Federal regulations also limit the ability of healthcare providers to provide discounts to Medicare-eligible self-pay patients. We encourage you to learn what your out-of-network benefits are and consider exploring other plan options that include SMH and your preferred physicians.
If you are a member of United's Medicare Advantage plans or Medicare-eligible, we encourage you to explore your options during this year’s open enrollment (October 15-December 7) and ask which plans preserve access to the doctors, hospital and care you depend on.
Where can I get help with Medicare enrollment?
We encourage you to review all of your options during Medicare Open Enrollment, Oct. 15 - Dec. 7. Before choosing a plan for 2027, check whether your specific plan will include SMH and FPG as in-network providers.
To compare plans available in our region, visit www.medicare.gov or call the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227); TTY users: 1-877-486-2048. CMS is available 24 hours a day, 7 days a week.
If I am on a Medicare Advantage plan, is there anything more I can do?
If having SMH and FPG as in-network providers is important to you, we encourage you to consider switching to original/traditional Medicare and a standard Medicare (Medigap) supplement plan. SMH and FPG always accept traditional Medicare and supplement plans.
A list of Medicare Advantage plans SMH and FPG will accept as of Jan. 1, 2027 is on our website at www.smh.com/Medicare
You can also learn about your Medicare Advantage options by calling your insurance broker or meeting with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased, and confidential. Call the Florida Elder Helpline at 1-800-963-5337 or visit www.floridashine.org.
Please understand this communication is provided for informational purposes only and is not intended to solicit or encourage any changes to your relationship with Sarasota Memorial, First Physicians Group or your health plan.
If you choose to stay with UnitedHealthcare’s Medicare Advantage plans, we encourage you to call the number on your insurance card and tell UnitedHealthcare you want Sarasota Memorial and First Physicians Group in your network — with fair terms and strong patient protections.
Who can I contact with questions or concerns?
We understand that changes to health insurance can be confusing and concerning.
If you have questions about how this might impact care provided at Sarasota Memorial facilities or by your FPG physician, please call (941) 917-1100, option 2, from 8 a.m. to 5 p.m. weekdays.