Anthem Medicare Advantage: 2025–2026 Shakeups, Network Risks & What You Need to Know

Anthem Medicare Advantage is undergoing major shifts as of late 2025. Beneficiaries face new provider exits, payment increases from Medicare, and changing benefit designs — all combining to reshape what “Anthem Medicare Advantage” means for many Americans.

Federal Payment Boost Strengthens Anthem’s MA Position

One of the biggest developments affecting Anthem Medicare Advantage is a substantial increase in government payments. For Calendar Year 2026, Medicare is raising the amount it pays Anthem and other insurers by an average of 5.06% compared to 2025. This increase gives Anthem more financial flexibility to maintain or expand coverage and negotiate with hospitals.

This boost comes after a more modest payment proposal earlier in the year, and reflects updated cost data from Medicare fee-for-service. For Anthem, the higher payment rates are a double-edged sword: they ease financial pressure, but also set up expectations for better provider contracts, especially in high-cost markets.

Mount Sinai to Exit Anthem’s MA Network

A critical network change for Anthem Medicare Advantage members: Anthem’s contract with Mount Sinai Health System in New York is ending. Under the terms of the existing agreement, Mount Sinai physicians will leave Anthem’s MA network beginning January 1, 2026, and its hospitals and outpatient facilities will follow on March 1, 2026.

For Anthem MA members who use Mount Sinai, this could mean significantly higher costs for non-emergency care starting in 2026. Anthem is offering help to members in finding alternative in-network providers, and is making continuity-of-care exceptions for certain patients — but those who rely on Mount Sinai will need to evaluate their plans carefully.

Importantly, this contract termination impacts Anthem’s Medicare Advantage business only; Mount Sinai will remain in-network for some of Anthem’s other offerings, like Medigap (supplement) plans that don’t use narrow provider networks.

MU Health Care Parts Ways with Anthem MA

Anthem Medicare Advantage members in Missouri face another disruption. MU Health Care, a major hospital system in Missouri, has informed patients that its participation in Anthem’s MA network will end on March 31, 2025. As of April 1, Anthem MA enrollees will no longer have in-network access to MU Health Care’s hospitals, clinics, and providers.

The breakdown stemmed from a reimbursement dispute: MU Health Care says it had asked Anthem for a substantial rate increase to align with similar academic systems, and Anthem declined to meet those demands. While the two sides later reached a deal for Anthem’s commercial (non-MA) lines of business, that agreement does not cover Medicare Advantage plans.

For affected Anthem MA members, this exit could lead to higher out-of-pocket costs or the need to change healthcare providers. MU Health Care has set up a dedicated call center for patients to understand options, and Anthem is offering continuity-of-care evaluations for patients with complex or ongoing needs.

Later, Anthem and MU Health Care did reach a separate agreement on some terms — but that deal does not reinstate in-network status for Anthem Medicare Advantage members, meaning the disruption remains in place for MA policyholders.

What Anthem’s 2025 MA Benefit Changes Look Like

Amid these network disruptions, Anthem is updating its Medicare Advantage benefit structure for 2025 — in ways that both protect and complicate access for members.

• Premiums & Out-of-Pocket Costs: Some Anthem MA plans are adjusting cost-sharing and benefit caps. For example, certain HMO-POS plans include a defined maximum out-of-pocket cost, but specific limits depend heavily on the plan type and region.
• Prescription Drug Coverage: Anthem continues to bundle Part D prescription drug benefits into many of its Medicare Advantage plans, giving members access to a broad formulary, though changes to covered drugs and cost tiers are being made in different regions.
• Supplemental (Extras) Benefits: Anthem is enhancing its supplemental benefits for some MA lines. Some members in select areas will have access to non-medical supports—such as utility assistance or non-emergency transportation—especially in plans designed for people with chronic conditions.
• Transition & Continuity: Given the upheaval in provider networks, Anthem is emphasizing its continuity-of-care policies. For members already receiving care from an in-network provider losing contract status, there may be limited provisions to continue care under more favorable terms, but eligibility and approvals vary.

Implications for Anthem MA Members

These changes carry serious implications for Anthem Medicare Advantage policyholders:

• Network Risk Is Real: With providers like Mount Sinai and MU Health Care leaving Anthem’s MA network, many beneficiaries may lose access to preferred hospitals or specialists. This could force them to change doctors or face higher costs.
• Enrollment Decisions Become More Critical: During enrollment periods, Anthem MA members need to be especially diligent. If plan choices are limited in 2026, or if network access is shrinking, switching or reconsidering coverage may be necessary.
• Cost Uncertainty: Even though the federal payment increase helps Anthem, there is no guarantee all cost pressures will ease. Providers may demand higher rates, and Anthem may respond by rebalancing benefits or networks to manage its exposure.
• Continuity-of-Care Complexity: Members eligible for continuity-of-care may need to apply and demonstrate medical need. That means planning ahead, talking to Anthem, and possibly getting provider support to secure ongoing coverage for out-of-network care.
• Read the Fine Print: The devil is in the details. Anthem MA plan documents like the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) will reflect the most up-to-date terms — and members need to scrutinize them, especially if their doctors or hospitals are changing status.

What Anthem Could Do to Stabilize Things

To mitigate the disruption and preserve its Medicare Advantage value proposition, Anthem has some strategic options:

1. Negotiate Aggressively with Key Providers: Anthem should prioritize new deals with hospitals like Mount Sinai in major markets. Securing stable contracts could preserve its network competitiveness.
2. Expand Supplemental Benefits: By broadening support for chronic disease management, social needs, and non-medical benefits, Anthem can make its MA plans more attractive — especially to dual-eligible or chronically ill populations.
3. Communicate Proactively: Anthem must inform affected members early and clearly about network changes, continuity-of-care options, and alternate in-network providers. Transparent outreach can reduce surprises.
4. Streamline Continuity-of-Care Approvals: Simplifying the process to qualify for continuity-of-care would help patients maintain access during the transition period. Anthem could offer a dedicated team or online tool for this.
5. Monitor Quality and Star Ratings: Anthem should invest in quality metrics and star-rating improvements. Higher plan ratings can strengthen its negotiating power with regulators and providers alike.

Risks That Remain for Anthem and Its Members

Despite its potential, Anthem’s current trajectory carries nontrivial risks:

• Reputation Risk: Network exits, especially with high-profile systems, could damage Anthem’s brand among seniors who value provider choice and continuity.
• Regulatory Pressure: As Medicare Advantage continues to draw scrutiny over risk-adjustment and overpayments, Anthem may face regulatory headwinds — particularly if audits or policy changes tighten.
• Member Attrition: Some beneficiaries may leave Anthem MA due to network disruptions or cost concerns. Switching to other MA plans, or even to Original Medicare + Medigap, is a real option.
• Cost Inflation: Health system inflation may outpace Anthem’s new revenue, pushing it to make tough choices on network terms or benefit richness in future years.
• Enrollment Chaos: With changing provider networks, the typical open enrollment (and special enrollment) periods could become more contentious, confusing, or result in more switching than usual.

What Anthem MA Members Should Do Right Now

If you’re enrolled in or considering Anthem Medicare Advantage, here’s a practical action plan:

• Verify Your Network: Contact Anthem or use its online tools to confirm whether your preferred hospitals, doctors, or clinics will remain in-network in 2026.
• Evaluate Plan Alternatives: Use Medicare’s plan finder or talk to a broker/advocate to compare Anthem’s MA plans with others — especially if your provider is exiting.
• Consider Continuity-of-Care: If your current provider is going out-of-network, ask Anthem whether you qualify for continuity-of-care and how to apply.
• Read Your Plan Documents: Review your Evidence of Coverage and Annual Notice of Change carefully. Pay special attention to provider networks, covered drugs, cost sharing, and supplemental benefits.
• Enroll Strategically: Use open enrollment (or other election periods) wisely. If you need to change your plan, now may be the time to act.
• Seek Help: Reach out to State Health Insurance Assistance Programs (SHIP), Anthem customer service, or your employer group (if you’re under an employer plan) to understand your rights and options.

Looking Ahead: What to Watch in 2026 and Beyond

• Mount Sinai Negotiations: Whether Anthem and Mount Sinai reach a new deal, either locking in or further loosening access, will be a crucial indicator of network stability.
• Further MA Plan Exits or Redesigns: Anthem (and other carriers) may continue restructuring their Medicare Advantage portfolios, especially if provider cost pressures rise.
• Regulatory Changes: Watch for any CMS or legislative updates on MA payment policies, risk-adjustment, or non-medical supplemental benefits.
• Quality Performance: How Anthem performs on quality (star ratings) in 2026 could influence its bonus payments, reputation, and appeal to beneficiaries.
• Member Response: Will a significant portion of Anthem MA members switch plans or revert to Original Medicare? Trends in disenrollment or switching will signal how serious the disruption is.

Conclusion

Anthem Medicare Advantage is navigating a turbulent moment. On one hand, the significant 5.06% increase in Medicare payments for 2026 gives Anthem a financial boost. On the other, major provider exits — like Mount Sinai in New York and MU Health Care in Missouri — threaten access and stability for members.

For beneficiaries, the message is clear: stay informed, evaluate your options, and act proactively. The decisions you make now — around enrollment, continuity-of-care, and provider choice — could determine both your access to care and your out-of-pocket costs in the year ahead.

If you’re affected by any of these changes or just want to explore your Anthem Medicare Advantage options, now is a good time to reach out for help, compare plans, and ensure you’re covered in 2026.