A local health system trims Medicare Advantage participation as another expands
AI-generated summary reviewed by our newsroom.
- MultiCare will exit Medicare Advantage PPO plans in 2026 and focus on HMOs.
- Affected patients will get assistance from PSW and Chapter to find replacement plans.
- Virginia Mason Franciscan expands Medicare Advantage PPO contracts for 2026.
Story has been updated with additional information regarding group PPO plans.
Some area seniors are having to switch gears with their medical teams heading into next year as a major health provider in the South Sound will no longer be a part of some Medicare Advantage plans.
Meanwhile, a local competitor has announced an expansion of coverage.
In a statement sent to The News Tribune in response to questions, MultiCare said Friday, “Beginning in 2026, MultiCare will no longer participate in Medicare Advantage PPO plans and will focus on HMO plans, which allow us to better coordinate care within our network. This change helps us provide more consistent, high-quality care for our patients.”
A MultiCare media representative told The News Tribune via email in response to questions that the change affects “fewer than 15,000 patients across our system.”
In general, Medicare PPOs give plan members more leeway to see providers outside the network than Medicare HMOs do, according to information on United Healthcare’s website describing the plans.
MultiCare added that the health system “is committed to ensuring that no patient experiences a disruption in their care.” It said that for those affected by the changes, “MultiCare partners with two independent Medicare adviser agencies — PSW and Chapter — to help patients find new plans.”
MultiCare’s statement also noted, “If a transition in care is necessary, we will work closely with your new provider to make the process as smooth as possible.”
Regence is one of the insurers who’s alerted their clients of the change.
“This decision by MultiCare means that beginning Jan. 1, 2026, all MultiCare providers and facilities in the Puget Sound region will be out-of-network for Regence Medicare Advantage PPO plans,” a Nov. 7 release from the insurer stated. “We are disappointed by this decision and are available to actively assist our Medicare Advantage PPO members who visit MultiCare providers to find a new provider if they wish to stay with Regence.”
Its notice included a list of alternative providers.
On Nov. 19, in response to questions, MultiCare sent additional details regarding group PPO plans covering retirees.
“We are continuing to accept Group PPO plans – these are typically offered to retirees through their employer. Most allow patients to go out of network to any provider – whether contracted or not.”
The statement added that “Our intent is to continue to accept these plans as they do not go through open enrollment on the Medicare cycle – they cannot choose a new plan right now. They are also listed as Accepted Medicare Advantage health plans on our website.”
A full list of MultiCare’s accepted health insurance plans is available online at this link. The link also includes more information on contacts for further assistance.
VMFH taking different approach
Meanwhile, an area medical network rival to MultiCare said Friday it would be expanding its offerings for Medicare Advantage patients.
Lori Fleming is chief of payer strategy and analytics for Virginia Mason Franciscan Health and CommonSpirit Health, Northwest Region.
In response to questions, Fleming told The News Tribune, “Looking ahead to 2026, Virginia Mason Franciscan Health has expanded its Medicare Advantage PPO contracted payers to best serve patients across our system.”
This story was originally published November 17, 2025 at 2:14 PM.
