7 recent Medicare Advantage contract suspensions, terminations

CMS has taken a series of enforcement actions against Medicare Advantage plans over the last year and a half, suspending enrollment and terminating contracts over issues ranging from network adequacy to financial solvency failures.

Seven updates:

1. In May, CMS said it was suspending enrollment into Provider Partners Health Plans’ institutional special needs plan in Maryland, effective June 14, after the plan lost all contractual relationships with its long-term care facilities at the end of last year.
   
   
2. In February, CMS suspended enrollment into Aspirus Health Plan’s MA plans after the  insurer’s third-party administrator, UCare, was placed into state rehabilitation by Minnesota regulators, leaving Aspirus unable to fulfill its federal contract requirement to accept new enrollees.
   
   
3. In December, CMS terminated its MA contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The plan served about 495 beneficiaries through an I-SNP in Texas.
   
   
4. In September, CMS terminated UCare’s MA contracts after the insurer missed an execution deadline amid its wider business closure.
   
   
5. In September, CMS suspended enrollment into Gold Kidney Health Plan’s MA plan in Florida after state regulators found the insurer failed to obtain required approvals for certain executive appointments, significantly delayed mandatory filings, failed to provide required financial documents and showed substantial gaps between projected and actual financial performance. CMS lifted the sanction in December after Florida regulators permitted new enrollments.
   
   
6. In April 2025, CMS suspended enrollment into two MA-PD plans from eternalHealth after Massachusetts regulators ordered the insurer to stop marketing its products and services following failures to meet state financial solvency and operational requirements. CMS lifted the sanction in September after the state lifted the restrictions.
   
   
7. In September 2024, CMS suspended enrollment into Wellcare of Missouri’s MA plan after the insurer failed to meet the 85% minimum medical loss ratio requirement for three consecutive contract years, a sanction that carried into 2025. CMS lifted the suspension for 2026 enrollment after Wellcare reported its 2024 MLR exceeded the 85% threshold.

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