Members will maintain their coverage through the end of 2026, but they will need to review their Medicare options for the coming year. There will be a special enrollment period until February 28, 2027.
Memorial Hermann Health System will close its Medicare Advantage plan on December 31, 2026 and will discontinue it in 2027. The decision requires Houston-area members to review their health insurance options for next year, especially if they want to keep their doctors, continue treatments or maintain prescription drug coverage.
Current coverage will remain in effect until the last day of December. Members will continue to use services and benefits included in their policies during that period, according to Memorial Hermann Health Plan.
The measure affects Memorial Hermann’s Medicare Advantage insurance business, not the overall operation of its hospitals and medical centers. The health system attributed its decision to factors such as rising competition, regulatory demands and operating costs of health plans.
Members who do not switch plans will generally return to Original Medicare
Memorial Hermann Medicare Advantage closure does not eliminate the right of its members to Medicare. However, the coverage they will receive starting January 1, 2027 will depend on the enrollment choices they make in the coming months.
Those who do not enroll in another Medicare Advantage plan will generally return automatically to Original Medicare, composed of Part A, which mainly covers hospital services, and Part B, which covers certain medical and outpatient services.
This change does not guarantee that the same costs, additional benefits or drug coverage as the previous plan will be maintained. Original Medicare, by itself, does not include the usual prescription drug coverage of Part D.
Options include enrolling in another Medicare Advantage plan available in the resident area or remaining in Original Medicare and separately evaluating prescription drug coverage and a possible Medigap supplemental insurance.
The special enrollment period to change coverage ends on February 28, 2027
The annual Medicare open enrollment began on October 15 and will continue through December 7, 2026. During that period, beneficiaries can review the available options for the coming year.
Because Memorial Hermann will not renew its Medicare Advantage plan, its members also have a special enrollment period that extends until February 28, 2027.
Memorial Hermann established the following transition conditions:
- Until December 31, 2026: requests for a new plan will generally allow coverage to begin on January 1, 2027.
- From January 1 to February 28, 2027: affected members may still apply for a new plan through the special period. Coverage will generally begin on the first day of the month following receipt of the application.
- From January 1, 2027: those who have not chosen another Medicare Advantage will generally transition to Original Medicare.
The Medicare special enrollment period expressly contemplates cases where an insurer decides not to renew a plan. This right allows changes outside the usual annual calendar.
Enrolling before the end of December generally allows the new coverage to begin immediately after closing. A later enrollment may leave a gap during which the beneficiary has Original Medicare, but does not yet have the new drug plan or the additional benefits they have chosen.
Continuity with doctors and hospitals will depend on the new insurance
Beneficiaries will be able to keep their scheduled visits under Memorial Hermann Medicare Advantage through December 31, 2026, provided that the services are covered according to the terms of their policy.
For appointments, surgeries or treatments scheduled from January onward, coverage will depend on the rules of the new plan. The participation of a hospital or specialist in the current network does not guarantee inclusion with another insurer.
Before changing coverage, it is necessary to check the participation of primary care physicians, specialists, hospitals and other providers. Copayments, deductibles, prior authorization requirements and restrictions on out-of-network care should also be reviewed.
Patients receiving ongoing treatments may have federal continuity-of-care protections when joining another Medicare Advantage. The applicability depends on the type of treatment, the conditions of the new plan and the corresponding authorizations.
Memorial Hermann noted that people with active treatments should contact the new insurer as soon as their enrollment begins to review protections and authorizations available.
Medication authorizations will not automatically transfer to the new plan
Memorial Hermann Medicare Advantage pharmacy benefits will remain in effect through December 31, 2026. Beginning in January, the conditions to fill prescriptions will depend on the new coverage chosen.
Prior medication authorizations, quantity exceptions and related approvals granted by Memorial Hermann will expire with their plan.
The new insurer will have to evaluate medications under its own rules. Therefore, before enrolling, it is necessary to check that regular prescriptions are included in the formulary of the new plan and review costs and participating pharmacies.
Mail-order drug prescriptions will not transfer automatically either. Beneficiaries who use this service will have to set it up again with their new insurer or approved pharmacy.
Federal transition rules may allow temporary supplies of medications during the changeover. The new insurer must inform about applicable procedures when a medication requires prior authorization or is not included in its formulary.
Those returning to Original Medicare should consider an independent Part D policy if they need prescription drug coverage. Remaining without credible prescription coverage during the period established by Medicare could result in a late enrollment penalty.
Medicaid beneficiaries will retain their state benefits
Beneficiaries enrolled in a Medicare and Medicaid special needs plan, known as a D-SNP, will not automatically lose Medicaid due to the closure of Memorial Hermann Medicare Advantage.
However, they should review how they will receive their Medicare services in 2027, as the coordination rules between the two programs may change when selecting another plan.
The Texas Health and Human Services Commission handles Medicaid inquiries at 1-800-964-2777.
Beneficiaries interested in supplementing Original Medicare with a Medigap policy may also have special purchase rights without medical underwriting for certain policies due to the plan’s closure. The conditions are explained in the non-renewal notice and can be reviewed with the Texas Department of Insurance at 1-800-252-3439.
Houston offers free counseling to compare Medicare plans
The Harris County Area Agency on Aging, which operates through the Houston Health Department, offers free, one-on-one counseling on Medicare, Medicaid and supplemental insurance.
The service is part of the Health Information, Counseling and Advocacy Program (HICAP), the Texas version of the federal SHIP program that provides assistance on health insurance.
Although several agency services are aimed at Harris County residents over 60, HICAP counseling is also available to Medicare beneficiaries with disabilities, regardless of age.
The free benefits counseling in Harris County is available by phone at 832-393-4301. Counselors can help understand the differences among plans, costs and coverage, without the counseling being conditioned on purchasing a policy.
Medicare also maintains the plan comparator for 2027, which allows searching options by ZIP code, adding medications and reviewing estimated costs. Phone assistance is available in Spanish via 1-800-MEDICARE (1-800-633-4227).
Memorial Hermann Health Plan directly handles inquiries about the coverage ending in December at 855-645-8448 (TTY 711).
The plan will continue to cover the relevant services until December 31, 2026. The special enrollment period for affected members ends on February 28, 2027.
