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MultiCare won’t accept some Medicare Advantage plans next year

The Tacoma-based health system MultiCare will no longer accept certain Medicare Advantage plans next year, leaving a few thousands seniors without in-network access to its hundreds of Puget Sound facilities.

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Starting in 2026, the company will no longer participate in the Medicare Advantage PPO plans, company spokesperson Scott Thompson confirmed to the Kitsap Sun and Gig Harbor Now. The Tacoma News Tribune first reported the shift. 

The change means that come January, MultiCare’s 300 clinics and 13 hospitals, including those on the Kitsap Peninsula, will be out of next work for people with Medicare Advantage PPO plans. The company says it will affect fewer than 15,000 patients.

HMO vs. PPO

MultiCare chose to focus on HMO plans, allowing for better coordinated care within its network, Thompson said. “This change helps us provide more consistent, high-quality care for our patients.” 

An HMO, or health maintenance organization, is a model in which patient coverage is limited to a specific network of providers. They are often cheaper than PPOs, preferred provider organizations, which allow patients to receive coverage from a wider variety of providers.

MultiCare’s shift comes in the middle of the open enrollment window for Medicare, the federal insurance program for those older than 65. Until Dec. 7, qualifying individuals can select either traditional Medicare or Medicare Advantage plans for the upcoming year. 

While both programs cover major medical needs, Medicare Advantage is sold through a private insurance company, approved by the government, and functions more like employer-based insurance.

Medicare Advantage

Medicare Advantage offers “bundled plans,” which provide a wider variety of coverage for things like prescription drugs, hearing, dental or vision care, not covered by original Medicare. But bundled plans often limit which doctors or providers are in-network. 

MultiCare will work with two independent Medicare adviser agencies (PSW and Chapter) to help patients affected by the policy change find new plans, Thompson said. 

PSW offers in-person and virtual support at 360-338-3897, and Chapter provides virtual support at 800-341-6048 or askchapter.org/mc.

“If a transition in care is necessary, we will work closely with [their] new provider to make the process as smooth as possible,” Thompson said.