Three dates now sit within a six-week span for older adults in Virginia and West Virginia who get their care at Valley Health and carry a UnitedHealthcare Medicare Advantage card. The contract between the health system and the insurer terminates on September 30, 2026. Valley Health’s hospitals, facilities and physicians become out of network for those plans the next morning. Medicare’s Annual Enrollment Period, the once-a-year window for changing plans, opens two weeks after that, on October 15.
September 30 ends the contract, and October 1 begins the out-of-network period
Both sides of this dispute have published the same core fact, which is unusual in a contract fight. UnitedHealthcare’s notice, stamped as updated August 7, 2026, says Valley Health’s hospitals, facilities and physicians throughout Virginia and West Virginia will be out of network for UnitedHealthcare Medicare Advantage individual plans and Group Retiree plans beginning October 1, 2026. Valley Health’s patient page describes the same outcome from the provider side: the insurer rejected the system’s proposal to renew the Medicare Advantage contract past its termination date of September 30, 2026.
The insurer says it is notifying affected Medicare Advantage members so they can weigh their options over the coming weeks. Valley Health says no changes are in effect today and that patients should keep their appointments and access care as they normally would through September 30. Neither organization publishes how many people are enrolled in the affected plans, and neither has announced a settlement or an extension on the Medicare Advantage line.
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Medicare Supplement, D-SNP and Medicaid coverage is not part of this
The change is narrower than the phrase “UnitedHealthcare members” suggests. UnitedHealthcare states that people enrolled in its Dual Special Needs Plan, known as a D-SNP, are not impacted and will keep network access to Valley Health’s hospitals, facilities and physicians on and beyond October 1, 2026. Valley Health adds that Medicare Supplement policyholders see no change in coverage or out-of-pocket costs. Medicaid coverage, including the UnitedHealthcare Community Plan, Cardinal Care and Dual Complete plans, is also unaffected, because the two organizations agreed to extend that contract. Coverage through the Community Care Network for military veterans continues as well.
Commercial coverage is the open question. Valley Health says it could also become out of network for UnitedHealthcare commercial plans, meaning coverage through an employer or bought on the marketplace, beginning October 1, 2026, if no agreement is reached, and that those talks remain active. That is a conditional outcome rather than a scheduled one, and it is separate from the Medicare Advantage termination, which both organizations describe as settled.
Out-of-network cost sharing works differently for individual PPO and Group Retiree members
For someone in a Medicare Advantage individual PPO plan, a Valley Health visit after October 1 is generally still covered, but at a higher share of the cost. UnitedHealthcare says individual PPO members have out-of-network benefits and can receive services from providers who do not participate in the network, while noting that the member’s cost-share responsibility will be higher than for in-network care. The insurer also encourages members who intend to use those benefits to check with the Valley Health provider first and confirm the office will keep seeing them as an out-of-network provider.
Group Retiree PPO members are in a different position. UnitedHealthcare says people enrolled in its Medicare Advantage Group Retiree PPO plans may still receive care from a Valley Health physician or hospital as an out-of-network provider, and that the member’s share of the cost will be the same as if the provider were part of the network. Emergency care is treated the same way for both groups: the insurer says members should go to the nearest hospital and that emergency care is covered at the in-network benefit level regardless of network status. For members who would rather move their care, UnitedHealthcare lists in-network alternatives in the region including Berkeley Medical Center and Jefferson Medical Center, both part of WVU Medicine, HCA StoneSprings, Inova Loudoun Hospital, LifePoint Fauquier Hospital, Loudoun Medical Group, Meritus Hospital and Privia Medical Group.
Continuity of care, and a Special Enrollment Period that CMS has to approve
People in active or ongoing treatment for a serious or complex condition at the moment the network changes may qualify for continuity of care, which extends in-network benefits for a limited period after a provider goes out of network. Both organizations describe it the same way, and both stress that the health plan has to approve it. Valley Health points to scheduled surgeries and ongoing treatment for a serious or complex condition as examples, and tells patients to call the UnitedHealthcare customer service number to request approval.
A second route exists outside the annual window. Medicare’s rules allow a Special Enrollment Period in certain exceptional circumstances, including when an enrollee is notified of a significant change in a plan’s provider network; those cases are evaluated one at a time, and someone who qualifies gets two months to join a plan or switch. Valley Health notes that a Special Enrollment Period must be approved by the Centers for Medicare and Medicaid Services and directs patients to 1-800-MEDICARE to ask about it.
October 15 to December 7, with coverage that starts January 1
The Annual Enrollment Period is the route that requires no approval from anyone. It runs from October 15 to December 7, and Medicare says the changes made during it take effect on January 1 of the following year, provided the plan receives the request by December 7. In that window a beneficiary can join, drop or switch a Medicare Advantage plan, move back to Original Medicare, or change drug coverage. Valley Health tells patients that selections made this fall take effect January 1, 2027.
The spacing of the dates is the part worth planning around. The network change lands on October 1, the ordinary window to respond does not open until October 15, and a new plan chosen in that window does not begin paying claims until January 1. Free help is available in between. Valley Health lists the State Health Insurance Assistance Program lines for both states it serves, 1-800-552-3402 in Virginia and 1-877-987-4463 in West Virginia, as the place to get free, unbiased, one-on-one Medicare counseling.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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