Contract disputes between Florida Blue and two of Broward County’s largest public hospital systems, Broward Health and Memorial Healthcare, have left tens of thousands of South Florida members, including Medicare Advantage enrollees, unable to get in-network care unless they walk into an emergency room. If you carry a Florida Medicare Advantage plan that includes either hospital in its network, you may be wondering what is still covered, what counts as an emergency, and how to keep your care on track.
This guide explains exactly how Medicare Advantage networks work, what federal law requires carriers to pay, and the specific steps you can take to protect your coverage during a hospital contract dispute.
Compare Medicare Advantage plans in Florida at YourMedPlan to see what networks fit your hospital and doctor preferences.
What Happened With Florida Blue, Broward Health, and Memorial?
In recent months, Florida Blue and Broward County’s two public hospital systems have been negotiating a new contract. During the dispute, Florida Blue members cannot access in-network non-emergency care at Broward Health or Memorial Healthcare facilities. Cleveland Clinic was also at risk of falling out of network but reached a deal shortly before the deadline, which keeps it in-network for Florida Blue’s employer-sponsored plans, Marketplace plans, and Medicare Advantage plans.
For Medicare Advantage members, a hospital falling out of network can affect:
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Elective surgeries and scheduled procedures
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Specialist visits and follow-up appointments
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Physical therapy and rehabilitation
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Routine imaging and lab work
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Scheduled outpatient care
The Broward County dispute is one of several network changes playing out across Florida, and similar disputes can happen with any Medicare Advantage carrier in any state.
How Do Medicare Advantage Networks Work?
Medicare Advantage plans, also called Part C, replace Original Medicare with a private insurance plan that must cover everything Original Medicare covers. Most Medicare Advantage plans are built around a provider network:
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HMO plans require you to use in-network providers for all non-emergency care, and often require referrals for specialists.
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PPO plans let you go out of network, but you pay higher cost-sharing.
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HMO-POS and PFFS plans add some flexibility but still reward staying in network.
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SNP (Special Needs Plans) serve people with specific chronic conditions, dual Medicare-Medicaid eligibility, or those living in institutions, and often have their own dedicated networks.
Networks change throughout the year as carriers and providers negotiate contracts. Your plan must notify you in advance when a significant network change occurs, but the change itself can happen mid-year.
ER or Urgent Care: Which One Do You Need?
Before worrying about networks, match your symptoms to the right level of care.
Go to an emergency room if you have:
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Chest pain, pressure, or tightness
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Trouble breathing
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Sudden numbness or weakness on one side of the body
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Severe bleeding or head injury
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Sudden, severe pain
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Signs of stroke (face drooping, arm weakness, speech difficulty)
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Any symptom you believe is life-threatening
Start with urgent care for:
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Cough, sore throat, runny nose
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Minor cuts and sprains
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Ear infections
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Mild fever or flu-like symptoms
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Minor burns or rashes
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Diarrhea or vomiting without severe dehydration
Urgent care visits cost significantly less than ER visits. Many Medicare Advantage plans charge a copay of $0 to $40 for urgent care versus $90 to $150 or more for an ER visit. If the situation is life-threatening, go to the nearest ER, even if it is out of network, or call 911.
Does Medicare Advantage Cover Emergency Care at Out-of-Network Hospitals?
Yes, Medicare Advantage plans must cover emergency services at any hospital in the United States at your in-network cost-sharing level, regardless of whether the hospital is in your plan’s network. This rule comes directly from federal Medicare regulations (42 CFR 422.113), and it applies in every state.
That means if you have a Florida Blue Medicare Advantage plan and you go to a Broward Health or Memorial emergency room during the contract dispute, your emergency care is still covered at in-network rates. The same is true for any other out-of-network hospital, anywhere in the country.
Key points to remember:
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Emergency coverage applies whether you drive yourself, take a rideshare, or arrive by 911 ambulance
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Whether you go home the same day or get admitted, emergency care and emergency stabilization are covered at in-network rates
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You cannot be asked to waive this right while receiving emergency care
Who Decides What Counts as an Emergency?
This is where emergency billing gets tricky. Emergency room doctors decide the treatment you need, but your insurer ultimately decides whether that care qualifies as an emergency for billing purposes. That creates room for disputes, especially when a hospital is out of network.
Both the federal Emergency Medical Treatment and Labor Act (EMTALA) and the No Surprises Act protect your access to emergency care. However, once a hospital stabilizes you, your emergency designation ends. After that point, ongoing care, admission decisions, and follow-up treatment revert to normal network rules under your Medicare Advantage plan.
If your Medicare Advantage carrier denies an emergency claim, you have strong appeal rights, and you should use them.
What If You Are Admitted to the Hospital From the ER?
If an out-of-network hospital admits you after an emergency room visit, your hospital stay for that emergency is covered at your Medicare Advantage in-network cost share. Florida Blue specifically addresses this on its website for the Broward dispute. The same rule applies to every Medicare Advantage plan.
Important caveat: Not every ER admission qualifies as a continuation of the emergency. Once you are stabilized, your insurer may reclassify the rest of your stay as non-emergency care, which then follows standard network rules. Review every bill carefully and appeal any in-network denial that feels wrong.
Are Follow-Up Appointments Covered After an Out-of-Network ER Visit?
No. Medicare Advantage plans typically cover only the emergency portion of care at an out-of-network hospital. Once you are discharged, follow-up care counts as elective, and you must use in-network providers to get your in-network cost-sharing rates. That includes:
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Post-surgical follow-ups with the same hospital’s physicians
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Physical therapy
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Scheduled imaging
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Specialist visits
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Routine labs
If you need follow-up care from a doctor who works primarily at an out-of-network hospital, ask your Medicare Advantage plan to verify whether that provider also sees patients at an in-network facility.
Are Prescription Drugs Covered After an Emergency Admission?
Yes. Medications and therapies prescribed during an emergency hospital stay are typically covered as in-network, even if the hospital itself is out of network. Two tips to avoid surprise costs:
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Fill prescriptions at an in-network pharmacy after discharge
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Confirm physical therapy providers are in your plan’s network before starting a treatment plan
What About Ambulance Rides?
If 911 sends an ambulance to transport you to the nearest hospital, most Medicare Advantage carriers treat the ride as emergency transportation, and it is covered at in-network rates. Non-emergency ambulance rides, like transfers between facilities or rides you call yourself for a non-emergency, can be denied or limited under your plan.
Miami-Dade and Broward counties both have rules that limit how much ambulance services can charge, but carriers still apply their own coverage rules. If you receive a large ambulance bill, review your plan’s explanation of benefits and appeal if something looks wrong.
Where Can Florida Medicare Advantage Members Get In-Network Care During the Broward Dispute?
If your Medicare Advantage plan is tied to Florida Blue, several large health systems remain in-network in the Broward and South Florida region (as of 04/24/2026):
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HCA Florida: 14 hospitals across South Florida, over 65 MD Now Urgent Care locations, 12 freestanding ERs, and 100+ physician offices
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Baptist Health South Florida: Physician practices, urgent care centers, and outpatient centers across South Florida (hospitals located outside Broward)
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Holy Cross Hospital in Fort Lauderdale
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Cleveland Clinic Weston
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Nicklaus Children’s physicians working inside Broward Health facilities remain in-network
Always verify coverage directly with your plan before scheduling care, because network changes can happen at any time.
How to Protect Your Medicare Advantage Coverage During a Network Dispute
Follow these six steps to stay covered and avoid surprise bills:
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Call your Medicare Advantage carrier and ask specifically whether your hospital and physicians are still in-network
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Verify coverage before every scheduled appointment, not just the first one
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Know your urgent care options. Urgent care centers are in-network for most plans and cost far less than ER visits
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Read every document before signing, especially at out-of-network providers. Consent forms can sometimes waive your protections under the No Surprises Act
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Keep a record of every call. Note the date, representative, reference number, and what they told you
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Appeal every denied claim you believe should be covered. Fewer than 1% of denied claims nationwide get appealed, yet nearly three-quarters of appeals succeed
What Should You Do If Your Claim Gets Denied?
Always appeal a denial you believe is wrong. For Medicare Advantage plans, you have formal appeal rights built into federal Medicare rules. Your denial letter must explain why the claim was denied and how to appeal.
Steps to take:
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Request the denial in writing
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Ask your provider for a letter of medical support explaining why the service was necessary
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Submit your appeal within your plan’s deadline (65 calendar days from the date of the denial notice for Medicare Advantage, effective January 1, 2025)
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Track every communication
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Escalate to Medicare, your state regulator, or the federal No Surprises help desk at 1-800-985-3059 if your appeal fails
Florida SHINE, Florida’s Division of Consumer Services, YourMedPlan, and other local advocacy groups also help answer insurance questions at no cost.
Should I Switch Medicare Advantage Plans Because of a Network Dispute?
Maybe, but timing matters. You can change Medicare Advantage plans during two specific windows:
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Medicare Annual Enrollment Period (AEP): October 15 to December 7 each year
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Medicare Advantage Open Enrollment Period: January 1 to March 31 each year (you can switch to another Medicare Advantage plan or return to Original Medicare)
If your plan’s network change qualifies as a Special Enrollment Period, you may be able to switch outside these windows. Losing access to a primary care doctor, a major hospital, or a specialist treating an ongoing condition can sometimes trigger a Special Enrollment Period, but the rules are strict. Call a licensed Medicare agent at YourMedPlan to review your options.
Frequently Asked Questions
Does Medicare Advantage cover emergency care at out-of-network hospitals?
Yes. Federal Medicare rules require every Medicare Advantage plan to cover emergency services at in-network cost-sharing at any hospital in the United States, regardless of whether the hospital is in the plan’s network.
What if my Medicare Advantage plan drops my hospital?
Emergency care remains covered at in-network rates. Elective care, follow-up appointments, scheduled surgeries, and physical therapy at that hospital will move out-of-network unless your plan allows out-of-network PPO coverage. Compare plans during Annual Enrollment if your preferred hospital no longer participates.
Can I switch Medicare Advantage plans mid-year if my hospital goes out of network?
Usually not, unless the change qualifies you for a Special Enrollment Period. Most plan changes must wait until Medicare’s Annual Enrollment Period from October 15 to December 7 or the Medicare Advantage Open Enrollment Period from January 1 to March 31.
Is the No Surprises Act the same as Medicare’s emergency coverage rules?
They overlap but are not identical. The federal No Surprises Act protects commercial and Marketplace health plan members from surprise bills at out-of-network emergency rooms and certain in-network hospital situations. Medicare Advantage has its own emergency coverage rules that require in-network cost-sharing for emergencies at any hospital. Both protections combined give Medicare Advantage members strong rights during network disputes.
Will my prescriptions still be covered during a hospital network dispute?
Yes, as long as you fill them at an in-network pharmacy and they are on your plan’s formulary. Medications prescribed during an emergency hospital stay count as in-network care, even if the hospital itself is out-of-network.
What happens if I drive myself to an out-of-network ER?
You still get in-network emergency coverage under Medicare Advantage. How you got to the ER does not change your coverage for the emergency services you receive there.
How do I appeal a denied Medicare Advantage claim?
Request the denial in writing, ask your provider for a letter of medical support, and file a formal appeal with your plan within the deadline on your denial letter (65 calendar days from the notice date for Medicare Advantage reconsiderations). Track every step and escalate to Medicare or your state regulator if your initial appeal fails.
Who can help me understand my Medicare Advantage coverage during a network change?
Contact your plan directly, a licensed Medicare agent at YourMedPlan, Florida SHINE for free counseling, the Florida Division of Consumer Services, or the federal No Surprises help desk at 1-800-985-3059.
The Bottom Line: Stay Informed, Stay Protected
Hospital network disputes are becoming more common across the country, and Medicare Advantage members in Florida are living through one right now. Federal law protects your access to emergency care no matter where you go. Beyond that, the best protection is knowing your plan’s network, confirming coverage before every scheduled appointment, and appealing any denial that feels wrong.
If your current Medicare Advantage plan no longer covers the hospital or doctors you rely on, it may be time to compare options. YourMedPlan’s licensed agents. can help you find a plan that covers the providers and hospitals you use.
Compare Florida Medicare Advantage plans at YourMedPlan and get a free quote today.
Disclaimer: SandStone Partners Health, dba YourMedPlan, is a licensed health insurance agency. We are not affiliated with or endorsed by the U.S. government or HealthCare.gov. We do not offer every Medicare or individual plan available in every area. Currently, we represent multiple organizations that offer a variety of products in your area. For information on all available options, please contact Medicare.gov, 1-800-MEDICARE or your local State Health Insurance Assistance Program SHIP.
