Avera Health Will End Participation in Aetna Medicare Advantage Network

Avera Health will end participation as an in-network provider with Aetna Medicare Advantage on Dec. 31, 2025, due to ongoing issues that negatively affect the patient experience.

Among issues that are creating difficulties for patients include denials and reduced reimbursement of necessary services and care.

Avera Health has informed patients who carry Aetna Medicare Advantage coverage about this change. People can select a new plan during fall Medicare open enrollment period of Oct. 15 - Dec. 7, 2025. Avera is working with Chapter Medicare to offer Medicare advisors to help people navigate changes in coverage. Avera will continue to be in-network for Aetna group employer insurance.

"At Avera, we want our patients to have an excellent experience. We understand this will mean a change for numerous patients. This was a difficult decision, but we feel it is in the best interest of our patients and providers," said Stacey Lenker, Vice President of Payer Strategies, Avera Health.

Patients who choose to keep their Aetna Medicare Advantage plan for 2026 can still receive care from Avera providers, however, services would likely be out of network, and that may mean a higher cost share for patients.

Avera Health will be in the Aetna Medicare Advantage plan network through Dec. 31, 2025. Patients who have appointments or procedures scheduled in 2026 should check their 2026 Medicare plan coverage network to make sure their Avera provider, surgery center or hospital is included, and contact their insurance company if they have questions about coverage.

"Medicare open enrollment from Oct. 15 to Dec. 7 is the best opportunity for Medicare enrollees to consider their coverage for 2026. They have opportunity to change between Medicare Advantage plans, or to select Original Medicare plus a Medicare Supplement plan," Lenker said.

If you are affected by this change, you will receive a letter in the mail. You may contact your local insurance agent or Chapter Medicare at 641-426-2691 for assistance, or schedule an appointment at askchapter.org/partners/avera.