A Common — and Frustrating — Situation
You’ve been seeing the same doctor for years, your Medicare Advantage plan has covered every visit without issue, and then a letter arrives: your doctor is leaving the plan’s network. It happens more often than people expect, and it’s one of the more disruptive changes a Medicare Advantage enrollee can face mid-year or heading into a new plan year.
Why Providers Leave Networks
Contracts between insurance carriers and provider groups or hospital systems are typically negotiated and renewed on a schedule, and negotiations don’t always succeed. A hospital system might decide reimbursement rates aren’t sufficient, a plan might narrow its network to control costs, or a provider group might restructure entirely. Whatever the reason, the result is the same for you: your doctor is no longer considered in-network.
What Happens to Your Coverage
If your doctor leaves your plan’s network outside of AEP, your options are more limited than you might expect. In most cases, seeing that doctor going forward means paying out-of-network rates, which can be substantially higher or not covered at all, depending on your specific plan’s structure (this varies between HMO and PPO-style Medicare Advantage plans). Some plans offer a “continuity of care” provision for beneficiaries actively receiving treatment for a serious condition, allowing a limited transition period at in-network rates — but this isn’t automatic or guaranteed, and you typically have to request it.
If This Happens Mid-Year
Outside of AEP and the Medicare Advantage Open Enrollment Period (January 1–March 31), your ability to change plans is generally limited to Special Enrollment Periods, which require meeting specific qualifying circumstances. A significant network change sometimes qualifies, but not always — it depends on the details. Our guide on Medicare Special Enrollment Periods explains which situations typically qualify.
If This Happens Around AEP
If you receive notice that your doctor is leaving the network as part of your Annual Notice of Change, you have a real opportunity to act: AEP (October 15–December 7) lets you switch to a different plan that still includes your doctor, effective January 1. This is exactly why reading your ANOC carefully matters — see our guide on reading your ANOC before AEP 2026.
How to Respond
- Confirm the change directly with both the plan and your doctor’s office — don’t rely on a single source.
- Ask your doctor’s office if they’re planning to join a different Medicare Advantage plan, or if they’re leaving Medicare Advantage networks generally.
- Ask your current plan whether a continuity of care exception applies to your situation.
- If you decide to switch plans, confirm your doctor is actually in-network for the new plan before enrolling — don’t assume based on marketing material alone.
Reducing the Risk Going Forward
Network changes are largely out of your control, but you can reduce how disruptive they are by reviewing your ANOC every single year, even when you’re happy with your plan, and by keeping a running list of your key providers so you can quickly check them against any plan you’re considering. For help walking through your specific situation, a licensed agent can review your options with you by phone and help you understand what continuity of care or Special Enrollment Period options might realistically apply.
Ready to Talk Through Your Options?
Have questions? Schedule a free review with Kayla Price, a licensed insurance agent at Price Services Group. Call 866-648-1578 or visit priceservicesgroup.com/schedule.
Price Services Group, LLC is not affiliated with or endorsed by the U.S. government or the federal Medicare program. NPN: 18530055 | Agency NPN: 20387435