What If Your Doctor No Longer Accepts Your Medicare Advantage Plan?

You received a letter in the mail saying your longtime primary care physician or specialist no longer accepts your Medicare Advantage plan. You’re upset, and a little worried: Now what? What will happen with my care?

If your doctor leaves your Medicare Advantage plan’s network, you may still have options for keeping your health care on track. Start by confirming the network change with both your plan and your provider. Then ask about the cost of future visits, continued coverage for ongoing treatment, and help finding another suitable provider.

Losing access to a doctor who knows you well can be jarring, especially when you’re managing a difficult health condition. But a network change doesn’t always mean you must stop seeing that doctor immediately—or pay the full bill yourself.

What happens if your doctor leaves your Medicare Advantage network?

An in-network doctor has an agreement with your Medicare Advantage plan to provide covered care under its terms. But providers and plans can terminate their contractual relationship during the year, outside of the standard Medicare enrollment periods.

When the agreement between a provider and a plan ends, the provider becomes “out-of-network” for plan members. That means your plan may pay less for future visits with that provider, or it may not cover them at all. 

This happened to Amy T., when the health system her doctor belongs to left her Medicare Advantage plan's network. This departure threatened her ability to keep seeing the provider she’d been with for nearly 10 years. "I love her so much," she told The New York Times, explaining that the health system is “where I get all my care.”

Amy is not alone in her plight. According to Becker's Hospital Review, 34 health systems across the country ended (or announced plans to end) participation in at least one Medicare Advantage network in 2026. Some of these changes are scheduled to take effect in 2027.¹ Meanwhile, insurers are discontinuing certain Medicare Advantage plans in select markets, leaving some older adults with fewer coverage choices—and potentially fewer ways to keep their current doctors.

“The reality is that doctors can exit a Medicare Advantage plan network at any point, which can leave many patients scrambling for new care,” said Ryan Ramsey, a Medicare expert and NCOA’s Associate Director of Health Coverage and Benefits. “If your current provider is no longer in-network, what happens next depends on your plan, the provider’s contract, and the type of care you need. You may be able to get temporary in-network coverage if you’re being treated for a serious health condition, or your plan may cover out-of-network visits in certain circumstances.”

At least 30 days before a provider leaves a Medicare Advantage plan’s network, the plan should send a written notice to all members who see that provider. Once you receive that notice, don’t rush to cancel your next appointment with your doctor. Instead, you’ll want to first verify exactly what’s changing and when. 

How do I confirm whether my doctor is still in-network?

Visit your health insurer’s (e.g., Humana, Blue Cross) official website and look for their provider directory. Be sure you’re using the correct plan name, since insurance companies often offer several plans with different networks. Search for your doctor in the directory. You can also use the Medicare Plan Finder to see if a certain doctor or hospital is included in a Medicare Advantage plan’s network.

Since online directories aren’t always accurate or up to date, you should also contact your doctor’s office directly to verify if they stopped taking your health plan. Be sure to give them your full plan name and ask about the specific location where you receive care.

Ask your doctor’s office:

• Is my doctor leaving my specific plan’s network?
• What date does the change take effect (not all changes take effect immediately)? Will my upcoming appointment still be covered at in-network rates?
• Are other doctors in the same practice or health system staying in-network?

If the online directory and your doctor’s office give conflicting information, ask the plan to provide you with a clear answer before your visit. Save screenshots, written notices, and call notes, including dates, names of the representatives you spoke to, and reference numbers. Ask for written confirmation of any coverage arrangement.

What happens if my doctor leaves the network while I’m receiving treatment?

If you’re receiving ongoing treatment, contact your plan right away—especially if you are: 

• Being treated for a serious and complex condition (e.g., cancer)
• Undergoing inpatient or institutional care (e.g., recovering from surgery in the hospital)
• Scheduled to undergo a non-elective surgery 
• Terminally ill 

Ask your plan if it can arrange for you to temporarily continue treatment with your current provider at in-network rates. Explain why changing doctors could disrupt your care, and ask your doctor to provide supporting information. The available arrangements, approval requirements, and length of extended coverage all depend on your circumstances and plan. Be sure to get any approval in writing, including covered services, costs, and the end date.

How do I find a new in-network doctor who accepts new patients?

Ask your current doctor to recommend someone who is reputable and well-qualified to handle your condition. They may have colleagues who share a similar approach to care or specialize in your specific health needs. The provider’s office may even be willing to help arrange a “warm handoff” to another doctor or specialist—rather than just sending you a list of providers to sort through.

Your plan should also be able to help you find in-network providers who fit your criteria and are accepting new patients. Before scheduling that first appointment, confirm the doctor’s specialty and network status. And ask if you need a referral before you can book a visit.

If your plan’s network can’t meet your medical needs, notify your insurer. Medicare Advantage coordinated care plans must arrange and cover medically necessary care outside the network in this case and charge you the usual in-network rates. Contact your plan for approval before getting non-emergency care.

Once you do find a new provider, make arrangements to transfer your medical records, medication list, treatment plan, and any recent test results. Find out who will handle issues like prescriptions and follow-up questions until your new doctor takes over.

Will I pay more if my doctor becomes out-of-network?

Possibly. The answer depends partly on your plan type:

• Health Maintenance Organization Plan (HMO): Non-emergency care under an HMO generally must come from in-network providers. Without a plan-approved exception, you could owe the entire cost of an out-of-network visit. Exceptions include emergency care, out-of-area urgent care, and temporary out-of-area dialysis. Some HMOs with a point-of-service option (HMOPOS) allow enrollees to go out of network for certain services, typically with a higher copayment or coinsurance. 
• Preferred Provider Organization Plan (PPO): With a PPO, you can generally receive covered care outside the network, but you’ll likely pay more out of pocket. 

Before receiving out-of-network care, contact your plan to confirm coverage, ask about your share of the costs, and find out whether you need approval. Also, ask if the amount you pay will count toward your plan’s annual out-of-pocket spending cap. Ask the provider’s billing office for a cost estimate, too, keeping in mind that an office visit and an outpatient procedure can have vastly different charges. 

Can I switch Medicare Advantage plans if my doctor is no longer in-network?

Maybe. A doctor leaving your plan’s network mid-year doesn’t automatically qualify you for a Special Enrollment Period (SEP). But if Medicare determines a network change is significant, affected members can qualify for an SEP to change their coverage.

If you feel your doctor’s departure from your plan’s network will hinder your ability to get important medical treatment, call 1-800-MEDICARE (1-800-633-4227). Explain the situation and ask if it qualifies you for an enrollment exception.

Not eligible for an SEP? You can still explore other coverage options during regular Medicare Open Enrollment (Oct. 15–Dec. 7), or Medicare Advantage Open Enrollment (Jan. 1–March 31) if you’re already enrolled in Medicare Advantage.

Remember Amy T., whose beloved doctor was leaving her plan’s network? She switched to another Medicare Advantage plan that allowed her to keep seeing her provider.

Things to keep in mind before switching to a new plan

Before choosing new coverage: 

• Confirm your providers are in-network: Check with both the new plan and your providers to make sure your preferred doctors and facilities participate in the plan you’re considering. You don’t want any surprises later on.
• Ask about ongoing treatment: Under CMS Rule 42 CFR § 422.112, if you join a new Medicare Advantage coordinated care plan while receiving treatment, the plan must allow your active course of treatment to continue for at least 90 days without requiring a new prior authorization—even with an out-of-network provider. Contact the plan and provider to coordinate care and confirm your costs. 
• Check your options before returning to original Medicare: Before switching from Medicare Advantage to original Medicare, verify that your doctors accept Medicare and compare your total costs. Original Medicare has no annual out-of-pocket spending limit. Medigap can help cover some out-of-pocket costs, but depending on your circumstances and state rules, an insurer can charge more or deny you a Medigap policy based on your health. You may also need a separate Part D prescription drug plan and a way to pay for any dental, vision, or hearing services you’ll lose by switching out of a Medicare Advantage plan. 

Need help choosing a Medicare plan?

Some Medicare Advantage plans are changing their cost sharing terms, extra benefits, enrollment capacity, and availability for 2027. Your State Health Insurance Assistance Program (SHIP) can help you navigate these changes through 100% free, unbiased counseling. Find your local SHIP at shiphelp.org or call 1-877-839-2675. 

You can also call 1-800-MEDICARE (1-800-633-4227) to talk with a customer support representative or visit Medicare.gov to start a live chat. TTY users should call 1-877-486-2048. 

What to Do If Your Doctor No Longer Accepts Your Medicare Advantage Plan: A Checklist

Source

1. Becker's Hospital Review. 34 health systems dropping Medicare Advantage plans | 2026. September 22, 2026. Found on the internet at https://www.beckershospitalreview.com/finance/16-health-systems-dropping-medicare-advantage-plans-2026/