Actions to Take If Your Doctor is No Longer in Your Medicare Advantage Plan’s Network

Actions to Take If Your Doctor is No Longer in Your Medicare Advantage Plan’s Network

If you or someone you know has been notified that one of your medical providers in your Medicare Advantage (MA) plan will no longer be part of the plan’s network, you may switch to another MA plan or return to Original Medicare. Here are your options:

  • Use Medicare’s Annual Election Period (AEP) to switch to a different Medicare Advantage plan or return to Original Medicare. If you chose another MA plan and want to stay with your doctor, make sure your doctor participates in that MA plan and is accepting new patients.
    As the AEP runs from Oct 15 to Dec 7, you only have until 11:59 pm on Saturday Dec 7 to use this option. See our section on the Annual Election Period for more information.
  • If you miss the AEP, use the Medicare Advantage Disenrollment Period (MADP), Jan 1 to Feb 14, to disenroll. The MADP allows you to disenroll only and return to Original Medicare. You may not switch to another MA plan during this Period. You also have a coordinating Special Election Period (SEP) to enroll in a stand-alone Part D prescription drug plan. See our section on the Medicare Advantage Disenrollment Period for more info.
  • Use your Medigap guaranteed issue. If you decide to go back to Original Medicare, whether using the Annual Election Period or MA Disenrollment Period, you have a guaranteed issue right to buy a Medigap policy. You can choose from plans A, B, C, F (including F with a high deductible), K, L, M, or N from any company that sells one of these plans. A Medigap, technically called Medicare supplement insurance, helps pay for Medicare cost-sharing. For more information about Medigaps, see our Medigap section. For more information specific to the situation where your doctor is no longer in the plan’s network, see the 3rd bullet under Guaranteed Issue.

If you have questions and/or would like assistance in reviewing your options, contact 1-800- MEDICARE (1-800-633-4227) or your local Health Insurance Counseling and Advocacy Program (HICAP).

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

Join us for an educational webinar

Back by Popular Demand: COVID-19 Scams & Healthcare Fraud ~ Updated with New Information!

July 13, 2020 » 11 a.m. - 12 p.m. PDT

Learn More