What if my doctors stop taking my plan?
The short answer
If your doctors stop accepting your plan, you may need to switch plans during an enrollment period, find new doctors within your network, or pay higher out-of-network costs, depending on your plan type.
The full explanation
Doctors and health systems can leave a plan's network at any time, and it happens more often than people expect. If your primary care doctor or a specialist you rely on drops out of your Medicare Advantage plan's network, you generally have a few options. You can stay with that doctor and pay more if the plan allows out-of-network care, you can find a new in-network doctor, or you can wait for an enrollment period to switch to a plan where your doctor participates. If the situation qualifies, you may have a Special Enrollment Period. Otherwise, you'd typically wait for the Annual Enrollment Period, which runs from October 15 through December 7 each year, to make changes that take effect January 1. With Original Medicare, this concern is less acute. Most doctors who accept Medicare accept all Medicare patients, so a doctor leaving a specific plan's network isn't the same issue. That said, some doctors do stop accepting Medicare altogether, which is a separate problem. The best habit is to re-check your doctors' participation each fall during open enrollment, before you confirm or change your coverage for the coming year. Plan details and networks change annually.
Related Medicare Resources
In
Utah
specifically
In Utah, providers affiliated with Intermountain Health and University of Utah Health have at times had varying relationships with different Medicare Advantage carriers. It's worth confirming each fall that your specific doctors and facilities are still in-network for the plan you're keeping or considering.
What this means for you
For you, this means your coverage situation can shift even if you don't change anything, so checking your plan and your doctors every fall is a habit worth building.
Related Questions
What happens if my doctor leaves my Medicare Advantage network?
How often do Medicare Advantage provider networks change?
What if the plan directory says my doctor is in-network but the office says they are not?
What is a Special Enrollment Period for Medicare?
What if I choose the wrong Medicare plan and then get very sick?
