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.
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.
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.
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.
Our Commitment to Reliable Medicare Information
At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.
To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.
Our Medicare plan pages and comparison tools are powered by CMS datasets, including:
When possible, we link to the original CMS resources so you can review the source material directly.
We follow the CMS release schedule and update our website as new data becomes available.
We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.
We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.
We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.
Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.
CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.
This includes:
All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.
We keep internal records of the CMS dataset versions used on our site.
If CMS issues corrected or revised files, we update our website to reflect the latest available version.
Please keep the following in mind:
For personalized Medicare assistance, please use these official resources: