If your doctor leaves your Medicare Advantage network, you may need to find a new in-network provider or pay higher out-of-pocket costs to keep seeing them. You may qualify for a Special Enrollment Period to switch plans in some cases.
It's unsettling when a doctor you trust leaves your plan's network. Here's what actually happens. If your physician drops out of your Medicare Advantage plan's network mid-year, your plan is generally required to give you notice. In some situations, especially if you're in active treatment for a serious condition, you may have the right to continue seeing that doctor temporarily, sometimes called a continuity of care provision. Your plan must tell you your options.If the doctor simply isn't in-network anymore and no special protections apply, you can still see them, but you'll likely pay significantly more out of pocket, or the visit may not be covered at all depending on your plan type. HMO plans (which require you to stay in-network except in emergencies) are stricter about this than PPO plans, which give you more flexibility to see out-of-network providers at a higher cost.In certain circumstances, losing a primary care doctor can trigger a Special Enrollment Period, allowing you to switch plans outside of the usual October-December Open Enrollment window. It's worth calling your plan directly and also contacting a licensed Medicare agent to understand your specific options. Plan details vary, so always verify current network status before assuming a provider is covered.
Utah's major health systems, Intermountain Health and University of Utah Health, each have stronger relationships with certain carriers. If keeping access to a specific system matters to you, it's worth confirming network participation with a local agent before enrolling or switching plans.
For you, this means losing your doctor doesn't necessarily mean you're stuck. You have options, and it's worth making a few calls to understand them before your next appointment.
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: