What Happens When Your Doctor or Hospital Leaves Your Medicare Advantage Network

10 October 2026 Coach

You've seen the same cardiologist for five years. She knows your history, and you have appointments booked for the next few months. Then a letter arrives from your Medicare Advantage plan: she is leaving its network.

Do you have to find a new doctor? Will the plan still pay for those appointments? Can you switch plans?

It depends on the kind of plan you have, the care you're in the middle of, and whether Medicare treats the change as big enough to let you switch. One thing it doesn't depend on: a doctor leaving your plan's network doesn't end your coverage, doesn't guarantee you can keep seeing that doctor at in-network prices, and doesn't by itself give you the right to change plans.

Can a Medicare Advantage plan change its network in the middle of the year?

Yes. A plan can add or drop doctors, hospitals and other providers at any time, and a provider can choose to leave. What the plan can't do is leave you without care: Medicare requires it to protect you from interruptions in treatment and to make sure you can still get medically necessary covered services.

The plan also has to tell you, in writing and in advance:

If it's your primary care doctor or a behavioral health provider, at least 45 days before the doctor leaves. The plan must also try once to reach you by phone, unless you've told it not to call you about plan business. You get this notice if you're assigned to that primary care doctor, or if you've seen that provider at any time in the past three years.
If it's any other kind of provider, such as a specialist or a hospital, at least 30 days before. You get this notice if you see the provider regularly, which Medicare defines as being assigned to them, being in their care now, or having been seen by them in the past three months.

The rule is 42 CFR 422.111(e). When the plan drops a provider for cause, it only has to make a good-faith effort to meet those deadlines. Medicare's own booklet, Understanding Your Medicare Advantage Plan's Provider Network, still says "at least 30 days" for everyone; the 45-day rule for primary care and behavioral health has applied since 2024.

If you think a network change will interrupt your care and put your health at risk, call Medicare at 1-800-MEDICARE (1-800-633-4227).

Does the No Surprises Act let you keep your doctor for 90 days?

Not with Medicare Advantage. This one causes a lot of confusion, because the 90-day rule is often described as if it covered every kind of health insurance.

The No Surprises Act does give some patients up to 90 days of continued care, on the same terms, when their doctor or hospital leaves their plan's network. It covers "continuing care patients": people who are

being treated for a serious and complex condition,
receiving inpatient or institutional care,
scheduled for non-elective surgery, including the care after it,
pregnant and being treated for the pregnancy, or
terminally ill and being treated for the illness.

The 90 days start when the plan sends its notice, and end sooner if the patient no longer falls into one of those groups.

But the law applies to employer plans and individual health insurance, such as Marketplace coverage. CMS says plainly that the No Surprises Act's protections don't apply to people whose only coverage is Medicare, including Medicare Advantage. So don't count on a 90-day grace period. Ask your plan what it will do for your treatment under Medicare's own rules.

Sources:

No Surprises Act continuity-of-care provision, 42 U.S.C. § 300gg-113
CMS: No Surprises Act, overview of key consumer protections (who the protections do and don't cover)

What happens if your doctor leaves?

That depends mostly on your type of plan.

HMO. You generally have to get non-emergency care from the plan's network. If your primary care doctor or a specialist leaves, you'll need a new in-network one for covered care from then on. If you're in the middle of treatment, ask the plan whether you can keep seeing the departing doctor for a while, for which services and at what cost. Ask it for in-network doctors who can take over, and check that they're taking new patients.

HMO with a point-of-service option (HMO-POS). These plans cover some care out of network, usually at a higher cost. Your plan's Evidence of Coverage says which services; some still need a referral or have to be in network.

PPO. You can keep seeing a doctor who has left the network, but you'll usually pay more, and the doctor doesn't have to agree to see you or to bill the plan. Before you go, ask the plan for the out-of-network deductible and coinsurance for the care you need, and ask for the answer in writing.

An HMO member stands to lose more when a doctor leaves than a PPO member does. But no type of plan promises that a doctor will stay, or stay at the same price.

What if your hospital leaves the network?

A hospital leaving can affect planned surgery, outpatient procedures, specialist care and any future stay. Check the hospital and the doctors separately: your surgeon may still be in network even if the hospital isn't, or the hospital may stay while a physician group leaves.

If you have a procedure scheduled, ask the plan and the hospital:

Will the hospital still be in network on the day of the procedure?
Will the surgeon, the anesthesiologist and everyone else involved be in network?
If the hospital is out of network, will the plan cover the procedure there, and what will you owe?
Is there an in-network hospital that can do the same procedure?

Emergencies are different. Your plan must cover emergency care at any hospital in the U.S., in or out of network, including outside its service area. Never delay emergency treatment to check whether a hospital is in network.

Can a network change let you switch plans?

Sometimes. When CMS decides that a change to a plan's network is significant, it opens a Special Enrollment Period (SEP) for the members affected. You're affected if you're assigned to, being treated by, or have been seen in the past three months by a provider or facility that's leaving.

Most departures don't qualify. CMS has to make that decision, and when it does, your plan sends you a letter saying you're eligible. (CMS proposed opening this SEP to everyone affected by any provider leaving, but dropped the idea from its final rule for 2027.) From there:

You have three months. The SEP runs from the month you're told you're eligible through the end of the second month after it.
You can make one change. Switch to another Medicare Advantage plan, or drop Medicare Advantage for Original Medicare. If you go back to Original Medicare, a matching SEP lets you join a stand-alone Part D drug plan.
Medigap isn't guaranteed. Leaving this way doesn't, by itself, give you a federal right to buy a Medigap policy. Unless you have that right for another reason, such as Medicare's "trial right" in your first year of Medicare Advantage, a Medigap company in most states can turn you down or charge you more because of your health. Check before you leave.

The rules are in section 30.6.33 of CMS's Medicare Advantage and Part D Enrollment and Disenrollment Guidance. Medicare's list of Special Enrollment Periods covers this SEP and others you might qualify for.

If the change doesn't qualify, you still have the regular windows:

Open Enrollment, October 15 to December 7. Change plans for any reason. The new plan starts January 1.
Medicare Advantage Open Enrollment, January 1 to March 31. If you're in a Medicare Advantage plan, you can make one change: to another Medicare Advantage plan, or to Original Medicare with a Part D plan.

What if the provider directory was wrong?

Directories can be out of date. A doctor can be listed long after leaving, or a recent change may not show up yet.

If you chose a plan because its directory listed your doctor, save a screenshot or printout of the listing, with the date you checked. Keep your enrollment papers and anything the plan sent you. Then ask the plan to look into it: whether it will honor the listing for the care in question, how it will handle the claim, and how to appeal or complain if you get a bill you didn't expect.

The No Surprises Act's directory protections don't apply to Medicare either, so what the plan owes you here depends on Medicare's rules and the facts of your case.

What to do, step by step

1. Confirm the change with your doctor's office and your plan

Ask the doctor's office:

What is the last day you'll be in my plan's network?
What happens to appointments I have after that date?
If I'm in the middle of treatment, will you keep treating me, and on what terms?
If I have to move my care, who do you recommend?

Then call the member services number on your plan card and ask the plan to confirm the date and tell you how it affects your coverage. The doctor's office knows its contract, but only the plan can tell you what it will pay for.

2. Tell the plan about your treatment

If you're being treated for cancer, seeing a specialist regularly, scheduled for surgery, recovering from a procedure, or managing a condition where a change of doctor could set you back, tell the plan. Ask:

Can I keep seeing this doctor for now? For which services, and until when?
Will I pay my usual in-network cost sharing?
If not, how will you help me find a doctor who can take over?

Your doctor's office can explain to the plan why continuing with them matters. The plan needs that to decide what it can offer.

3. Get the costs in writing

Before any non-emergency care from a doctor who may be out of network, ask the plan:

Is this service covered?
Do I need an in-network doctor, a referral or prior authorization?
Will my in-network or out-of-network deductible and cost sharing apply?
If you've approved continued care, what does it cover, and when does it end?

Ask for the answers in writing, and note the reference number for the call. A doctor being willing to keep seeing you doesn't mean the plan will pay in-network rates.

4. For hospital care, check with everyone involved

If a hospital is leaving, contact the hospital, the plan and the doctors treating you. For a planned procedure, ask the hospital's financial or insurance office whether it has confirmed your coverage with your plan. If you're already in the hospital or getting ongoing treatment there, tell the care team and the plan, and ask how your care will continue.

5. Ask whether you qualify for a Special Enrollment Period

Ask your plan whether CMS has opened an SEP for this change, and call 1-800-MEDICARE to confirm your eligibility and deadline (see above).

6. Get help comparing plans

If you enrolled through an agent or broker, they can find the other plans sold in your county, compare their networks, premiums, costs and drug coverage, tell you which enrollment periods might apply, and help you enroll. But a broker can't grant you an SEP or promise that a plan will cover something; only the plan and Medicare can. Many brokers represent only some insurers and are paid by the plans they sell, so ask whether they can show you every plan in your area.

For free, unbiased help, your State Health Insurance Assistance Program (SHIP) counsels people on Medicare. Find yours at shiphelp.org.

7. Keep records, and push when you need to

Keep the plan's letter, the directory screenshots, your appointment details and anything the plan puts in writing. For each call, write down the date, the name of the person you spoke to and any reference number.

If the plan can't tell you how you'll get the care you need, ask for a supervisor or its care coordination department, or call 1-800-MEDICARE. If it denies coverage for a service, ask for the decision in writing and follow the appeal instructions that come with it.

The doctors you can see are part of the plan

Networks change during the year. For some people that's a nuisance. For someone in the middle of treatment, or who depends on one hospital, it can be a real disruption. When you compare Medicare Advantage plans, the doctors and hospitals you can actually use are as much a part of what you're buying as the premium and the extra benefits.