Medicare Advantage Provider Networks

My Doctor Is Leaving My Medicare Plan—What Can I Do?

You open a letter and discover that your doctor—or perhaps an entire medical group or hospital system—is leaving your Medicare Advantage plan’s network. Your first thought may be, “Can I keep my doctor?” Your second may be, “Does this mean I can change plans?”

Take a breath before you cancel anything. A network change can affect your access and costs, but the letter does not always mean what people assume it means.

The short answer: You may be able to continue seeing the doctor, choose another in-network provider, or change Medicare Advantage plans—but your options depend on your plan type, the timing, the size of the network change, and whether CMS grants affected members a Special Enrollment Period. One doctor leaving does not automatically let everyone switch plans.

First, Confirm What Is Actually Leaving the Network

Do not rely on a hurried phone conversation or a vague message from a medical office. Read the entire notice and call both the plan and the provider’s office.

You need to know whether the change involves:

One individual doctor
An entire medical group
A hospital or hospital system
An imaging center, surgical center, rehabilitation facility, or other facility
Only one location within a larger practice

That distinction matters. Your doctor may still be in the network at another location, or another doctor in the same practice may remain available. On the other hand, an entire medical group or hospital system leaving could affect several specialists and facilities at once.

Questions to ask your Medicare Advantage plan

Exactly which provider, group, facility, or location is leaving?
What is the effective date?
Is my doctor still in-network anywhere else?
Which comparable in-network providers are accepting new patients?
Do I qualify for continuity of care?
Does my notice grant me a Special Enrollment Period?

Medicare says plans should make a good-faith effort to give members at least 30 days’ notice when a provider they regularly see is leaving the network. Your notice should give you time to understand the change and find another provider when necessary.

What Happens If My Doctor Is No Longer In-Network?

The answer depends heavily on the type of Medicare Advantage plan you have. “We take Medicare” is not the same as “We are in your plan’s network.” Always verify the exact plan name and network.

Plan type	What usually happens outside the network	What to confirm
HMO	You generally must use network providers except for emergency care, out-of-area urgent care, and temporary out-of-area dialysis.	Whether an HMO point-of-service benefit or another plan exception applies.
HMO-POS	Certain services may be covered outside the network, often at a higher cost.	Which services qualify and the exact copay or coinsurance.
PPO	You can generally use out-of-network providers for covered services, but you may pay more and the provider must be willing to treat you.	Out-of-network cost sharing, authorization rules, and whether the doctor will bill the plan.

Never assume that keeping the doctor will cost “just a little more.” Ask the plan for the actual out-of-network rules and estimated cost. Also ask the doctor’s billing office whether it will continue seeing members of your specific plan.

If you are still learning how Medicare Advantage works, visit my free Medicare video library for more step-by-step explanations.

Ask About Continuity of Care Before Treatment Is Interrupted

If you are in active treatment, do not wait until your next appointment is canceled. Call the plan and ask for its continuity-of-care or transition-of-care process.

This may be especially important if you are:

Receiving treatment for cancer or another serious or complex condition
In the middle of a planned course of treatment
Pregnant and receiving ongoing care
Scheduled for non-elective surgery
Receiving inpatient or institutional care
Terminally ill and continuing care with an established provider

Important: Continuity-of-care protections and plan procedures depend on the situation. Ask the plan whether your treatment qualifies, how long continued care may be covered, what forms are required, and whether prior authorization is needed. Get the answer in writing whenever possible.

Do not use the phrase “continuity of care” as though it guarantees that you can see the same doctor forever. It is generally designed to prevent an abrupt and unsafe interruption while care is transitioned.

Does a Doctor Leaving Give Me a Special Enrollment Period?

Not automatically.

Normally, you can change Medicare Advantage coverage during an applicable enrollment period, including:

Medicare Open Enrollment: October 15 through December 7
Medicare Advantage Open Enrollment: January 1 through March 31, if you are already enrolled in a Medicare Advantage plan
A Special Enrollment Period: if you qualify because of a specific circumstance

CMS may determine that a provider-network change is significant and grant affected members a Special Enrollment Period. Under federal rules, this SEP allows an eligible member to leave the affected Medicare Advantage plan for another Medicare Advantage plan or Original Medicare.

If CMS grants this SEP, it begins in the month you are notified of your eligibility and continues for two additional calendar months. It can be used once for that significant network change.

Read the entire notice. If CMS has granted you an SEP, the plan’s notice should tell you that you are eligible and explain how to use it. If the notice only says the doctor is leaving and does not mention an SEP, call the plan or 1-800-MEDICARE to confirm—but do not assume you are free to change plans.

Under the regulation, an enrollee is considered affected by a significant network change when the person is assigned to, currently receiving care from, or received care within the previous three months from the provider or facility being terminated.

One provider leaving may be personally significant to you without meeting CMS’s definition of a significant network change.

Should I Follow My Doctor to Another Plan?

Maybe—but do not compare plans based on one doctor alone. A new plan could include that doctor and still be a poor fit for the rest of your healthcare.

Before changing, compare the complete picture:

Your primary-care doctor and every specialist you use
Your preferred hospitals, medical groups, and outpatient facilities
Your prescriptions and formulary restrictions
Your preferred pharmacies
Monthly premium and medical deductible
Copays and coinsurance
Maximum out-of-pocket limit
Prior-authorization and referral requirements
Dental, vision, hearing, transportation, and other benefits you actually use

A plan may include your doctor but cost you substantially more for prescriptions, specialists, or hospital care. Keeping your current plan and choosing a different doctor may be the better overall decision if the plan continues to work well for your other needs.

Use my Medicare Open Enrollment Checklist to organize the details before comparing coverage.

Be Careful Before Leaving Medicare Advantage for Original Medicare

Leaving Medicare Advantage for Original Medicare is not the same as automatically receiving a Medigap policy.

Medigap is separate private insurance that helps pay certain costs left by Original Medicare. Outside your Medigap Open Enrollment Period or another protected situation, an insurance company may be allowed to use medical underwriting, depending on federal protections and your state’s laws.

Do not cancel your Medicare Advantage plan based on an assumption that you can buy any Medigap plan you want. Confirm your enrollment rights, Medigap eligibility, available policies, prescription-drug coverage, costs, and effective dates before making a change.

If CMS has classified the provider-network change as significant and you switch to Original Medicare, federal guaranteed-issue rights may allow you to buy certain Medigap plans. The exact protection and timing matter. Read the official notice and the current Medicare guide carefully.

For a deeper explanation, read Can You Switch Medicare Supplement Plans Without Underwriting? and the rules for switching Medigap plans.

Six Steps to Take When Your Doctor Is Leaving

Confirm who is leaving—and when

Identify the exact doctor, medical group, facility, and location affected. Write down the effective date.

Check your plan type

Find out whether you have an HMO, HMO-POS, PPO, or another plan type and how it covers out-of-network care.

Ask what it would cost to keep the doctor

Confirm plan coverage, the doctor’s willingness to continue seeing you, and your estimated out-of-pocket responsibility.

Request continuity of care when needed

If you are in active treatment, ask for the process immediately and request written instructions.

Verify whether you can change plans

Check the calendar, read the notice for SEP eligibility, and confirm your options before submitting an enrollment request.

Compare your complete healthcare picture

Know what you gain, what you lose, and what you could pay before you follow the doctor or keep the plan.

Confirm the facts. Compare the full picture. Then decide.

Frequently Asked Questions

Can my doctor leave my Medicare Advantage plan during the year?

Yes. Provider networks can change during the year. Your plan should notify you when a provider you regularly see is leaving and help you identify available in-network alternatives.

Can I keep seeing my doctor after the doctor leaves the network?

Possibly. A PPO or HMO-POS plan may cover certain out-of-network services at a higher cost. An HMO generally requires network providers except in limited situations. You may also qualify for continuity of care during active treatment. Confirm the rules with both the plan and the doctor.

Does my doctor leaving automatically let me change Medicare plans?

No. You need a valid enrollment period. CMS may grant affected members a Special Enrollment Period when it determines that the provider-network change is significant, but a single provider leaving does not automatically create an SEP.

How long does the significant-network-change SEP last?

It begins in the month you are notified that you are eligible and continues for two additional calendar months. It can be used once for that significant network change.

Can I switch to Original Medicare and buy Medigap?

You may be able to switch to Original Medicare during an applicable enrollment period, but your right to buy Medigap depends on your timing, federal guaranteed-issue protections, and state law. A CMS-determined significant network change may create a federal guaranteed-issue right to certain Medigap plans if you switch to Original Medicare. Confirm this before leaving your Medicare Advantage plan.

Who should I call if the network change could disrupt my care?

Start with the member-services number on your plan card and your provider’s office. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Need Help Comparing the Complete Picture?

I can help you review your doctors, prescriptions, costs, and coverage options before you make a change.

Request a Medicare Review

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Written & Reviewed by

Robin Dall

Independent Medicare Broker & Educator

Licensed Since 2013 • NPN 17032552

Official Medicare & CMS Sources

Sources reviewed July 29, 2026.

Disclaimer: This article is for general educational purposes only and is not personal medical, legal, financial, tax, or insurance advice. Medicare rules, costs, benefits, plan availability, provider networks, formularies, enrollment rights, and eligibility requirements may change and can vary by plan, location, and individual circumstances. Confirm current information directly with your plan, Medicare, your State Health Insurance Assistance Program, and an appropriately licensed insurance professional before changing coverage.

Robin Dall is an independent licensed insurance agent. RobinsWisdom is not connected with or endorsed by the U.S. government or the federal Medicare program. This article does not represent every plan available in your area. For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE.