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What to Do When Your Doctor Leaves Your Network

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By Daniel Petkevich

Jul 15, 2025

An overview of what to do when your doctor leaves your network for Medicare.

1 Verify it’s real

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

2 Ask about “continuity-of-care” rights

If you’re in mid-treatment (chemotherapy, pregnancy, post-op, etc.), the No Surprises Act lets you keep seeing that doctor for up to 90 days at in-network rates while you transition. Tell the plan you want to elect transitional care.

Centers for Medicare & Medicaid Services

3 Decide how to proceed

Option A: Stay with the doctor out-of-network. Expect higher cost-sharing—sometimes 100 % in an HMO. Option B: Pick a new in-network provider. Use the updated directory and get referrals transferred. Option C: Switch plans. If CMS rules the termination a “significant” network change, you get a Special Enrollment Period (SEP) to move to another Medicare Advantage plan—or drop MA, return to Original Medicare, and buy a Part D plan (and, in many cases, Medigap on a guaranteed-issue basis).

Centers for Medicare & Medicaid Services

4 Check timing

  • A CMS-granted SEP lasts two months after you’re notified.

  • Otherwise, your next chance to change plans is the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31) or the annual fall window (Oct 15 – Dec 7).

5 Keep records

Save letters, EOBs, and any bills. If costs spike because the plan didn’t give proper notice or honor continuity-of-care, file an appeal and include your documentation.

Need help?

Call 888-376-2028 and our licensed Medicare advocates will:

  • Confirm your eligibility for a Special Enrollment Period,

  • Compare every local plan’s provider list, and

  • Walk you through the switch—no cost, no pressure.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

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