What to Do When Your Doctor Leaves Your Network

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What to Do When Your Doctor Leaves Your Network

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.

Call the doctor and your plan to confirm the contract ended—directory errors happen.
Plans must give you at least 30 days’ written notice when a provider you use regularly is dropped.
Medicare

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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What to Do When Your Doctor Leaves Your Network

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

1 Verify it’s real

Speak with a Medicare Advocate

2 Ask about “continuity-of-care” rights

3 Decide how to proceed

4 Check timing

5 Keep records

Need help?

Speak with a Medicare Advocate

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About

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