What if Your Doctor Leaves Your Medicare Advantage Network?
Short answer
If your doctor leaves a Medicare Advantage network, contact the plan promptly about continuity-of-care protections and replacement providers. One doctor’s departure does not automatically create an unrestricted SEP.
Coverage
The plan can explain the effective date of the network change, transition or continuity provisions and available in-network alternatives.
Not Automatic
CMS may provide additional rights for certain significant network changes, but those protections are event-specific and should not be inferred from every individual provider departure.
Practical Example
A member in an active course of treatment may receive transition protections even though another member seeing the same doctor for routine care does not receive a new plan-change SEP.
Questions to verify
- When does the doctor leave the network?
- Does continuity of care apply?
- Is another enrollment period currently available?