What if a Hospital Leaves Your Medicare Advantage Network?
Short answer
If a hospital leaves your Medicare Advantage network, verify the effective date, continuity protections and alternative in-network facilities. A hospital departure does not automatically create an unrestricted SEP.
Coverage
Scheduled non-emergency care is subject to plan network rules, while emergency-care protections are different and should not be delayed merely to find an in-network facility.
Not Automatic
Significant-network-change protections are event-specific; do not assume them from any hospital departure without the plan/CMS notice.
Practical Example
A scheduled surgery may need to move to another in-network hospital, while emergency care should be obtained immediately under emergency coverage rules.
Questions to verify
- When does the hospital leave the network?
- Can current treatment continue there temporarily?
- What emergency protections apply?