Medicare Your Coverage Options

If your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans

Written by Diane Archer

There are reasons you should not trust your health plan’s provider directory, and you can read about them on Just Care here.  One reason is that health plans have the right to change their network of doctors and hospitals at any time during the year and, until recently, there was little members could do about it. Beginning this year, if your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans.

At the end of last year, the Centers for Medicare and Medicaid Services issued a new protection for people in Medicare Advantage plans whose doctors leave the network mid-year. Under the new policy, CMS may grant members of a Medicare Advantage plan the right to switch plans as a result of a “significant” change in the provider network.  CMS does not define “significant.” But, according to Kaiser Health News, it has been granting this right to some health plan members who have seen changes in their networks.

If your network doctors leave your Medicare Advantage plan, and you want to switch plans, contact your local state health insurance program for help. You may have the right to switch to another Medicare Advantage plan or to traditional Medicare.

Even if CMS does not notify you of a right to switch, it still might offer you the right to switch as a special protection. You may need to be persistent and explain why it’s important you continue care with your current doctors.

For other situations in which CMS allows Medicare Advantage members to switch plans, click here.

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