Your doctor is leaving your Medicare plan's network. What now?

It usually comes up in one of three ways. Your plan's letter says a doctor or clinic is leaving. The front desk tells you they won't take your plan next year. Or a friend mentions their doctor dropped out, and you start to wonder about yours.

If you have a Medicare Advantage plan, this is the time of year to sort it out. Until December 7 you can still choose a plan for 2027 with your doctors in mind.

First, find out for sure

Networks for next year are set between the plan and each doctor's practice, and the information doesn't always line up. Check it two ways:

• Ask the doctor's office. Ask whether they will be in network for your plan, by its full name, starting January 1. A practice can stay with one of a company's plans and leave another, so "we take that company" isn't the same answer.
• Look it up in the plan's directory, and make sure the one you are reading is for 2027. This year's and next year's can differ.

If the two answers disagree, the plan's answer decides what it pays, and the office's answer tells you who they expect to see. Ask both to put it in writing if you can, and tell us when you call.

Check the hospital you would want to go to as well. A specialist you see twice a year often matters less than where they can admit you.

If your doctor is staying

Good. Keep checking the rest: each drug at your dose on next year's drug list, and your pharmacy. Networks are the change people hear about; drug lists are the change that tends to cost them.

If your doctor is leaving

You have until December 7 to choose a different plan for 2027. Before you do:

• List every doctor who matters, not just the one leaving. A plan that keeps one doctor and loses two others isn't an improvement.
• Check the drugs again in any new plan. Moving for a doctor and finding a drug costs more in the new plan is the surprise to avoid.
• Ask whether you could keep seeing the doctor out of network, and at what cost. Some plans pay part of the bill outside the network and some pay nothing outside it except for emergencies and urgent care.

The Medigap question

Some people decide they are done with networks and want to go back to Original Medicare, where any doctor who takes Medicare can see you. You can leave a Medicare Advantage plan during Annual Enrollment.

The catch is the Medicare Supplement policy most people want to go with it. Colorado has no birthday rule and no yearly window for Medigap, so outside a few specific situations, applying means answering health questions, and the insurance company can say no. Find out whether you would be accepted before you give up the Advantage plan.

If it happens in the middle of the year

Doctors leave networks during the year too. When that happens, your plan has to tell you in writing: at least 45 days before the date for a primary care or behavioral health provider, and at least 30 days before for a specialist you see regularly. Those letters are worth reading the day they arrive, because what you can do next depends on the time of year. Call us with the letter.

How we can help

Book a review call, by phone or on video, whichever you prefer. Bring the names of your doctors and your prescriptions, and we will check them against next year's plans from the companies we represent.

What to check during Annual Enrollment · Book a review