My Doctor Dropped Out of Network—What Should I Do Next?

Dear AMAC,

I changed my Advantage plan at the end of 2025 and I just received a notice that my doctor dropped out of network! I didn’t know they were allowed to do this right now. What should I do next?

—Jim (Landisville, PA)

Hello Jim,

Thank you for writing to us. Medicare Advantage plans (Part C) and other network-based insurance plans establish agreements with providers, but these agreements are not permanent. Although it’s not the outcome you expected after switching plans, let’s talk about what happens when your doctor drops out of the network.

When Can a Doctor Drop Out of Network?

Doctors and healthcare providers can leave a network plan at any time due to contract disputes, retirement, or changes in their practice. Your doctor may decide not to renew their contract, or the insurance company may remove them during a routine review.

Either way, these changes impact your ability to receive in-network care. Since Medicare Advantage plans operate within a network, this could leave you paying for your visits out-of-pocket if you continue seeing them.

How Much Notice Is Required Before a Network Change?

The timing of notice depends on whether the doctor or the plan initiated the change. Medicare Advantage plans must notify enrollees when a significant network change occurs. However, minor changes, like a single doctor leaving, do not always trigger a required notice period. Even though this can change at any time, beneficiaries should regularly check their plan’s provider directory to ensure their preferred doctors are still in-network.

Doctors, on the other hand, may or may not notify patients directly when they leave. Some will send letters or emails, while others may simply stop accepting your insurance at your next visit. If you receive a notice, review it carefully to see when the change takes effect.

Do I Qualify for a Special Enrollment Period (SEP) If My Doctor Leaves the Network?

A Special Enrollment Period (SEP) allows Medicare beneficiaries to change their plan outside of the standard Medicare enrollment periods due to qualifying life events. However, a single doctor leaving a network is usually not enough to qualify for an SEP unless the change is considered a significant disruption—such as a hospital or large provider group leaving.

Medicare Advantage plan enrollees typically have these key enrollment periods:

• Annual Enrollment Period (AEP): Occurs October 15 – December 7 annually, and allows everyone to switch or drop a Medicare Advantage plan (among other options).
• Medicare Advantage Open Enrollment Period (MA OEP): Occurs January 1 – March 31 annually, and allows Medicare Advantage plan enrollees to switch Medicare Advantage plans or drop their plan and return to Original Medicare.
• Special Enrollment Period (SEP): Triggered by life events throughout the year like moving, losing coverage, or major network changes.

Unless a large-scale provider change occurs, you likely won’t qualify for an SEP simply because your doctor left the network. This means you may need to wait until the Annual Enrollment Period or another eligible period to switch plans.

What Can I Do If My Doctor Drops Out of Network?

If your doctor is out of network, you still have options:

1. Check if your plan offers out-of-network coverage. Some Medicare Advantage plans provide coverage for out-of-network services at a higher cost, but your provider must agree to treat you.
2. Find a new provider. Most plans have an online portal that includes a provider lookup tool. You can search for in-network physicians here, or you can call the customer service phone number located on the back of your insurance card for help.
3. Pay out of pocket. If you strongly prefer your current provider, you may continue seeing them and pay full costs. Just keep in mind that the fees you pay may not count towards your deductible or the Out-of-Pocket Maximum.
4. Consider other options. Speak with a licensed insurance agent to see if you have any other options.

Understanding these choices can help minimize disruption in your healthcare. Always verify costs before making any changes.

All in All

Medicare Advantage plans operate within networks, so doctors can leave at any time. Unless a significant change occurs, an individual doctor leaving will not trigger an SEP, meaning you may need to wait until the next enrollment period to switch plans.

If your doctor is out of network, explore alternative providers, ask about out-of-network visit fees, or consider plan changes. Consulting a licensed insurance agent can help you understand your options and make choices that suit your healthcare needs.

Need Help Navigating Your Medicare Plan?

For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote by clicking on the button below.

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