Medicare 2026

When Your Doctor Leaves Your Medicare Advantage Network: Notices and Your Options

Few things rattle a Medicare Advantage member faster than opening the mail and learning their doctor is leaving the plan's network. The good news: federal rules spell out exactly what the plan must tell you, how much warning you deserve, and when a mid-year plan change may be on the table. Here is a plain-English guide to what to expect and what you can do.

Networks can change any time of year

Medicare Advantage plans build networks by signing contracts with doctors, hospitals, and other providers. Those contracts can end at any point in the year — sometimes because the plan drops the provider, sometimes because the provider walks away. Either way, federal rules require the plan to keep protecting members from interruptions in care and to maintain access to qualified doctors and specialists.

That protection shows up in two main ways: advance notice, and help finding another provider or, in some cases, another plan.

The written notice: what it must say, and when

Under federal rules at 42 CFR 422.111(e), the timing of your notice depends on the type of provider leaving:

• Primary care or behavioral health provider: The plan must send written notice at least 45 calendar days before the termination date to members assigned to that primary care provider, and to anyone who has been that provider's patient within the past three years. The plan must also make one attempt to reach you by phone, unless you have told them not to call about plan business.
• Other specialists: The plan must send written notice at least 30 calendar days before the termination date to members who see that provider regularly — meaning you are assigned to them, currently receiving care from them, or have received care from them (or the facility) within the past three months.

These rules apply whether the provider was terminated for cause or not. In a for-cause termination, the plan must make a good-faith effort to meet the timeframes.

The notice itself must be a hard-copy letter and must include:

• The date the provider leaves the network.
• Names and phone numbers of in-network providers available to continue your care.
• An explanation of how to request continuation of ongoing treatment or therapy with your current provider.
• Information about the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period.
• A statement that you can call 1-800-MEDICARE for help switching coverage or to ask to be considered for a Special Enrollment Period based on your individual circumstances.

Beyond the letter, Medicare says the plan will also help you choose a new provider, help you continue care that is already in progress, and tell you about the enrollment periods and options you may have.

When you may be able to change plans mid-year

Federal rules at 42 CFR 422.62(b)(23) create a Special Enrollment Period for members affected by a significant change in a plan's provider network. It is available to those assigned to, currently receiving care from, or seen within the past three months by the terminated provider or facility. You can use it to switch to another Medicare Advantage plan or to move to Original Medicare.

A few important details:

• The plan notifies eligible members when CMS instructs it to.
• The window begins the month you are notified and lasts two more calendar months.
• It can be used once per significant change.
• Medicare.gov notes that Special Enrollment Periods for significant network changes are evaluated case by case.

If you aren't offered this Special Enrollment Period but you believe the loss of your provider will seriously disrupt your care, you can still call 1-800-MEDICARE to ask whether you qualify based on your circumstances.

If no Special Enrollment Period applies

Outside of a Special Enrollment Period, most members whose doctor leaves won't be able to switch plans mid-year. The usual path is to pick a new in-network provider — using the names and numbers in your notice, or your plan's updated directory — and keep your coverage until an enrollment window opens.

Those windows include:

• The Annual Enrollment Period (October 15 – December 7, 2026, for 2027 coverage), when anyone with Medicare can change Medicare Advantage or Part D plans or move between Medicare Advantage and Original Medicare.
• The Medicare Advantage Open Enrollment Period (January 1 – March 31), when Medicare Advantage members can make one change.
• Any other Special Enrollment Period you qualify for (for example, a move or a change in other coverage).

Thinking through your options

Losing a trusted provider is a reasonable moment to step back and look at the bigger picture. Some members prefer the structure and extra benefits that a Medicare Advantage plan may offer, and are willing to work within a network. Others value the broad provider access of Original Medicare, often paired with a stand-alone Part D plan and, if eligible, a Medigap policy to help with cost-sharing. Each path has trade-offs around cost, flexibility, and paperwork — the right fit depends on your health, budget, and how important specific providers are to you.

Program-wide, Part D will have an annual out-of-pocket cap of $2,100 in 2026 and $2,400 in 2027, with the maximum allowable Part D deductible set at $700 in 2027. The 2027 Part B standard premium and deductible, and the IRMAA income brackets, had not been announced at this writing; CMS typically releases them in the fall.

Extra protections if you have Medicaid or Extra Help

If you have full Medicaid or qualify for the Part D low-income subsidy (Extra Help), you have a monthly Special Enrollment Period to move from Medicare Advantage to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible members can also enroll in an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where to get personalized help

For official information and to compare options, visit Medicare.gov. To speak with someone, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week; TTY users can call 1-877-486-2048. If you believe a network change will interrupt your care and put your health at risk, that same number is the right place to start.