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Dear Connie,
I’ve had the same Medicare Advantage plan for three years because I like my doctor. Someone told me my doctor might not be in-network next year, even with the same plan. Is that true, and how do I avoid losing my doctor?
Worried about my doctor,
Diane from Tulsa, Oklahoma
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Local, licensed insurance agents with 25+ years of combined experienceDear Diane,
Yes—it can happen. Thank you for asking.
Even with your exact plan, doctors, specialists, or hospitals can still leave the network. A provider network is the group of providers under contract with your health insurance plan. Keeping the same plan doesn’t guarantee every provider stays the same.
Here’s why this happens, what it could cost you, and how to check your coverage.
Medicare Advantage insurers negotiate yearly contracts with doctors, specialists, hospitals, and health systems that set pay rates and rules. When one ends, that provider becomes out-of-network.
According to a Medicare.gov fact sheet, plans can add or remove providers at any time. Check your coverage every year, even if nothing else about your plan changed.
A provider leaving your network doesn’t always mean they stopped accepting Medicare. Often, they simply didn’t renew that one contract, and may still accept Original Medicare or other Medicare Advantage plans.
Skipping this check can cause real problems. Your doctor, specialist, or hospital could leave the plan, and you may not find out until after you’ve gotten care and received a surprise bill.
This isn’t rare. A 2026 study in JAMA, led by Johns Hopkins Bloomberg School of Public Health, found that about 1 in 10 Medicare Advantage members—roughly 2.9 million people—needed new coverage for 2026 due to contract changes. In Vermont, over 9 in 10 members were affected.
Using out-of-network services usually costs more. Your plan may charge higher copays or coinsurance, or may not cover a non-emergency visit at all. You could also face denied referrals or stricter prior authorization—the approval your plan requires before you get certain care.
For 2026, some plans cap out-of-pocket costs as high as $9,250 for in-network care, according to KFF. Not everyone pays this much, but going out-of-network can push costs beyond that limit, so confirm your providers’ in-network status.
Here’s something many people miss: a provider can leave one Medicare Advantage plan while still accepting a different plan from the same insurer—for example, dropping one plan while keeping another, or staying in-network with another insurance carrier.
The insurer’s name alone isn’t enough. Always verify the exact plan name, plan ID, and each provider individually. Don’t forget that location also matters. Never assume your doctor is in-network just because you recognize the insurer.
Take these steps:
Research from KFF, including work by policy expert Tricia Neuman, shows that when hospitals leave these networks, members in rural or underserved areas may face a choice: switch plans or pay more out of network.
Unsure if your plan still covers your providers? Want to compare your Medicare health plan options? A licensed insurance agent can help. Please contact us at (623) 223-8884 for a no-cost plan and provider review.
Medicare Advantage networks can change every year, even on the same plan. Reviewing your coverage each fall helps you avoid unexpected costs and a surprise change in doctors come January 1.
Take a few minutes this year to check your ANOC, search your provider directory, and call your doctor’s office.
No-cost, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of combined experience
Search your plan’s online provider directory or call your doctor’s office. Confirm your exact plan name, plan ID, and what your plan includes, not just your insurance company.
Yes. Providers can leave a network at any time their contract ends. You’re usually locked into your plan until the next enrollment period, unless you qualify for a special enrollment period.
You may pay more, or your plan may not cover a non-emergency visit at all. Always confirm a provider is in-network before your appointment.
Usually, you must wait until an enrollment period when changes are possible. Sometimes CMS grants a special enrollment period when a major provider leaves your plan.
No. With Original Medicare, you can see any doctor or hospital that accepts Medicare, and nearly all do.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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