I have heard of some people's providers dropping their Medicare Advantage plans. Should I be worried about this?

Question

Andrew Zurbuch, MBA · Accepted Answer

No, this does happen. Just stay away from low Star rated plans & please call a Broker for assistance. There is at least 1 Insurance Company whom sells Medicare Advantage plans that does not have a good reputation with providers. Don't use that Company if your concerned regarding providers & claims. Thank you.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Edward Smith, ChFC, CRPS, AIF · Answer

Since Medicare Advantage plans use networks, this can happen. If you are concerned about this, you could do one of two things. You could make sure you go with a PPO plan, so that even if the facility were to drop out of the carrier's network, there would still be some out of network coverage. Secondly, you could consider purchasing a Medicare Supplement plan. These plans do not use network and allow you to see any doctor or go to any facility that accepts original Medicare. I hope this helps.

Answered by Edward Smith, ChFC, CRPS, AIF on June 30, 2025

Broker Licensed in OH, GA, IN, KY & SC

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Holt Rushing · Answer

No, I wouldn't be worried about that at this time. I would have a secondary policy added to protect you from some of the higher copays though.

Sandra Teel · Answer

Yes and No.  Every insurance company goes through "contracting" with local medical groups.
This is usually done every few years.  Most of the time the insurance company and the medical groups come to an agreement and there is no interruption to your service.  Sometimes however, they do not come to an agreement by a specific time frame and that medical group is "out" of the insurance companies' network.
If you have an HMO plan this will affect you greatly, as you will no longer be able to see your doctors in that medical group. The HMO insurance company will reassign you to another in network medical group.  This can be very distressing.  It doesn't happen often, but it does happen. 
If you had an Advantage PPO plan, you might still be able to see your "out" of network doctor at the out of network price.  
This is something you should consider when you are choosing an Advantage plan

Corey Schuler · Answer

With Medicare Advantage plans, providers can leave the network at any time during the year.  You can always switch your provider to an in-network provider should this happen to you.

Stuart Graham · Answer

Yes, this has become more of an issue lately because of inflation and the impact of the IRA on insurance companies and providers. However, it is still a relatively small issue in the grand scope of Medicare Advantage. Many plans maintain great networks and network outages are many times short lived.

Answered by Stuart Graham on June 30, 2025

Broker Licensed in GA, AL, LA, MS, SC & TN

Answered by Stuart Graham Medicare Insurance Agent

James Stang · Answer

You shouldn't be too worried. It can happen under certain circumstances but the carriers will usually find a way to retain the providers in the network until the end of the year so their clients can find other policies that would allow them to continue to see their preferred providers.

Answered by James Stang on July 28, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

Aaron Lewis · Answer

If a provider no longer wants to participate in a Medicare Advantage plan you might be notified from the Insurance carrier and they would be able to help you find another provider in your plan . If you still want to continue seeing that out of network provider you would be responsible for his payment in full.

Answered by Aaron Lewis on June 30, 2025

Agent Licensed in NJ & NY

Answered by Aaron Lewis Medicare Insurance Agent

Fred Manas · Answer

Yes, you should be aware of the possibility of your Medicare Advantage plan dropping providers and how it could affect your care. While many people find Medicare Advantage plans to be a good fit, some providers are leaving these plans due to issues like low reimbursement rates or administrative burdens, according to multiple sources. This could lead to disruptions in your care if your current doctors or hospitals are no longer in your plan's network. Here's why you should be concerned and what you can do:
Provider Network Changes: Hospitals and doctors can choose to leave a Medicare Advantage plan's network, meaning you might need to switch providers or pay more to stay with your current one. Potential for Increased Costs: If your preferred doctor is no longer in your plan's network, you might have to pay out-of-pocket to continue seeing them, or switch to a different doctor within the network, according to Triage Cancer.  Disruptions to Care:
Losing access to your preferred providers can disrupt your care, especially if you have ongoing treatments or complex health needs.  "Guaranteed Issue" Period Limitations:
Switching back to Original Medicare after leaving a Medicare Advantage plan can make it difficult to find an affordable Medigap plan, especially if it's been more than six months since you first enrolled in Medicare Part B.  CMS Guidelines: The Centers for Medicare & Medicaid Services (CMS) has emphasized that Medicare Advantage plans must notify members of significant network changes, and members should have access to counseling to help them make informed decisions. What you can do: Check your plan's network:
Review your plan's provider directory to see if your current doctors and hospitals are still in the network. Consider switching plans: If your current plan is dropping providers you need, explore other Medicare Advantage plans or consider switching back to Original Medicare during the Open Enrollment Period (October 15 – December 7) or during a SEP.

Vachik Chakhbazian · Answer

If your doctor leaves your plan's network, you may need to find a new in-network provider, which could involve searching for doctors and potentially disrupting your care, especially if you have a chronic condition. Seeing a doctor outside of your plan's network might result in significantly higher out-of-pocket costs or even no coverage at all, depending on your specific plan. Medicare Advantage plans can have complex prior authorization processes and sometimes delay payments to providers, making it difficult for them to manage their practices.

Answered by Vachik Chakhbazian on June 30, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Roseann Vandevender · Answer

That may be the case. But if this does not need be a major concern because if they are involuntary disenrolled that will open up a SEP Special Enrollment Period for them to enroll in a new and maybe better plan for them.

Answered by Roseann Vandevender on July 14, 2025

Agent Licensed in OH, AZ, CO & TX

Answered by Roseann Vandevender Medicare Insurance Agent

Kathleen Emert · Answer

I believe in the upcoming year additional plans will be discontinued. You should continue to reveiw you situation and plan on an annual basis. Make sure to review all correspondence from your Medicar Advantage Carrier. If the plan is being discontinued you will receive a notification.

Answered by Kathleen Emert on June 30, 2025

Broker Licensed in NY, FL & PA

Answered by Kathleen Emert Medicare Insurance Agent

I have heard of some people's providers dropping their Medicare Advantage plans. Should I be worried about this?

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I have heard of some people's providers dropping their Medicare Advantage plans. Should I be worried about this?

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