What happens if my specialist leaves the network in the middle of the year?

Question

Gary Church · Accepted Answer

That will depend on which Medicare plan you have. If you're on a Medicare Advantage plan, you'll need to find another specialist that's in network with your current plan.

Mike Alexander · Answer

IN SOME CASES , YOU CAN CHANGE PLANS, IF YOUR DOCTOR CHANGES AFFECT YOUR QUALITY OF CARE  OR ASK YOUR PRIMARY Dr for a new refferal. Some plans like POS or PPO plans have out of network benefits.

Mark Bilgere · Answer

Unfortunately, this can and does happen. If your specialist does leave the network you have two options.

1. You can continue to see them but you will have to pay the higher, out-of-network costs.
2. You can select a new specialist that does accept payment from your network.

In some circumstance you may apply for Transition of Care benefits if you are in the middle of a specific treatment. Chemotherapy, surgery prep.

Steven Litzsinger · Answer

You have a few options:
- Remain with the specialist and request an out of network exception through the carrier/plan when there is a medical necessity,  lack of other specialist in the network within a reasonable distance, and for continuity of care;
- Remain with the specialist and assume out of network costs;
- Visit the member service website/portal to identify a specialist that is in network and accepting new patients (the website will have the most up to date information regarding in-network providers);
- Call your Trusted, Advisor and Medicare Agent for Support and Guidance;
- Contact member services for a recommendations of available in network specialist;
- or Notify your primary care provider and see who they recommend as part of their preferred referrals/specialist within the shared network of your plan. 

The goal is minimize any disruption in care and treatment. Your agent and plan will help you navigate all available options and help you identify the best solution.

James Carlson · Answer

If you owned a supplement this would not be an issue.  With a closed network you will have to
find a new doctor, or follow your current MD to be treated out of network.  I you wait until the next year, you can change plans with the old doctor in the new network.

Terry Salak · Answer

Providers are contracted with plans at various dates.  If a contract ends between a carrier and a provider mid-year you would have to either pay an Out of Network co-pay (if on a PPO) or change your specialist to an in-network provider if you were on an HMO.

If you were on a Medicare Supplement plan this wouldn't be an issue as any Dr. who accepts Medicare Assignment would still continue to see you as a patient.

Armand Smith · Answer

Unfortunately this does happen. Your choices as far as I know are to find a new specialist and or on open enrollment find a plan that has your specialist in it.

Diane Walker · Answer

Several things will happen.  If you have appointments after their departure, you will be considered out of network and pay a higher copay.  You may or may not be notified by your provider and/or doctor's office.  Claims before any departure are safe, will still be processed in network even if they are submitted afterwards.  Lastly, you may be able to request a Continuity of Care Exception if you are in active treatment or have a long standing relationship with the specialist.

Hope this helps!

Andre Meschi, Pharm.D. · Answer

If you are in an HMO........ contact your Primary Care MD and relay that you need a new specialist.

If you are in an HMO........ contact your Primary Care MD and relay that you need a new specialist.

If you are in an HMO........ contact your Primary Care MD and relay that you need a new specialist.

If you are in an HMO........ contact your Primary Care MD and relay that you need a new specialist.

Rachida Silva · Answer

If you have a Medicare Advantage plan and your provider leaves the network, this is often considered a "significant change" to the network. In some specific cases, this may trigger a Special Enrollment Period (SEP), allowing you to switch plans mid-year, though this depends on CMS guidelines and the specifics of the departure.

Answered by Rachida Silva on January 26, 2026

Broker Licensed in FL, AR, CT & 20 other states

Answered by Rachida Silva Medicare Insurance Agent

Kendra Siemiesz · Answer

It depends what type of Medicare advantage network you have. If you have a PPO, and that doctor still accepts your PPO even out of network then you can continue to see them (sometimes at a higher cost). With an HMO-POS network, it's also similar to how the PPO works where you would pay a higher cost to see out of network providers as long as that provider agrees to take payment from your insurance. An HMO is the most restrictive where you must see in network providers (unless of an emergency). Throughout the entire year (outside of annual enrollment) there are special election periods where you may be able to change your plan to a different network plan or a different carrier that would accept your doctor if that were to happen. Regardless, you have options and it's best to speak to a license Medicare Broker to go over your options and make sure you can see all your doctors, your medications are covered, and you are set up with the correct benefits to fit your health and financial needs.

Answered by Kendra Siemiesz on November 12, 2025

Broker Licensed in FL, AL, AR & 19 other states

Answered by Kendra Siemiesz Medicare Insurance Agent

Rosanne Thompson · Answer

If a specialist leave the network in the middle of the year, you will have an option of choosing a new provider or you may have to pay the out of network amount,

Gary Burroughs · Answer

If your specialist leaves your plan mid-year, what happens depends on your coverage.

• Medicare Advantage (HMO/PPO):
You may need to switch doctors. HMO plans usually won’t cover out-of-network care, while PPO plans may—but at a higher cost. In some cases, you can request a temporary “continuity of care” exception if you’re in active treatment.

• Original Medicare + Supplement:
No networks—so you can keep seeing your doctor as long as they accept Medicare.

Donna Hernandez · Answer

My advice is to contact your Primary Care Provider for a good referral, they are more knowledgeable on the kind of care you will need when it comes to a specialty and a specialist provider.

Jose Silva · Answer

It all depends on your plan. You might need to find another Specialist in network or you might be able to use the same one if you have a PPO plan and pay out of network prices.

Sharon Boncek · Answer

If your specialist (or any Doctor) leaves the network in the middle of the year, you may have to choose a different Doctor or pay out of pocket. There might be a special enrollment period option for you depending on your area. For example, is there a 5 star plan available, do you have a certain health condition that would qualify for a csnp plan and possibly others. An independent licensed broker/agent can help if you find yourself in that situation.

Answered by Sharon Boncek on October 1, 2025

Broker Licensed in TX, FL, MI & 8 other states

Answered by Sharon Boncek Medicare Insurance Agent

Marisa Padilla · Answer

Unless there is an SEP (special election period) in force that applies to you and your situation, then you would wait until AEP (annual enrollment period from Oct 15th to Dec 7th) to investigate alongside your broker if there are any other plans that work for you that your doctor accepts in their new network so you can continue seeing them the following year after the newly selected plan goes into effect on January 1st.

Answered by Marisa Padilla on May 11, 2026

Broker Licensed in IL, KY, MO & WA

Answered by Marisa Padilla Medicare Insurance Agent

What happens if my specialist leaves the network in the middle of the year?

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