What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?

Question

Aisha Saleem · Accepted Answer

You can go to any doctor or hospital with Medicare Advantage. Although, there have been instances where a hospital drops the Medicare Advantage plan. You can switch plans during Medicare Advantage open enrollment, Jan 1 to March 31. If you can't find another plan to switch to, you could return to Original Medicare and you could also pair Original Medicare with Medigap.

Answered by Aisha Saleem on March 13, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Melonie Wood · Answer

If a member likes their plan, they can find out where else they can go for services, they also can change their plan, and possibly get an exception to go to their hospital

Brian Moore · Answer

If your preferred hospital isn’t in-network with your Medicare Advantage plan, it’s a significant issue—over 25 years, I’ve found most people won’t abandon the trust they’ve built with their doctors and hospitals due to insurance limitations, making it essential to work with a professional to confirm network coverage upfront. You can switch plans during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment (January 1 to March 31) to align with your hospital, and with today’s wide range of competitive plans, we can typically find one that includes your providers without much trouble. If you’re caught mid-year, a Special Enrollment Period might apply—like after a move or loss of other coverage—or you’ll face higher out-of-network costs, which vary by plan and can add up quickly.

Answered by Brian Moore on March 27, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Joseph Bachmeier · Answer

That is something you want your Medicare agent to advise you on. In some cases, you may fall into a Special Election Period. But for the most part before you purchase an Advantage Plan you will want your broker to check the network for your hospital and doctors.

Answered by Joseph Bachmeier on March 25, 2025

Agent Licensed in PA, AZ, DE & 5 other states

Answered by Joseph Bachmeier Medicare Insurance Agent

Amy Putrino · Answer

Call your trusted Medicare plan advisor. There are special election periods (SEPs) throughout the year that might offer a chance to change plans, during the year if needed, so you can have access to the hospitals and providers you prefer. Your advisor should have knowledge of what SEPs are available to you.

Answered by Amy Putrino on March 26, 2025

Agent Licensed in RI, CT, FL & 11 other states

Answered by Amy Putrino Medicare Insurance Agent

John L Herman Jr · Answer

First check to see if another Medicare Advantage Plan works and is accepted by that Hospital.  Also consider looking at a Hospital Indemnity Plan to go with your Advantage Plan.

Also determine what the out-of-network costs would be to keep your Plan and understand the cost risk to stay with that Hospital or review Hospitals that do accept your current Plan.

Sean Davis · Answer

If you discover that your preferred hospital isn’t in-network with your Medicare Advantage plan, here are some steps you can take:

Contact Your Plan: Reach out to your Medicare Advantage plan's customer service for clarification on your coverage options and whether any exceptions can be made.

Check for Out-of-Network Coverage: Find out if your plan covers out-of-network services and what the associated costs would be.

Explore In-Network Alternatives: Look for other hospitals or providers in your plan's network that can provide similar services.

Consider Plan Changes: If you're unhappy with your current plan, consider switching to another Medicare Advantage plan during the next open enrollment period that includes your preferred hospital.

Consult With a Medicare Advisor: If you're feeling overwhelmed, seeking assistance from a Medicare advisor or agent can help you understand your options and make informed decisions.

John Lopez · Answer

If your preferred hospital drops out of your Medicare Advantage network, you should consult with an independent agent to determine your options. You may have a special enrollment period if you have access to a five-star plan in your area. There may be other options available to you as well. Consult a local independent health agent to get your best option. It's a no-cost appointment for you.

Answered by John Lopez on April 25, 2025

Broker Licensed in DE, MD, NC, NJ, NY & PA

Answered by John Lopez Medicare Insurance Agent

Vicki Farley · Answer

Regrettably, you will have to use the hospital in their network or pay a higher out of pocket. Rather your plan is an HMO or a PPO, would determine the out of pocket cost. HMO's having a stricter network. During the annual AEP from October 15th through December 7th, you can review other plans to see if you can find a better fit for you that may include your hospital of choice.

Answered by Vicki Farley on May 8, 2025

Broker Licensed in IL, AL, AZ, IN & KY

Answered by Vicki Farley Medicare Insurance Agent

Sam Silva · Answer

If your preferred hospital isn't in-network, contact our consultants to explore other plan options or find a suitable alternative. We're here to help you navigate your choices.

Deborah Webster · Answer

this is concerning that you don't have your preferred hospital in the network. Are you on a Medicare Advantage PPO plan? This would still allow you to go to that hospital (although you may pay a higher co pay), If it is an emergency situation, your plan would still cover an out-of-network hospital.

Answered by Deborah Webster on April 11, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Michael Turkaly · Answer

I would definitely check the provider list to see what hospital is in the network for your plan. Remember you can make a change at AEP between 10-15 and 12-7 of every year with the effective date being January 1st of the following year. 

Also during OEP, you make one change to a different plan between Jan 1 and March 31.

Al Saponar · Answer

First, I always check doctors, hospitals and prescriptions for my clients.

But, if something changed network wise, if its is still during open enrollment, we can make a change. If not, we can schedule a meeting for the upcoming Annual Enrollment period.

We also have ancillary plans available year round that can help cover what the Medicare Advantage doesn't fully cover.

What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?

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What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?

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