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. 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 October 22, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Mike Alexander · Answer

You may be able to enroll in another plan if you hqve a special enrollment in your state. You can also change plans during the oep frim jan 1st to March 31st

Mark Bilgere · Answer

If your preferred hospital is no longer in your Advantage plan network, you have three choices.

1. Select a new hospital that does accept your plan.

2. Change plans during the next enrollment period you have a available.

3. Continue at the preferred hospital but pay the out of network costs. (Least attractive option)

Norman Smith · Answer

This is one of the reasons the Open Enrollment period exists.

With an MA plan, an In-Network facility or Doctor could drop the acceptance of that plan at any time. This could be for various reasons. So, if you plan to stay with MA plans, your only hope is that your hospital is in the plan and will remain in that plan for the year.

If that is of major concern for you, you may consider using this time to shift back to Original Medicare and having a proper Supplemental Plan to ensure that will never happen.

Terri Reagin · Answer

You have two choices. Pick a different hospital that IS in network or contact an agent about changing to a plan the hospital accepts.

Voss Speros · Answer

Voss Speros here, Greek god of Medicare. If Medicare is all Greek to you, you're in luck, I'm Greek. So the question is, I found out my preferred hospital isn't in my Medicare Advantage's network. And I'm like, did you meet with a broker? We checked doctors, hospitals, pharmacies, and drugs to make sure that what you use is in network with the Advantage Plan. So that one kind of threw me off a little bit. Then we had to go and look into some things. But if you're in the middle of the year and you need help, you're gonna have to go to another hospital, sorry to say. But once you go to the hospital and then if you go to a skilled nursing facility, that does create a small window to change. So you could go back to a different plan that has your hospital network. But it's probably better just to wait till the next open enrollment and meet with a broker, sit down, and make sure everything's in order first before you jump on it. Don't just jump on Medicare.gov and sign up for a plan because it gives a couple extra bucks back towards a different benefit. Give us a call. We'll send a broker out to you to help you figure things out. Hope you have a good day.

Mark Maliwauki · Answer

Ask them to get in-network, find out what your out of network charges will be compared to in network charges, negotiate with the hospital for a cash price, enroll into a different plan that is in network when you are able to do so.

Answered by Mark Maliwauki on May 25, 2025

Broker Licensed in ID, AZ, CA & 13 other states

Answered by Mark Maliwauki Medicare Insurance Agent

Pamela Masters · Answer

If you can find a plan that has it in the network it might be worth switching or see if a PPO is available in your area and has a reasonable out of network hospital co-pay, it’s an option. Also, you might consider ia medigap plan. On a medigap plan you can go to any doctor that accepts Medicare.

Answered by Pamela Masters on November 16, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

Charise Karjala · Answer

This question kind of makes me crazy. It is, what should I do if I find out after the fact that my preferred hospital isn't in network with my Medicare Advantage policy? That's really unfortunate. Your main thing you'll need to do is wait until open enrollment the next time around and change to a different policy. Shame on your advisor for putting you into a policy where your preferred hospital isn't in network, or at least for not advising you that they're not in network with your policy so you can make alternative arrangements.

It's a really interesting question because some of the communities, my community has two public hospitals and a private hospital in the middle of it. Everybody wants to go to the private hospital. Generally speaking, people think they can go there, and they can, if they're showing up in the back of an ambulance or they've got a critical condition, or a car accident just happened and they've got blood everywhere. Yeah, they can go there and sit in the ER and wait, or they get triaged and off they go. It doesn't matter if your hospital is in or out of network; if it's truly a medical emergency, you're going to be taken to whatever hospital is closest and has appropriate care for you. If it's a trauma hospital, you're going to go there. If it's a gunshot wound, you're going to go there. If it's cardiology, you're going to go there. More than likely, your preferred hospital—think Cedar's Sinai, Mayo Clinic, Langone Medical Center—if those are your preferences, let's get those out front so you know that is where you can go to have your procedures done and stay with your favorite doctors. That should be right on the table.

If your agent isn't getting that information out and problem-solving around that for you, find a different agent. You're probably dealing with a sales agent that just wants to get your money and doesn't really care about you in the long term. So again, pick an agent who's been around for a long time. A broker represents five or more companies; they're going to do a needs analysis and then they're going to make a recommendation for five or more policies. Some of you might like them, some of you might not like them, they might be too expensive. Well then, you're going to work it down to what's reasonable. Alright?

Christy Jones · Answer

I would consider other options during the Annual Enrollment Period. Various MA plans are contracted with different hospitals. Your preferred hospital may also have a Medicare Advantage plan that is specific to that hospital.

Answered by Christy Jones on September 2, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Michael Denniston · Answer

You should not have a Medicare Advantage Plan that does not include your local or favorite hospital. Before you join a Medicare Advantage plan you or your agent should always check to be sure your doctors, hospital and all of your prescriptions are covered in your Advantage plan. If your hospital is not in your Advantage plans network, the needs analysis was not performed or not mentioned before enrolling. This should not happen. You are obligated to stay in the plan you pick until AEP Annual Enrollment Period which is from October 15th to December 7th each year. This date is when you make a change to a plan that has all of your doctors' hospitals and prescriptions covered. The plan you change to will be effective the 1st of January in the following year. There are many more scenarios that are not mentioned here but this is most common question and answer. For more info you can contact me

Answered by Michael Denniston on June 2, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston 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

Kelsey Hentzen · Answer

I would suggest having someone review your current Medicare Advantage plan from October 15th to December 7th. A broker can look at all plans in your area and ensure your favorite hospital will be in network for 2026.

Answered by Kelsey Hentzen on October 6, 2025

Broker Licensed in KS & MO

Answered by Kelsey Hentzen Medicare Insurance Agent

Darlene Murphy · Answer

First verify with the hospital and then if you feel you were misled, you may want to call and ask for a SEP. You can also look at using the hospital but paying more for services.

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

Patricia &#039;Tif&quot; Bush · Answer

During the open enrollment. October 15 to December 7, I would advise that you touch base with an agent at Insurance With T LLC and talk to them about the different options. You might have a plan with another carrier or a supplement plan.

Answered by Patricia 'Tif" Bush on September 23, 2025

Broker Licensed in ct, FL, NC & SC

Answered by Patricia 'Tif" Bush 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, AZ, CT & 12 other states

Answered by Amy Putrino Medicare Insurance Agent

Janix Barbosa-LLanos · Answer

Answer from Janix Barbosa-Llanos, MBA, PMP, CEP, RSSA, FSN
(Licensed Insurance Agent — For Educational Purposes Only)

If your Medicare Advantage plan is an HMO and the hospital is out of network, the hospital will not be covered. In most cases, this means all costs will be your responsibility, except in emergencies or urgent care situations as allowed by your plan.

If your Medicare Advantage plan is a PPO, you may still be able to go to that hospital, but your cost sharing will usually be higher for out-of-network care, often around 50%, depending on your specific plan.

It is your decision whether to keep your current coverage or explore other coverage options.

I encourage you to speak with your health insurance broker to learn whether you qualify for a Special Enrollment Period. You can also review your plan options during the Annual Enrollment Period if you would like to change your coverage.


Medicare / CMS Disclosure
For educational purposes only. Not affiliated with or endorsed by Medicare or any government agency. Plan availability and benefits vary by ZIP code and individual eligibility.

Jake Purvis · Answer

If your preferred hospital is not in network you will likely pay more to go there or have to pay the whole cost depending on your plan. You can review your plan, and try to find a plan that has your hospital in the network during the Annual Election Period. Your other choice would be to choose a new hospital that is in your current plans network.

Answered by Hannah Skinner on August 19, 2025

Agent Licensed in SC, AL, AR & 44 other states

Answered by Hannah Skinner Medicare Insurance Agent

Jay Larshus · Answer

If you have a PPO MAPD, then see if your hospital will accept your plan on a Out of Network basis. During Annual Enrollment (AEP), you may want to look at another Advantage plan that includes your hospital. You may also consider returning to Original Medicare and a Medicare Supplement/Medigap plan.

Answered by Jay Larshus on July 7, 2025

Agent Licensed in TN & VA

Answered by Jay Larshus Medicare Insurance Agent

Jamie Goble · Answer

Hello, Good question, I would reach out to a Medicare Broker . They (myself) Can look up all your dr, meds, and hospitals- to make sure they are in network. 
On Jan 1st. Is OEP so if you do not like your current Medicare advantage plan you have until March 31st to change.

JP Richardson · Answer

If you find out your preferred hospital is out of network you should contact your carrier to verify the network status. If it is confirmed out of network you can consider another hospital or look to make a change of plans if you have a valid enrollment period available.

Answered by JP Richardson on August 26, 2025

Broker Licensed in FL, AZ, CO & 10 other states

Answered by JP Richardson Medicare Insurance Agent

Steven Silverthorn · Answer

It is important to understand the type of Medicare Advantage plan that you have and its network. If your Advantage plan is a PPO, you should be able to go to the out of network hospital, but there will be a higher cost. If it is not a PPO, then you’ll need to stay in your plans network.
It is important to review your Medicare coverage during the Annual Election Period (10/15 to 12/07) because health insurance carriers make changes to plans, networks, and coverage annually.

Steven Bleicher · Answer

During the next Annual Open Enrollment period in the fall (October 15th through December 7th) for an effective date of January 1st of the next year, you have the right to switch to another company's Advantage plan which now includes your favorite hospital. BUT be aware that in the process, you could lose a favorite doctor or two who might be a part of your current network! It sounds likely that if you used an agent to “show you the ropes” of Medicare, that she/he failed to check on the doctors AND the hospital that you preferred! So, if I were you, I’d consider changing agents!

Answered by Steven Bleicher on May 23, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

You have several options:
     1) Contact your plan to clarify coverage options and inquire about potential exceptions or special circumstances. 
     2) Check for out-of-network coverage under your plan because some plans do provide out-of-network services, but at a higher cost.
     3) Explore other in-network alternatives, such as other local hospitals that are in your plan's network.
     4) Discuss your concern with your doctor, who may be able to recommend another option that is in network.
     5) Consider changing plans if it is during the Annual Enrollment Period (October 15th - December 7th) or the Open Enrollment Period (January 1st - March 31st).


During an Emergency, you should have out-of-network coverage, meaning you can go to your closest hospital for treatment, but again, you will pay higher costs to obtain that care.

Jim Tretola · Answer

You may want to consider changing Plans. Realize if you use an out of network hospital, your costs will be more.

Frank Carta · Answer

That is an intelligent question, and I would like to text you the answer, but I am not very good

at texting. You do have the option to contact me if you choose, and I would be honored to

communicate with you if you do. Who knows, we might just have a valuable conversation.

Hannah Skinner · Answer

If your preferred hospital is not in network you will likely pay more to go there or have to pay the whole cost depending on your plan. You can review your plan, and try to find a plan that has your hospital in the network during the Annual Election Period. Your other choice would be to choose a new hospital that is in your current plans network.

Answered by Hannah Skinner on August 19, 2025

Agent Licensed in SC, AL, AR & 44 other states

Juliette Chihade · Answer

You can still use the hospital anyway and understand the cost
Medicare Advantage plans vary in how they handle out-of-network care:
PPO Plans allow out-of-network care but at a higher cost-sharing. There for you'll pay more, but you're covered.

HMO Plans) generally don't cover out-of-network care at all, except in emergencies. Going out-of-network with an HMO could mean paying the full bill yourself.

Nick Sarant · Answer

CHANGE HOSPITALS OR CHANGE MEDICARE PLAN. YOU ARE USUALLY NOTIFIED THAT YOUR PROVIDER IS OR WILL NO LONGER BE IN NETWORK,

Marnie Applegate · Answer

You can appeal the decision or request an exception for special circumstance. You may want to switch plans during an enrollment period - Annual 10/15 to 12/7 or Open 1/1 to 3/31. Of course if you have an emergency it is covered.

Answered by Marnie Applegate on October 26, 2025

Agent Licensed in TN, AL, GA & TX

Answered by Marnie Applegate Medicare Insurance Agent

Michael Wallner · Answer

You are able to change your Medicare Advantage Plan during the Annual Enrollment Period, ( AEP, October 15 through December 7th), for an effective date of January 1. You are also entitled to change your Medicare Advantage Plan during the Open Enrollment Period, (OEP, January 1 through March 31st) of each year. If your Hospital non-participation with your Insurance Plan is a new development, for example the Hospital recently terminated its agreement with the insurance plan, you may also be entitled to a Special Election Period, (SEP), and allowed to switch your plan. A Medicare Insurance Agent can help you determine your eligibility to switch your plan and other options that may be available to you.

Answered by Michael Wallner on December 29, 2025

Agent Licensed in DE, MD & NY

Answered by Michael Wallner Medicare Insurance Agent

Paul Wyatt · Answer

The best advice is to shop your plan once Annual Enrollment begins on October 15th. If you don't have an agent to assist you then I do recommend finding one in your area because they will usually have the best knowledge for specific situations such as that.

Answered by Paul Wyatt on August 20, 2025

Broker Licensed in TN, KY & MS

Answered by Paul Wyatt Medicare Insurance Agent

Shalonda Cave · Answer

If it falls within the Annual Enrollment Period (AEP) or Open Enrollment Period (OEP), I recommend switching to a plan that includes your doctors or facilities in-network. AEP is from October 15th - December 7th and OEP is from January 1st - March 31st.

Answered by Shalonda Cave on November 24, 2025

Agent Licensed in OH, AZ & FL

Answered by Shalonda Cave Medicare Insurance Agent

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.

Gretchen Morris · Answer

Be prepared to pay out of network if your plan has that benefit or change plans before 12/7.  You should consult with a knowledgeable broker to determine.

Greg Giordano · Answer

There are a few options to consider:
Contact your plan: Call your Medicare Advantage plan's customer service to understand your out-of-network coverage. 
Explore in-network alternatives: Your plan will have a directory of hospitals and other providers within its network. See if there's another facility in-network that offers the services you need.
Emergency care exception: Medicare Advantage plans are required to cover emergency services at any hospital
Consider a plan change: If you consistently need out-of-network care and are dissatisfied with your current plan, you can switch to a different Medicare Advantage plan during the Annual Enrollment Period (October 15 - December 7) or the Medicare Advantage Open Enrollment Period (January 1 - March 31)

Robert Jones · Answer

Either select a hospital in the network or choose a new plan for January 1, 2026, that covers your hospital in network -you may be able to enroll sooner if you have a Special Enrollment Period (SEP). Call me if you wish to discuss further.

Bob Jones
Contact me.

Jeremy Henry · Answer

If you have a HMO (HMO has to stay in network vs. PPO can go outside network) you would want to figure out your next best choice as far as a hospital option. 

Then when the next election period comes up you could look at plan options that would include a network with your preferred hospital. The Annual Election Period is every year from October 15 - December 7 ... that would allow a person to change plans if needed/wanted.

Carla Butler · Answer

If you find out that your preferred hospital isn’t in-network with your Medicare Advantage plan, you should talk to your agent about switching to a plan that includes your hospital. This should be done during open enrollment or certain special periods.

Answered by Carla Butler on September 22, 2025

Broker Licensed in MO & KS

Answered by Carla Butler Medicare Insurance Agent

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

Andrew Kramer · Answer

All hospitals are in-network if you go to the ER and then get admitted. But if you have a pre-planned surgery, the Dr doing the surgery will choose the hospital that he prefers. You cannot have a say in that. But if there are few hospitals in your area and you have one that you know a Dr would choose to have surgery in, then change your Advantage plan to one that includes that hospital.

Answered by Andrew Kramer on November 29, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

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

Carol Conner · Answer

You will be paying higher cost if that’s the case or you’re gonna have to find a plan that your hospital will be in Network so I am a local agent in the Mckinney area if you’d like to contact me I would be glad to help you thank you

Answered by Carol Conner on November 23, 2025

Broker Licensed in TX

Answered by Carol Conner Medicare Insurance Agent

Andrew Kelly · Answer

During the annual enrollment period check to see what Medicare Advantage plans your preferred hospital is in, and consider changing to that other MAPD plan.

Julie Thompson · Answer

Now is the time to make a change if you want your hospital in-network. If you are unable to make this change before Dec 7th during Annual Enrollment Period (AEP). You will have one more opportunity to change starting Jan 1st. Contact an agent to be sure you choose the best plan for you and your future needs.

Answered by Julie Thompson on December 3, 2025

Agent Licensed in CA, AZ, KY, NV & TN

Answered by Julie Thompson 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.

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.

Ingrid Kollmann · Answer

Reach out to your Medicare agent first. Secondly, you can inquire with your preferred hospital what they would recommend you do. Have they signed a contract with another Medicare Advantage insurance company? If so which one? My best recommendation though is to talk to your agent.

Answered by Ingrid Kollmann on February 9, 2026

Agent Licensed in CA

Answered by Ingrid Kollmann Medicare Insurance Agent

Ashley King · Answer

You have a few options if you do not wish to change your preferred hospital or pay out of network costs. During Medicare's Open Enrollment Period which is January 1st-March 31st every year, you can choose a different Medicare Advantage Plan if your current isn't working for you. You also can change plans to one that has your preferred hospital in network during Medicare's Annual Enrollment Period which is October 15th through December 7th each year. It is important to make sure you review all doctors and prescriptions at that time to make sure plan changes fit your needs. Working with a broker such as myself I can help review your options available based on your specific needs.

Answered by Ashley King on June 15, 2026

Broker Licensed in MD, AL, AR & 9 other states

Answered by Ashley King Medicare Insurance Agent

Shahwali Hotaki · Answer

If your preferred hospital isn’t in-network with your Medicare Advantage plan, you’ll likely pay more or may not have coverage (except for emergencies). You can either use an in-network hospital, request an exception, or switch plans during an enrollment period if keeping that hospital is important.

Answered by Shahwali Hotaki on August 16, 2025

Agent Licensed in CA, CO, GA, IL & VA

Answered by Shahwali Hotaki Medicare Insurance Agent

Fran Lovelace · Answer

If you do not have a PPO which may allow out of network coverage for your hospital, you would have to change hospitals. During annual enrollment October 15 - December 7th you could change plans to one where your hospital is in network.

Answered by Fran Lovelace on May 12, 2025

Agent Licensed in NC, SC & VA

Answered by Fran Lovelace Medicare Insurance Agent

Robert Nunn · Answer

I would call my agent of customer service and find out what hospital is in network. I then would look at Ppo plans that allow me to get service where I want .

Tony Hardwick · Answer

First, confirm network status. Ask your plan to arrange care or an exception, or use urgent/emergency care protections if needed. You can also consider switching plans during an enrollment or special election period.

Answered by Tony Hardwick on March 18, 2026

Broker Licensed in GA, AL, AR & 32 other states

Answered by Tony Hardwick Medicare Insurance Agent

Tristan Gibbs · Answer

You can look into switching into a plan that is in network with your preferred hospital. Alternativly, you can look into hospital indemnity insurance as well as other hospital options in your area.

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.

Silvana Peacock · 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.

Answered by Sam Silva on May 5, 2025

Broker Licensed in FL, GA, NJ & 7 other states

Answered by Sam Silva Medicare Insurance Agent

Matthew Moreno · Answer

You may have to choose a new hospital if it's for doctor visits or specialists. However for a HMO Medicare Advantage Plan you can visit an out-of-network provider in the event it's an emergency.

LaShonda Smith · Answer

It all depends on the plan within your network. If you contact me. We can research and find the perfect solution to this.

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.

Kim Acacio · Answer

In the Medicare Advantage world, they are network based. If you make the choice to use an out of network facility, then you are subject to your plan out-of-network benefits. Some plans offer out-of-network coverage at a different rate than in-network, while others do not offer coverage at all if you are out of network. Always know your network.

Answered by Kim Acacio on June 9, 2026

Agent Licensed in WA, AZ, ID, OR & UT

Answered by Kim Acacio Medicare Insurance Agent

Morgan Luck · Answer

You can see how much out of network will be, if your plan offers that? You can look at other plans when aep happens. You also can see if you can find another hospital in network

Tommy Lawson · Answer

Hopefully, you are within the 12-month trial period for your Medicare Advantage plan that allows you to switch to a different plan that may work better for you. If not, you may have to wait until open enrollment, Jan. 1st-March 31st, to change plans if a special enrollment period is unavailable.

Answered by Tommy Lawson on May 21, 2025

Broker Licensed in KY, CT & IN

Answered by Tommy Lawson Medicare Insurance Agent

Fewee Bondad · Answer

If you are in an enrollment period that allows you to change your plan, then you may try to find a plan that covers your preferred in network hospital. If you are not able to change your plan or can't find a plan in your financial budget, you must check with your plan and use an in-network provider or you could/ will be responsible for 100% of the cost going out of the network.

Answered by Fewee Bondad on December 20, 2025

Broker Licensed in LA, AZ, NC, OK, SC & TX

Answered by Fewee Bondad Medicare Insurance Agent

Shawn-Marie Carmona · Answer

It is so important to have a dedicated agent to be able to reach out to with questions like these. An agent would definitely be able to help you navigate this situation. They can help with your options: 1.) Help you find a comparable hospital that does accept your Medicare Advantage Plan, or 2.) If you are within an open enrollment period or Special enrollment period, your agent can help you find a plan that services your preferred hospital.

Answered by Shawn-Marie Carmona on February 16, 2026

Broker Licensed in FL, AK, AL & 48 other states

Answered by Shawn-Marie Carmona Medicare Insurance Agent

Daniel Salzman · Answer

The good news is a lot of Medicare advantage plans are PPO’s and you can go in or out of network. The issue should have been handled when you initially signed up for Medicare. I run a Dr and hospital search to make sure these issues do not pop up down the road.

Answered by Daniel Salzman on May 18, 2026

Agent Licensed in NJ, AZ, CA & 6 other states

Answered by Daniel Salzman Medicare Insurance Agent

Deborah Krump · Answer

Choose a new Medicare Advantage plan during the fall AEP or in January during the MAOEP, Medicare Advantage Open Enrollment Period. This period ends March 31st each year.

Sherri Haskell · Answer

If your preferred hospital is not in your Medicare Advantage plan, this is a justified reason to look at other Advantage plans to see what hospitals are within their networks. 

It  is acceptable, based on certain conditions, to make changes. Do you have a knowledgable Medicare specialist that you work with? Please reach out if we can be of assistance.

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

Judith Barna · Answer

-
If I was your agent, that would not happen. I check before signing you up that your preferred hospital is in network.

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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Seniors: Ask a Question of Your Own

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Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website