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What do I do if my provider no longer contracts with my plan? 


Medicare insurance plans are constantly changing and updating their policies and coverage, which can be a source of confusion for seniors who have to keep up with the changes. One common issue that arises is when a Medicare beneficiary’s provider is no longer contracted with their insurance plan. Now that we are outside of the Medicare Annual Enrollment Period, you may be wondering what you can do in this situation.  The good news is, there are options available to you, and it’s important to understand those options and how you can access the care you need.  If you find out that your provider will not be returning as part of your plan’s network, you should consider all of the options available to you before making a decision.  

Check Your Plan’s Directory  

One option would be to find a new provider that is in your plan’s network. The first step you should take when searching for a new provider is to check your plan’s directory. The directory will list all of the providers who are in-network and contracted with your plan. You may find that there are other providers available who meet your needs and who accept your current insurance plan. If this is the case, you may not need to take any further action beyond making an appointment with your new provider.  

Consider Switching Plans  

Depending on where you live, there may be multiple health plans available, and some may include access to a larger network of providers than others. You should also consider whether switching plans makes financial sense for you, since many health plans have different costs associated with them based on where you live and how much coverage they offer.  For anyone in this situation who missed the opportunity to change plans during the Annual Enrollment Period, you will still have another opportunity to make a change.  The Medicare Advantage Open Enrollment Period runs from January 1st-March 31st and allows beneficiaries to make 1 change during that time frame.  You may also qualify for a Special Enrollment Period so it is always a good idea to contact your local Medicare specialist who can advise if you qualify to make a change as well as review your options. 

While receiving notification that your healthcare provider is no longer contracted with your Medicare insurance plan can be unnerving, rest assured, there are ways to ensure your continued healthcare coverage.  Our Medicare specialists here at VibrantUSA are available year-round to assist with issues like this to make sure that you get the plan that best fits your needs.   

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