How to Check if Your Doctors Are in a Medicare Advantage Network

For many people with a Medicare Advantage plan, the most important feature is not the premium or the extra benefits.

It is being able to keep seeing the doctors they trust. Networks are not fixed, though.

Doctors, specialists and hospitals can join or leave a plan's network from one year to the next, and sometimes during the year.

This guide shows you how to confirm your doctors will be in your plan's network next year,

why the directory alone is not enough and what to do if a doctor you rely on is leaving.

Why networks change

Medicare Advantage plans contract with doctors and hospitals to form their networks. Those contracts are renegotiated over time.

Sometimes a medical group and a plan cannot agree, and the group leaves the network.

Sometimes a plan adds new providers.

Either way, the network you had this year may not be the network you have next year.

Step 1: make your list

Write down every provider you rely on: your primary care doctor, each specialist,

the hospital you would want to go to, any clinic for tests or therapy, and your pharmacy.

Include the names of the practices, not just the doctors, because contracts are often made with the group.

Step 2: check the plan's directory for next year

Every Medicare Advantage plan publishes a provider directory.

Make sure you are looking at the directory for the coming year, not the current one.

Search for each provider on your list and note whether they appear, at which location, and whether they are accepting new patients.

Directories can contain mistakes or be out of date, so treat this step as a first filter, not the final answer.

Step 3: call each office

This is the step that prevents most surprises.

Call each doctor's office and ask a specific question: "Will Dr. Name be in network for this exact plan name next year?" Mention the full plan name,

because many insurers sell several plans with different networks.

Write down the date, the person you spoke with and the answer.

If the office is unsure, ask when they expect to know.

Then call the plan's member services line as well and ask the same question; if both say yes, you can be confident.

Step 4: check referrals and approvals

In many HMO plans you need a referral from your primary care doctor to see a specialist.

Some services also require prior authorization from the plan.

If you see specialists regularly, ask the plan how referrals work and whether any of your ongoing care will need new approvals next year.

If a doctor is leaving your network

If you find out that an important doctor is leaving, you have options:

• Look for another plan in which your doctor will be in network, and switch during the fall enrollment period, from October 15 to December 7.
• Ask about continuing care. If you are in the middle of treatment, ask the plan what it offers to help you finish it or transition safely.
• Find a new doctor in network, if you prefer to stay with your plan, and ask your current doctor to share your records.
• Consider Original Medicare, which lets you see any doctor who accepts Medicare, and think carefully about supplemental coverage before switching.

If a doctor leaves in the middle of the year, plans generally must notify affected members,

and in some cases you may qualify for a special opportunity to change plans.

Ask the plan and a SHIP counselor what applies to you.

Don't forget the hospital and the lab

People often check their doctors and forget the places where care actually happens.

If your doctor is in network but the hospital where they work is not, a surgery or an overnight stay could cost much more.

The same goes for imaging centers, labs and physical therapy clinics.

Add them to your list and check each one, especially if you have a procedure planned for next year.

If you see a specialist only once or twice a year, it is easy to forget them in your review.

Look through your calendar or your past visit summaries for the last year to make sure no provider is missing from your list.

Tools that help

Medicare's Care Compare tool lets you look up doctors, hospitals and other providers that work with Medicare, along with quality information.

It does not replace the plan's own directory, but it helps you find providers and confirm basic details.

The Medicare Plan Finder also lets you check whether certain providers are in a plan's network when you compare plans.

Do this every fall

Make network checking part of your yearly routine, right after you receive your Annual Notice of Change in late September.

Doing it in October gives you time to compare plans before the December 7 deadline,

instead of finding out in January when you try to book an appointment.

Keep your list of providers with your plan papers so next year's check starts from where this one ended,

and add any new doctor you see during the year.

A short script for your calls

• "Hello, I have the [full plan name] Medicare Advantage plan."
• "Will Dr. [name] be in network with this plan next year?"
• "Does the practice plan to keep accepting this plan for the whole year?"
• "Is there anything I should know about referrals or approvals for my ongoing care?"

Frequently Asked Questions

Can I see an out-of-network doctor in an emergency?

Yes. Medicare Advantage plans cover emergency care anywhere in the United States, even out of network.

What is the difference between an HMO and a PPO?

HMOs generally require you to use network providers and may require referrals.

PPOs let you go out of network, usually at a higher cost.

Who can help me compare networks?

Your State Health Insurance Assistance Program offers free, unbiased help, and you can also call Medicare directly.

This guide is general information and is not affiliated with Medicare or any insurance plan.

Sources and Further Reading

• Medicare.gov — Medicare Advantage plans: how plan networks, HMOs and PPOs work.
• Medicare.gov — Care Compare: find and compare doctors, hospitals and other providers.
• Medicare.gov — Talk to someone: how to reach Medicare for help.
• SHIP — State Health Insurance Assistance Programs: free, unbiased Medicare counseling.