Medicare Advantage Plan Drops Your Hospital: What to Do
What happens if your Medicare Advantage plan drops your hospital?
Simply put, if your Medicare Advantage plan drops your hospital, any non-emergent care you receive there will be treated as out-of-network—meaning higher costs for care or no coverage at all. You have the option to switch your health plan during the Annual Enrollment Period (Oct. 15–Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1–March 31).
Finding out your hospital is no longer in your Medicare Advantage plan's network can be unsettling—especially if you're mid-treatment or have a trusted care team there. Understanding what this change means and how to respond quickly can help protect both your health and your wallet.
What does "out-of-network" actually mean for Medicare Advantage?
Medicare Advantage plans—also known as Medicare Part C—are offered by private insurance companies approved by Medicare. Unlike Original Medicare, these plans use provider networks. When a hospital or health system exits that network, your plan stops covering services there at the in-network rate.
Depending on your plan type, the financial impact varies:
- Health Maintenance Organization (HMO) plans typically provide no coverage for out-of-network care, except in emergencies.
- Preferred Provider Organization (PPO) plans may offer partial out-of-network coverage, but your costs will be significantly higher.
When your health plan's network changes, your insurance company is required to notify you in advance if you’ve been treated recently (timeframes vary by state) by the provider or at the healthcare facility leaving the network. It's important to pay attention to these notices, review your options, and make any necessary changes before the network disruption occurs.
Insurance carriers are not required to notify all members about every network change. However, they must keep their online network directories current, so you can always confirm if a certain hospital or doctor is currently in-network.
Common Mistakes People Make When Their Hospital Leaves Their Plan’s Network
Waiting too long to act. Network changes typically take effect on Jan. 1. If you wait until after that date, your options may be more limited—and you could already face higher costs for care.
Choosing a new plan without checking the network. Always confirm your preferred doctors, specialists, and hospitals are in-network before enrolling in a new plan.
What Most People Don't Realize
Networks can change at any point during the year. Insurers can drop hospitals and doctors outside of the usual enrollment seasons — sometimes with little warning.
Also, many people aren't aware that continuity of care may apply during a network disruption. If you're mid-treatment, you may be able to keep seeing your current providers for a short transition period, typically up to 90 days.
How to Know if Your Plan is Affected
Your insurance carrier is required to notify you of any major changes to your coverage, but it's easy to miss these notices if you don't know what to look for.
Each September, you will receive an Annual Notice of Change (ANOC). This document outlines exactly what's changing in your plan for the upcoming year, including updates to your provider network, premiums, and benefits. Reviewing it carefully could save you from unexpected costs or gaps in coverage in the coming year.
If your hospital is leaving your network, the ANOC is often where you'll see it first. However, you will likely have to take additional steps to review the carrier’s provider and facility directory by visiting a website noted in your ANOC. It’s important to review the directory to ensure your preferred doctors and hospitals are still in-network for the coming year. If a doctor and/or hospital will no longer be in-network, acting on that information early gives you the time to explore your coverage options before the change takes effect.
If a network change occurs at another point in the year, you could receive a separate notice from your carrier if you’ve had a claim with the provider or facility within a specific period. You will not be alerted about all network changes. If you have questions or find that one of your doctors or healthcare facilities no longer accepts your Medicare plan, contact our team, and one of our advisors will help you navigate your options.
When can you switch plans after a network disruption?
When it comes to switching plans after a network disruption, timing is everything. If your hospital leaves your plan's network:
- You can make a coverage change during the Annual Enrollment Period (AEP), which runs from Oct. 15 – Dec. 7 each year. Any new plan you choose during this window takes effect on Jan. 1—so acting before the deadline ensures you're covered from the start of the new year.
- There’s also the Medicare Advantage Open Enrollment Period (OEP), which runs from Jan. 1 – March 31. During this window, you’re permitted to make one plan change, with your new coverage starting on the first of the following month. OEP is a helpful safety net if you missed AEP or if your situation changed after Jan. 1.
Frequently Asked Questions
Will I still be covered in an emergency if my hospital is out-of-network?
Yes. Medicare plans cover urgent and emergency care even at out-of-network facilities. However, for non-emergency services, coverage depends on your plan type. HMO plans generally require you to stay within your network for routine care, while PPO plans may offer some out-of-network coverage at a higher cost.
Can I switch Medicare Advantage plans mid-year if my hospital leaves the network?
In most cases, you'll need to wait for the Annual Enrollment Period (Oct. 15–Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1–March 31).
What happens if I do nothing after my hospital leaves the network?
If you take no action, any care received at the out-of-network hospital will either be covered at a much higher cost (on a PPO plan) or not be covered at all (on an HMO plan). It's worth reviewing your coverage options rather than assuming your current plan will still work for you.
How do I find a Medicare Advantage plan that includes my hospital?
Start by contacting a licensed advisor—like those at RetireMed—who can run a personalized plan comparison that includes your specific doctors, hospitals, and prescriptions.
Get the Coverage That's Right for You
Whether your hospital just left your plan’s network or you want to explore coverage options before the next enrollment period, our advisors are here to help. All our services are provided at no cost to you.