I'm choosing a plan
Is my doctor still in network next year?
Photo: Vitaly Gariev / Pexels
Do not assume. Networks change every year, so ask both the plan and the doctor's office whether the doctor will be in the exact plan you are choosing for next year, and get it in writing.
What to do
- Ask the plan, by phone or in its online directory, whether your doctor is in network for the exact plan name next year.
- Call the doctor's billing office and ask the same question. Directories are not always up to date.
- Ask about the hospital your doctor uses too. A doctor and a hospital can be in different networks.
- Write down the date, the person's name and what they said.
What to say
I want to confirm that Dr. [name] at [practice] will be in network for the [plan name] plan next year. Can you note in my file that I called today and send me that in writing?
Say it to both the plan and the doctor's office. Keep the names and dates.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Trusting the online directory alone. Listings can be wrong, and once you pick a plan you may have to wait until the next enrollment period to switch.
Better done together
We’re here to help
Network lists aren't always up to date, and a doctor can be in one of a company's plans and not another. We help you check the exact plan and the exact doctor, and show you how, so you can check it yourself every fall.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
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The rule behind it
Plans must keep their provider directories current. Under the No Surprises Act, job-based and Marketplace plans must check their listings at least every 90 days, and if a doctor leaves while you are in active treatment, you may keep seeing them at in-network rates for up to 90 days. Medicare Advantage plans have their own rules: they can change networks during the year and should try to give you 30 days' notice when your regular doctor leaves.
Sources
- CMS — No Surprises Act: Overview of Key Consumer Protections (provider directories, continuity of care)
- CMS — Action plan: Doctor going out-of-network
- Medicare.gov — Understanding Your Medicare Advantage Plan's Provider Network
- 42 CFR 422.120 — Medicare Advantage provider directories
- Your plan's Evidence of Coverage
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.