What to Do if Your Doctor Drops Your Medicare Plan

doctor drops your medicare plan


How long did it take to find a doctor you liked and who accepted your Medicare plan? For many seniors, this process can be a lengthy ordeal! Often, you invest quite a bit of time and effort to find the perfect physician for your needs. But do you know what to do if your doctor drops your Medicare plan?

Few seniors are aware that medical groups, as well as individual practitioners, can change their accepted insurance plans at any time. Changes to the insurance carriers your doctors work with can be upsetting, especially when you’re attached to your physician or practice. 

Right now, thousands of seniors in the San Diego area are currently facing this exact situation. If you’re a patient at UC San Diego Health, you’ve probably heard they will no longer accept plans from Blue Shield of CA or Brand New Day in 2024. At the same time, Scripps Clinic and Scripps Coastal recently announced that starting January 1, 2024, they will no longer accept Medicare Advantage (MA) plans.

UCSD patients may find this transition easier since the system there is much bigger. And, if you’re a Scripps patient who doesn’t have a Medicare Advantage plan, you don’t need to worry! Scripps has been clear in their communication with agents and patients that this change only applies to Medicare Advantage beneficiaries. 

What happens when your doctor no longer takes your Medicare insurance?

Doctors, practices and medical groups pick up or drop coverage options more often than you may think. Keep in mind, though, that these changes can’t happen overnight. When you’re facing a medical care disruption, you’ll have time to ask questions, research your options and decide what to do.

When you’re made aware of a change like this, don’t be afraid to ask your Medicare insurance agent questions. In these circumstances, information is power. But, generally, there are two options when your doctor no longer accepts your Medicare insurance plan.

Option #1: Purchase a Medicare Supplement Plan

If you really like your physician and want to remain a patient, you can. Of course, every choice in life comes with an upside and a downside. To stay with your current doctor, you’ll need to sign up for a Medicare Supplement Plan, also called Medigap, which will mean an increase in your monthly insurance costs. You can expect to pay about $150 to $250 more per month.

If you do choose to purchase a Medicare Supplement Plan, and you’re on an Advantage Plan, your situation is a little more challenging. This is because Medicare Advantage recipients can’t buy Medicare Supplement Insurance. 

Your doctors’ changes to their accepted insurance providers don’t constitute a Special Enrollment Period (SEP) so you’ll need to wait for an open enrollment. The Medicare Open Enrollment Period (OEP) starts on January 1 and concludes on March 31. At that time, your Medicare insurance agent can help you drop your current coverage and enroll in Medicare Part B and Medigap. 

Remember, unlike Advantage coverage, Original Medicare doesn’t include prescription drug coverage, so you’ll likely need to select a Part D plan, too.

Option #2: Find a new physician

As much as you love your doctor, you may not be able to afford a significant increase in your monthly expenses. On the bright side, if you don’t like your doctor this may be the nudge you need to find someone you actually do like!

You’ll need to find a new doctor that takes your insurance. In many cases, you don’t need to change medical groups. Different doctors within the same group can accept different types of insurance. Insurance providers, practices and individual providers aren’t mutually exclusive. 

If you’re a patient within a large medical organization, finding a new physician is much easier. Again, you may even be able to find another doctor within the practice you already use.

If your doctor has recently dropped your Medicare insurance plan, or you have questions about your plan, get in touch with us at 877.255.6273.


image credit: shutterstock/Panchenko Vladimir