For the media

What to do if your doctor stops taking Medicare Advantage

By The Health News Team | October 17, 2023
Woman reading paperwork with a laptop computer

Medicare enrollees understand the value of the annual enrollment period (AEP), a time each fall when members can switch their plan to better suit their needs. But what if you need a plan change outside the AEP?

To help enrollees navigate needed plan changes outside the allotted time, Medicare offers special enrollment periods that allow for certain changes. These changes include, but are not limited to:

  • Loss of coverage due to moving outside of coverage area

  • Loss of coverage due to contract changes with Medicare

  • Opportunity to receive coverage through new employment or a union

  • New qualification for Medicare and Medicaid

  • New qualification for Medicare’s Extra Help program to assist with drug prescription costs

  • Loss of qualification for Medicare’s Special Needs program

Medicare options during special enrollment periods

Many San Diegans may find themselves qualifying for a special enrollment period due to changes with their medical provider — specifically, their medical group no longer accepts their Medicare Advantage plan. Medicare Advantage is Medicare’s all-inclusive plan that enhances standard benefits.

To accommodate the changes, Medicare allows its members to choose 1 of 3 options outside the AEP:

  1. Original Medicare, plus a Part D plan for prescription drugs to avoid the Part D penalty

  2. Medicare supplement or medigap plans, plus a Part D plan to avoid the Part D penalty

  3. Medicare Advantage plans, which include Part D, vision, hearing, dental and emergency coverage

What to expect with special enrollment plan changes

Making changes to your Medicare plan may seem daunting, especially if the circumstances around the change were neither wanted nor expected. However, Medicare accommodates special enrollment changes frequently, and once you choose and enroll in a new plan, you should have coverage up and running within 30 days.

Depending on the situation, you may need to choose a new primary care doctor — or establish new refill requests with your pharmacy. These tips can help ease the transition:

  • Request a copy of your health records from your current doctor.
    Your plan may require that you choose a new doctor, so having your records on hand, whether in paper or digital format, will help your new doctor get up to speed on your health history and needs.

  • Get your current prescriptions filled before your insurance runs out.
    To ensure you have your prescriptions on hand when you need them, ask your current doctor to order any refills to keep you covered through the transition.

  • Bring your prescription bottles to your new doctor.
    On your first visit with your new doctor, skip the list of prescriptions and bring the bottles instead. The pharmacy labels may have information your doctor will need.

At Sharp, original Medicare, all Medicare supplement plans, and Medicare Advantage plans offered by Sharp Health Plan and United Healthcare are accepted. If you need guidance through the Medicare experience, visit Sharp’s Medicare classes and events page to speak with an English- or Spanish-speaking specialist or to register to attend a live or virtual webinar.

Learn more about Medicare health insurance at Sharp HealthCare; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.

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