Key Takeaways
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When your doctors leave your plan’s network, your coverage and costs can change immediately, and understanding these changes helps you act before the AEP window closes on December 7.
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You can respond quickly by reviewing your current plan materials, checking updated networks, and exploring other available options for 2026 coverage.
Understanding A Shift In Your Doctor’s Network Status
When one of your trusted doctors leaves your plan’s network, it can feel sudden and stressful. This type of change can happen at any time of the year, but it becomes especially important during the Annual Enrollment Period (AEP) from October 15 to December 7. This is the period when you can review your options for the upcoming year and switch to a plan that better fits your needs. Because your coverage for 2026 begins on January 1, you have a clear timeline to work with as you evaluate how this change affects you.
Losing in-network access means you may face higher out-of-pocket costs if you continue seeing the same doctors. In some cases, certain services may no longer be covered at all unless you stay within the network. This makes it important to understand what has changed and what your next steps should be.
Why Do Doctors Leave A Network?
Doctors and medical groups leave networks for several reasons. While you may not receive a detailed explanation, common causes include contract changes, reimbursement disagreements, or shifts in how healthcare practices manage their services. These changes can occur without warning to patients, which means you may only find out when you receive a notice from your plan or when you try to schedule an appointment.
Regardless of the reason, your focus should be on confirming the updated network information and learning how the change affects your care, medications, and future appointments.
What Should You Check First?
Has Your Plan Notified You?
Your plan should send you a written notice when a doctor or facility leaves the network. This notice might arrive by mail or through a digital message if you signed up for electronic communications. Review this notice carefully. Look at the effective date, whether the change impacts referrals or specialists, and any temporary provisions that may apply during the transition.
Are You In The Middle Of Treatment?
If you are currently receiving active treatment, such as physical therapy, wound care, behavioral health support, or treatment for a chronic condition, confirm whether your plan offers a transition-of-care period. Many plans provide short-term continuity for certain medical needs, meaning you may be able to continue with your doctor for a limited time even after the network change takes effect.
Have You Checked Your Plan’s Updated Network?
Network directories can change frequently, especially during the weeks leading up to AEP. Visit your plan’s network directory or call customer service to verify whether other doctors in the same practice remain in network. Sometimes only one provider leaves while others stay.
When Should You Consider New Options?
Because AEP for the 2026 plan year runs through December 7, you have several weeks to decide what to do. However, if your doctor leaves the network before AEP ends, you should make a decision promptly so you have enough time to compare your choices. Think about switching plans if:
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You have multiple doctors who are leaving the network.
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Your preferred specialists are no longer covered.
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Your routine visits would become more expensive.
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Your current plan no longer fits your health needs for the upcoming year.
Plan changes go into effect on January 1, so any decisions made by the December 7 deadline will apply to your coverage for the entire 2026 calendar year.
How Can You Respond Quickly?
1. Review Your Current Plan’s Summary Of Benefits
Start by reviewing your plan’s benefits for the current year and any updates for 2026. Compare costs for office visits, specialist care, outpatient treatment, and covered services. This helps you understand how much the network change will impact you.
2. Make A List Of All Doctors You Want To Keep
Prepare a list of your primary care doctor, specialists, therapists, or facilities you prefer. Use this list when checking plan networks. Confirming that all your providers accept your coverage for 2026 gives you confidence when choosing a plan.
3. Confirm Drug Coverage For 2026
If you take prescription medications, check the current formulary and the 2026 formulary updates. Part D rules update annually, and the new year may include changes to covered drugs, tier levels, or cost-sharing. Considering the Part D changes for the coming year, including cost limits and the $2,000 annual out-of-pocket maximum, it is helpful to confirm how your medications align with potential plans.
4. Look For Network Stability
Some plans have more consistent network relationships, while others experience more frequent changes. Look for patterns in your past notices. If year-to-year network turnover is common, you may prefer a plan with broader doctor access.
5. Reach Out To Your Doctors’ Offices
Contact the offices of your primary and specialty doctors to ask if they expect to remain in your plan’s network for the upcoming year. Medical offices often know network changes ahead of time and can confirm whether the change affects your care for 2026.
What Costs Can Change When A Doctor Leaves The Network?
When your doctor becomes out of network, you may notice changes in your expenses for 2026, such as:
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Higher copayments for office visits
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Increased coinsurance for specialist care
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Higher bills for tests, scans, or procedures
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Separate charges if your doctor no longer participates in your plan
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Possible full cost of services if the plan does not cover out-of-network visits
These cost changes can vary based on the type of plan you have, whether it limits out-of-network care, and how the plan structures its provider network for the next calendar year. Reviewing your Annual Notice of Change (ANOC) helps you understand any updated cost amounts for 2026.
Should You Switch Plans If Only One Doctor Leaves?
Your choice depends on how important that doctor is to your care and whether it is easy to find a similar provider in network. Some beneficiaries choose to stay in their plan because most of their doctors are still covered. Others prefer switching because one specialist plays a major role in their long-term care.
During AEP, you have the flexibility to review all available plans and choose the one that meets your needs for the upcoming year. If your preferred doctor is a major part of your care routine, switching may give you long-term stability and convenience.
What If You Discover The Change After AEP Closes?
If you learn about the network change after December 7, you may have fewer options to switch for the 2026 coverage year. However, some situations qualify for Special Enrollment Periods (SEPs), depending on the circumstances. If your situation qualifies, you may have the ability to change plans outside of AEP. If not, you may need to wait until the next AEP, which begins on October 15, 2026.
This is why reviewing your coverage early in AEP is important. Acting as soon as possible during the October to December window ensures you have enough time to make an informed decision.
Ensuring Your Care Stays On Track In 2026
The most important goal is to maintain access to the care you rely on. When a doctor leaves your plan’s network, clear steps and careful review help you avoid unexpected costs and disruptions. Keep track of the AEP timeline, review your notices, compare the available options for 2026, and confirm which providers will accept your coverage.
If you feel unsure about the changes or want help reviewing your choices, consider reaching out to any licensed agent listed on this website. They can help you understand your options and provide guidance based on your personal situation.
