Finding out your doctor is no longer "in network," or that a medication you have taken for years is suddenly not covered, is stressful. It is also more common than people expect, and it usually is not about you. It is about contracts and formularies that get reset every year. Here is why it happens and what you can do about it, in the order we would do it.
Why plans drop doctors and drugs
A Medicare Advantage plan is built on a network: contracts between the plan and each doctor, hospital and pharmacy. Those contracts have end dates, and either side can decide not to renew, often over payment rates. When a contract ends, that provider is out of network for the plan.
Drug coverage works the same way, just with a different list. Plans with drug coverage keep a formulary, and they can change which drugs are covered, which tier a drug sits on, or what rules apply (prior authorization, step therapy, quantity limits). Plans are expected to send you an Annual Notice of Change and an Evidence of Coverage each fall. CMS advises everyone with a Medicare health or drug plan to review those documents to make sure the plan will still meet their needs next year.
If it is your doctor
- Get the notice and the date. Your plan must tell you when a provider leaves its network. Keep the letter and note the end date. Older CMS guidance calls for written notice at least 30 days before a termination, but confirm the timing with your plan.
- Ask about continuity of care. If you are mid-treatment, ask the plan and the doctor's office whether you can keep seeing the provider for a transition period.
- Ask in writing whether you qualify for a Special Enrollment Period. CMS's enrollment guidance describes an SEP for people affected by a provider termination, but it applies to significant network changes, so it is not guaranteed. CMS also proposed a rule in late 2025 that would broaden it for 2027; we have not confirmed that it is final, so ask us or your plan what applies today.
- Compare plans that include your doctor. Medicare's Plan Finder and a licensed agent can both check networks.
If it is your drug
- Ask your prescriber about alternatives. A covered drug in the same class may work for you.
- Request an exception if it does not. A formulary exception asks the plan to cover a drug not on its list or waive a rule; a tiering exception asks for a lower cost-sharing tier. Your prescriber generally must send the plan a supporting statement, and the plan's decision clock starts when it arrives.
- Ask about a transition supply. CMS's long-standing transition policy expects plans to help with a temporary supply while you switch or seek an exception. The rules differ by situation, so call your plan before you reach the pharmacy counter.
- Appeal a denial. If an exception is denied, you have appeal rights.
Want someone to check your doctors and drugs against 2027 plans?
Send us your provider and medication list. We will show you which plans keep them, free and with no pressure.
Check my doctors and drugsYour switching options
- Now through December 7, 2026 (AEP): join, switch or drop a Medicare Advantage plan, or change Part D drug plans, for coverage starting January 1, 2027. See our Annual Enrollment guide.
- January 1 – March 31, 2027: if you are in an Advantage plan, you may switch to another Advantage plan or return to Original Medicare, per the Medicare enrollment periods fact sheet. More in when you can switch plans.
- Original Medicare: there is no network; any doctor who accepts Medicare and takes new Medicare patients can treat you. You would add a Part D plan and consider Medigap, which can involve medical underwriting if you apply outside your guaranteed-issue window.
Medicare help in your state
Honorbrook is licensed in the 11 states below. Plan availability, costs and some rules vary by state and county, so call us at (571) 354-0146 for what applies where you live.
- Virginia · county pages
- Maryland · county pages
- North Carolina · county pages
- South Carolina · county pages
- Georgia · county pages
- Alabama · county pages
- Louisiana · county pages
- Texas · county pages
- Michigan · county pages
- Indiana · county pages
- West Virginia · county pages
How Honorbrook helps
We are an independent agency, so we can look across carriers to find plans that keep your specific doctors and drugs. We do not offer every plan in every area; Medicare.gov lists them all. Start with our Medicare Advantage overview, or ask us.
This article is general information, not insurance advice. Rules and dates depend on your plan and situation; a licensed agent can confirm what applies to you.