Robert A. Di Ieso, Jr.

Q. My doctor is leaving my provider network in the middle of the year. Does that unexpected change mean I can switch to a new plan?

A. Some life changes entitle you to switch plans outside your health plan’s regular annual open enrollment period—losing your on-the-job coverage is one example—but losing access to your doctor generally doesn’t qualify.

There are some exceptions, however. Several states have “continuity of care” laws that allow people to keep seeing a specific doctor after the physician leaves a provider network if they’re undergoing treatment for a serious medical condition, have a terminal illness or are pregnant, among other things. How long a patient is allowed to continue to see that doctor varies by state. It may be 90 days or for the duration of treatment or the end of a pregnancy, for example.

State continuity of care laws don’t apply to self-funded plans that pay their employees’ claims directly.

Some seniors in private Medicare Advantage plans may also be allowed to change plans midyear if their physicians or other providers leave their current network, according to rules that went into effect this year.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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