If your doctor leaves your network, first ask your insurer whether you qualify for continuity of care. If you're in active treatment, pregnant or scheduled for surgery, most ACA and employer plans must keep covering that doctor at in-network rates for up to 90 days. Use that time to transfer records, refill prescriptions and choose a new in-network doctor. Then, at the next Open Enrollment, pick a plan that includes the doctors you want.
- Under the No Surprises Act, continuing care patients can get up to 90 days of in-network coverage after a doctor leaves the network.
- You qualify if you're in treatment for a serious and complex condition, are pregnant, need inpatient care, have a scheduled surgery or are terminally ill.
- A doctor leaving your network usually isn't, on its own, a reason to switch plans mid-year.
- Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 on HealthCare.gov.
Why Doctors Leave Networks
A doctor leaves a network when their contract with your insurer ends. Sometimes the two sides can't agree on payment rates. In other cases, a medical group joins a new hospital system, or the doctor retires or moves. Insurers also redraw networks when they launch new plans for the coming year.
Either way, the result is the same for you. Your next visit could cost far more, because out-of-network care is billed at higher rates. Our guide to in-network vs. out-of-network costs shows the difference with real numbers.
Your Continuity of Care Rights
When a doctor leaves your network because their contract expired or wasn't renewed, federal law gives some patients a bridge. It's called continuity of care, and it comes from the No Surprises Act. It applies to most ACA Marketplace plans and employer plans.
| You may qualify if you are… | What it means |
|---|---|
| In treatment for a serious and complex condition | Ongoing care for a condition that's serious enough to need specialized treatment over time |
| Receiving inpatient or institutional care | A hospital stay or care in a facility |
| Scheduled for non-elective surgery | Includes your follow-up care after surgery |
| Pregnant and in treatment for the pregnancy | Prenatal care and delivery |
| Terminally ill | Treatment for a terminal illness |
If you qualify, your plan must notify you about the change and your right to keep seeing the doctor. Your coverage then continues at in-network terms until the earlier of two dates: 90 days after the notice, or the day you no longer need that care. During that time, the doctor must accept your plan's payment and your normal cost sharing as payment in full.
This protection doesn't apply if the doctor was removed for fraud or quality problems. It also doesn't apply to short-term plans. Federal rules are still being finalized, so plans follow a good-faith reading of the law for now. Some states add their own protections on top.
6 Steps When Your Doctor Leaves Your Network
A doctor leaving your network feels urgent, but you have more options than most people realize. Work through these steps in order.
1. Confirm the change and the date
Call member services and ask when the doctor leaves the network. Sometimes contracts are renewed at the last minute, so check again close to that date.
2. Ask for continuity of care
If you're in treatment, ask the insurer how to request transitional care. Get the approval in writing, along with the end date.
3. Transfer records and refill prescriptions
Next, ask the office to send your records to your new doctor. Request refills and referrals while you're still covered.
4. Find a new in-network doctor
Then search your plan's directory and confirm by phone. Our guide on how to check if a doctor is in network shows exactly what to ask. Need a starting point? Use our Find a Doctor in My Network tool, or read how to choose a primary care doctor.
5. Ask about network exceptions
If no in-network doctor offers the care you need nearby, ask your insurer for a network exception. Some plans approve in-network rates for an out-of-network specialist in that case. Ask for the decision in writing.
6. Compare the cost of staying
Finally, price out staying with your doctor. PPO and POS plans pay part of out-of-network care. Some offices also offer a cash price. Compare both against your plan's in-network option before you decide.
Read every renewal letter your insurer mails in the fall. Network changes for the new plan year often show up there first, which gives you time to switch during Open Enrollment.
Can You Switch Plans When Your Doctor Leaves?
Usually, not right away. A doctor leaving your network isn't, by itself, a qualifying life event for a Special Enrollment Period. Moving, losing other coverage, marriage or having a baby can open one. Our guide to buying health insurance after Open Enrollment lists the events that count.
Otherwise, your next chance is Open Enrollment. For 2027 coverage, HealthCare.gov Open Enrollment runs November 1, 2026 through January 15, 2027. Pick a plan by December 15 to start January 1. States that run their own exchange may use different dates. Our guide to switching health insurance plans covers what to compare.
A licensed Vivna agent can check which plans in your ZIP code include your doctor before Open Enrollment closes.
Pregnancy, Surgery and Ongoing Treatment
These are the moments when a doctor leaving your network hurts most. Fortunately, they're also the situations continuity of care was built for.
- Pregnancy. If you're being treated for the pregnancy, ask for continuity of care right away. Then confirm your delivery hospital's network status.
- Scheduled surgery. Non-elective surgery and its follow-up visits can qualify. Ask your surgeon's office to help with the request.
- Cancer or other complex care. Ongoing treatment for a serious and complex condition can qualify. Ask your care team about a transition plan.
Also check the hospital and lab tied to each doctor. Our guide to out-of-pocket maximums explains your yearly cost cap for in-network care.
How to Avoid This Next Year
You can't stop a doctor from leaving a network. However, you can lower the odds that it disrupts your care.
- Review your plan every fall. Use our yearly coverage review checklist.
- Weigh broader networks. A PPO often costs more, but it pays for some out-of-network care. Compare HMO vs. PPO plans and EPO vs. POS plans, or see every option in our guide to types of health plans.
- Check every doctor before you renew. Don't assume your plan stayed the same. Read what to check before you renew.
Doctor Leaves Network: FAQs
Will my insurer tell me if my doctor leaves the network?
For continuing care patients, plans must send a timely notice. Others may only see the change in the directory, so check before each visit.
How long can I keep seeing my doctor at in-network rates?
If you qualify for continuity of care, up to 90 days after your plan's notice. It ends sooner if you no longer need that ongoing care.
Can my doctor still see me if they leave my network?
Yes. You'll just pay out-of-network rates unless you qualify for continuity of care or a network exception.
Does continuity of care apply to short-term plans?
No. The federal rule covers most ACA and employer plans, not short-term plans. Check your policy for any similar benefit.
What if my dentist leaves my dental network?
Dental plans have separate networks and rules. See how to find an in-network dentist.
Vivna compares plans from 50+ carriers and checks your doctors first. Call Monday through Friday, 9am to 6pm.
Sources
- CMS: No Surprises Act continuity of care and provider directory training
- CMS: No Surprises Act implementation status
- HealthCare.gov: Open Enrollment dates and deadlines
- HealthCare.gov: Special Enrollment Periods
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. This article is general information, not legal advice. Plan rules, networks and state protections vary. Short-term plans are available only in approved states and are not ACA-compliant coverage.