Medicare Advantage Plan Members Can Opt Out If Plans Drop Doctors Without Cause

Apr 9, 2014

New rules for Medicare Advantage plan members give seniors more flexibility to opt out of plans that drop their doctors from the network.

Seniors with Medicare Advantage have more flexibility to opt out of plans, thanks to new rules.
Credit Aaron Read / RIPR

The Centers for Medicare and Medicaid Services has announced that Medicare Advantage plan members will be able to switch plans if those plans drop doctors mid-year without cause. These are Medicare plans offered by private insurance companies and often operate like HMOs.

The move comes after several Medicare Advantage plan providers, like United Healthcare, dropped thousands of doctors from its networks in Rhode Island, Connecticut, and several other states, without saying why. The Rhode Island Medical Society and others raised concerns about United’s decision, saying it would leave plan members without access to certain services at in-network prices. Doctors complained the insurer had given them no reason for cutting them from the network.

CMS will also now require Medicare Advantage plans to notify it at least 90 days before any major mid-year changes to its provider networks.