Part of our Medicare and Medicaid Help for Families guide
Mom's Medicare Advantage Plan Is Ending or Her Doctor Left: What Now?
Picture this: an envelope from Mom's health plan has been sitting under the fruit bowl for two weeks, and today you finally open it. It says the plan is leaving. Or maybe it says her favorite doctor is.
First, find out which letter it is. If the plan itself is ending, Mom keeps Medicare, gets a Special Enrollment Period from December 8 to the end of February, and may have a right to buy Medigap without health questions. If only a doctor is leaving, the plan goes on and her usual windows apply. Call SHIP before choosing.
This guide is for US families helping a parent through a plan non-renewal letter or a "your doctor is leaving our network" notice. You get a "which letter is it?" quiz, example dates for a plan ending December 31, 2026, myth vs fact cards, and a free one-page check.
Did you know? A plan ending can open a door that is usually shut. Outside a person's one-time Medigap Open Enrollment Period, insurers can usually ask health questions. But when a Medicare Advantage plan leaves Medicare or stops giving care in her area, and she switches to Original Medicare, federal rules give her the right to buy certain Medigap policies. The same table lists a significant change in the plan's network. CMS: Choosing a Medigap Policy, page 18
Which letter did Mom get?
Look for two phrases. If the letter says the plan is leaving Medicare, is not renewing, or will no longer serve her area, the plan is ending. If it names a doctor, clinic, or group that is leaving the network, the plan continues without that provider. The rights and the dates are different for each.
Plans have to warn people. Federal rules say a Medicare Advantage plan that does not renew its contract must mail each member at least 90 days before the nonrenewal takes effect (42 CFR 422.506). Medicare.gov says the Plan Non-Renewal Notice usually comes in October. When a doctor leaves, the plan must send written notice at least 45 days ahead for a primary care or behavioral health provider (plus one phone call attempt), and at least 30 days ahead for other specialists she sees regularly (42 CFR 422.111(e)).
Not sure which one you are holding? Tap each made-up example below.
Example 1: "Harbor Valley Advantage will not be offered in your county next year. Your coverage ends December 31."
The plan is ending for her area. She has a Special Enrollment Period, and if she goes to Original Medicare she may have a guaranteed issue right to buy certain Medigap policies. Keep this letter. It is her proof.
Example 2: "Dr. Lee's cardiology group will leave our network on January 31."
The plan continues. Ask the plan how she can keep getting care, and use Open Enrollment (by December 7) or the January 1 to March 31 Medicare Advantage Open Enrollment Period to switch. If many doctors are leaving, ask 1-800-MEDICARE whether a special window applies.
Example 3: "Here is what will change in your plan next year": a higher copay and a new drug list.
That is the Annual Notice of Change, not an ending. Her plan continues unless she picks a new one during Open Enrollment. Our ANOC decoder shows what to circle.
Example 4: Mom is moving in with your family two states away, outside her plan's area.
That is a moving Special Enrollment Period. It starts when she moves and lasts 2 full months after, or starts the month before if she tells the plan first. Moving out of the service area is also on the Medigap guaranteed issue list.
What happens if Mom's Medicare Advantage plan is ending?
She keeps Medicare. She can pick a new Medicare Advantage plan, or go to Original Medicare with a separate drug plan and, if she wants, a Medigap policy. Medicare.gov gives her a Special Enrollment Period from December 8 to the last day of February. If she does nothing, she lands in Original Medicare.
Medicare.gov's Special Enrollment Periods page says that when a plan's contract with Medicare is not renewed, she can switch between December 8 and the last day in February of the following year, and she will be enrolled in Original Medicare if she does not join another Medicare Advantage plan before her current plan ends. Open Enrollment, October 15 to December 7, works too, and a plan chosen then starts January 1 (Medicare.gov: Joining a plan).
Here is how the example dates are counted, for a plan whose coverage ends December 31, 2026:
| Date | What it is | Where it comes from |
|---|---|---|
| By October 2 | Letter should arrive (90 days before) | 42 CFR 422.506 |
| November 1 | Earliest day to apply for Medigap (60 days before) | Medicare.gov and the Medigap guide |
| December 7 | Open Enrollment ends; a plan picked by now starts January 1 | Medicare.gov |
| December 8 to February 28, 2027 | Special Enrollment Period for a plan not renewed | Medicare.gov |
| March 4, 2027 | Latest day to apply for Medigap (63 days after) | Medicare.gov and the Medigap guide |
Contracts can also end in the middle of a year. Medicare.gov lists different windows when Medicare terminates a plan's contract, or when the plan and Medicare agree to end it, so use the date in Mom's letter, not ours.
Can she get Medigap without health questions when her plan ends?
Often, yes, if she goes to Original Medicare instead of another Medicare Advantage plan. Federal rules say she can buy certain Medigap policies sold in her state if she applies as early as 60 days before the plan coverage ends and no later than 63 days after. Medigap cannot start until the old plan ends.
This right is only for people who switch to Original Medicare, not for people who join another Medicare Advantage plan (Medicare.gov: When can I buy a Medigap policy?). Medicare.gov's Medigap Open Enrollment page calls these situations "guaranteed issue rights," where an insurance company cannot deny her a Medigap policy.
Which lettered plans? Two official sources list them a little differently, so here is what each says:
| Official source | Plans it lists for a plan that is ending |
|---|---|
| Choosing a Medigap Policy (CMS, March 2026), page 18 | A, B, C, D, F, or G sold in her state |
| Medicare.gov "When can I buy a Medigap policy?" tool | A, B, C, D, F, G, K, or L sold in her state |
| Both | Plans C and F only if she was eligible for Medicare before January 1, 2020 |
When two official pages differ, ask your SHIP counselor or State Insurance Department which list your state uses before Mom applies.
Keep the proof
Medicare.gov says to keep any letters, notices, emails, or claim denials from the Medicare Advantage plan, because she may need to include copies with her Medigap application to prove she has the right to buy a policy. That fruit bowl envelope is now an important document.
Do not forget drug coverage
If her old plan included drugs and she moves to Original Medicare, she needs a separate Medicare drug plan. Medicare.gov's side by side says Original Medicare includes Part A and Part B, and you add Part D for drugs (Your coverage options). Line up the drug plan to start the day after the old plan ends. If the drug bills are the worry, check whether she qualifies for Extra Help with Medicare drug costs.
What if her doctor is leaving the plan's network?
The plan keeps going, so Mom has three choices: stay and pick a new in-network doctor, switch plans during Open Enrollment by December 7 or during January 1 to March 31, or go to Original Medicare, where any doctor who takes Medicare works. If many providers are leaving, ask 1-800-MEDICARE about a special window.
Medicare.gov says a Special Enrollment Period may be possible when you are notified of a significant change in your plan's provider network, and that these cases are evaluated one by one (Special Enrollment Periods, "Other exceptional circumstances"). One doctor leaving usually does not count. A whole hospital system or many specialists leaving might. You will not know until you ask, so call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
Before anyone switches anything:
- Ask the plan for the exact date the doctor leaves and how Mom can keep getting care in the meantime, especially for an ongoing treatment.
- Ask the doctor's office which plans they expect to take next year, and whether they accept Original Medicare.
- Compare plans on Medicare Plan Finder with her full drug list and her doctors entered.
- Check the Medigap timing first if Original Medicare is the plan B. Without a guaranteed issue right or her trial right, an insurer may ask health questions. Our Medigap trial right guide explains the first-year rule.
What should we do this week?
Name the letter, write down the end date, and list the doctors and drugs that matter most. Then call SHIP, compare plans on Plan Finder, and decide between a new Medicare Advantage plan and Original Medicare. If Medigap is part of the plan, apply inside the window and line up a drug plan.
Step 1: Put the dates on paper
Write the date on the letter, the last day of the plan or the doctor, and the windows from the calendar above. When we built our Plan Ending? MA SEP + Medigap GI Organizer, we made the timeline page start from the letter date for exactly this reason: every other date is counted from it.
Step 2: Call SHIP before choosing
Your State Health Insurance Assistance Program gives free, unbiased counseling. Find yours at shiphelp.org. Ask: which letter is this, which Medigap plans can she buy in our state, and does our state add any rights?
Step 3: Choose, then line everything up
Join the new plan, or apply for Medigap and a drug plan, so the new coverage starts when the old one stops. Keep every confirmation number and letter.
Tap to tick, your progress saves on this device
Myth or fact: what do families get wrong when a plan ends?
The big one is panic: thinking Mom loses Medicare when her plan leaves. She does not. The other common slips are treating a doctor notice like a plan ending, throwing away the letter that proves her Medigap right, and forgetting that Original Medicare needs a separate drug plan. Tap each card to check.
Myth: if her plan ends, Mom loses Medicare.
Fact: her Medicare continues. Medicare.gov says she will be enrolled in Original Medicare if she does not join another Medicare Advantage plan before her current plan ends.
Myth: she has to choose by December 7.
Fact: Open Enrollment ends December 7, but a plan that is not renewed also gives her a Special Enrollment Period from December 8 to the last day of February. Choosing earlier just avoids a gap.
Myth: a plan ending means she can get any Medigap policy, any time.
Fact: the right covers certain lettered plans sold in her state, and only inside the window: as early as 60 days before the plan ends and no later than 63 days after. And only if she goes to Original Medicare.
Myth: one doctor leaving lets her switch plans right away.
Fact: the plan continues, so her usual windows apply. Medicare.gov says special windows for significant network changes are decided case by case. Ask 1-800-MEDICARE.
Myth: once she picks a new plan, the old letter can go in the recycling.
Fact: keep it, and the envelope. Medicare.gov says she may need copies of letters and notices to prove her right to buy a Medigap policy.
Myth: Original Medicare covers her prescriptions.
Fact: Original Medicare is Part A and Part B. Drug coverage is a separate Medicare drug plan (Part D), so set one up if she leaves Medicare Advantage.
Where can we get free help with the letter?
Start with your State Health Insurance Assistance Program at shiphelp.org. SHIP counseling is free, local, and not connected to any insurance company. You can also call 1-800-MEDICARE, or the plan's member services number on the letter. Bring the letter, her drug list, and her doctors' names to the call.
If it is a regular year with no ending, our Annual Notice of Change decoder shows what to circle on the fall letter, and the Medicare Open Enrollment checklist walks through the October 15 to December 7 window. If Mom is in her first year of Medicare Advantage, read how the Medigap trial right works too. For the bigger picture, start at our Medicare and Medicaid help hub. For a regular Open Enrollment comparison, our Medicare Open Enrollment Kitchen Table Kit has the drug and doctor grids laid out.
Want the paperwork already laid out? Our Plan Ending? MA SEP + Medigap GI Organizer is a 15-page printable for this exact letter: what "plan ending" letters mean, a timeline worksheet that starts from the letter date, an options map, a Medigap guaranteed issue worksheet for your SHIP call, call scripts, and a blank comparison grid. It does not quote or recommend plans. Get it on Gumroad for $12.99 (price checked October 21, 2026) or see it on Etsy.
Frequently asked questions
Will Mom lose Medicare if her Medicare Advantage plan ends?
No. Her plan is ending, not her Medicare. Medicare.gov says that if she does not join another Medicare Advantage plan before the old one ends, she will be enrolled in Original Medicare. Original Medicare does not include drug coverage, so she would still need to join a separate Medicare drug plan to keep her prescriptions covered.
Do we have to wait for Open Enrollment if her plan is not renewing?
No. She can use Open Enrollment, October 15 to December 7, like everyone else. A plan that is not renewed also gives her a Special Enrollment Period from December 8 to the last day of February. Choosing early is simpler, because a gap means time in Original Medicare without the new plan.
Can Mom keep her doctor if she goes back to Original Medicare?
Often, yes. Medicare.gov says that with Original Medicare you can see any doctor or hospital that takes Medicare, anywhere in the U.S. There is no network. Call the doctor’s office and ask, in these words, whether they accept Original Medicare. If she also wants a Medigap policy, check the guaranteed issue dates first.
What if Mom moves out of her plan’s service area?
That is its own Special Enrollment Period. Medicare.gov says her chance to switch starts when she moves and lasts 2 full months after the move, or starts the month before if she tells the plan first. The Medigap guide lists moving out of the service area as a guaranteed issue situation too.
Does every state follow the same Medigap rules?
Federal law sets the floor, and some states give extra rights to buy a Medigap policy. Medicare.gov says to check with your State Insurance Department about rights under state law. Your State Health Insurance Assistance Program (SHIP) can tell you what applies where Mom lives, for free.
Please note: This guide explains official rules in plain English. It is not legal or insurance advice and we are not affiliated with Medicare or any government agency. Confirm details with Medicare (1-800-MEDICARE), your plan, your State Health Insurance Assistance Program (SHIP), or an elder law attorney.
Sources
- Medicare.gov: Special Enrollment Periods (plan not renewed, contract ends, moving, other exceptional circumstances). Checked 2026-10-21
- Medicare.gov: Plan Non-Renewal Notice. Checked 2026-10-21
- eCFR: 42 CFR 422.506, nonrenewal of contract (mail notice at least 90 days before). Checked 2026-10-21 (eCFR current as of 2026-10-19)
- eCFR: 42 CFR 422.111(e), notice when a contracted provider leaves the network. Checked 2026-10-21 (eCFR current as of 2026-10-19)
- CMS and NAIC: Choosing a Medigap Policy (guaranteed issue rights table, page 18). Checked 2026-10-21 (CMS Product No. 02110, March 2026)
- Medicare.gov: When can I buy a Medigap policy? (plan leaving Medicare or your area). Checked 2026-10-21
- Medicare.gov: Medigap Open Enrollment and guaranteed issue rights. Checked 2026-10-21
- Medicare.gov: Joining a plan (Open Enrollment and Medicare Advantage Open Enrollment dates). Checked 2026-10-21
- Medicare.gov: Your coverage options (Original Medicare and Medicare Advantage side by side). Checked 2026-10-21
- SHIP: State Health Insurance Assistance Programs. Checked 2026-10-21
Save this guide for later
Keep reading
- Leaving Medicare Advantage: How the Medigap Trial Right Works
- Your Medicare Plan's Annual Notice of Change: What to Check Before December 7
- Medicare Open Enrollment: A Kitchen-Table Checklist for Helping a Parent
- Got a NOMNC? How a Medicare Fast Appeal Works
- Medicare and Medicaid Help for Families: start here
- The Medicare Prescription Payment Plan: Spreading Drug Costs Across the Year
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- Medicare Savings Programs: Help Paying the Part B Premium
- Extra Help for Medicare Drug Costs: Who Qualifies and How to Apply
- Medicaid Look-Back Period in Plain English: Myths vs Facts
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