Short answer: Coverage does not automatically transfer from one Medicare Advantage plan to another. Verify every important doctor, facility, prescription, and pharmacy under the exact new plan before enrolling.
How to verify doctors and hospitals
• Search the new plan’s current online provider directory. • Call the plan using its official number and name the exact provider and location. • Call the provider and give the complete plan name, type, and contract information. • Ask whether the provider is accepting new patients under that plan. • Save screenshots or notes, including the date and confirmation number. A doctor may accept one plan from an insurer but not another. Hospital participation does not guarantee that every physician working there is in-network.
How to verify prescriptions
Check the plan’s formulary for the exact drug, dosage, form, and quantity. Then review: • Drug tier and estimated copayment or coinsurance. • Deductible application. • Prior authorization. • Step therapy. • Quantity limits. • Preferred and standard pharmacy pricing. • Mail-order or specialty-pharmacy requirements. A listed drug can still have restrictions or a different cost from your old plan.
What about Original Medicare?
Original Medicare generally allows care from any provider that accepts Medicare. It does not cover most outpatient prescriptions, so check a separate Part D plan. Medigap does not include Part D.
Protect ongoing care
Ask whether the new plan offers continuity-of-care or transition assistance. Existing referrals and prior authorizations may need to be issued again. Contact the prescriber before coverage changes if a medication requires authorization or has no straightforward formulary substitute.
Frequently asked questions
Is the provider directory guaranteed to be current? - Directories can change. Confirm with both the plan and provider close to enrollment and again before non-emergency care. What if my drug is not covered? - Ask the prescriber about covered alternatives and ask the plan about formulary exceptions and appeals. Do not stop a prescribed drug without medical guidance. Will my old prior authorization transfer? - Not necessarily. Ask the new plan before treatment. Official resources - Compare plans, drugs, and pharmacies (https://www.medicare.gov/plan-compare/) · What Medicare drug plans cover (https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover)