Short answer: Contact your current plan, prospective plan, and treatment providers before the ending date. Confirm which coverage will be active, whether providers participate, and whether referrals or prior authorizations must be issued again.
Do not cancel necessary care on your own
A plan-ending notice does not mean medically necessary treatment should stop immediately. Continue following your clinician’s instructions while urgently coordinating coverage. Call emergency services or seek urgent care when medically necessary.
Create a treatment transition file
• The termination letter and coverage-ending date. • Treatment plan and upcoming appointments. • Referrals and prior authorization numbers. • Medication list and recent prescriptions. • Medical equipment and supply orders. • Provider names, locations, and phone numbers. • Notes from calls with plans and providers.
Questions for the current plan
• Through what date are authorized services covered? • How will claims for care before the ending date be processed? • Can current approvals be documented in writing? • Are transition or continuity-of-care protections available?
Questions for a replacement plan
• Are all treating clinicians and facilities in-network? • Must authorizations, referrals, or prescriptions be resubmitted? • Is there a transition period for active treatment or non-formulary drugs? • Which specialty pharmacy, home health agency, or equipment supplier must be used?
High-priority treatment situations
Start coordination early for cancer care, dialysis, surgery, pregnancy, rehabilitation, behavioral health, home health, skilled nursing care, oxygen, insulin and supplies, specialty drugs, and durable medical equipment. Ask SHIP, Medicare, and the plans about protections that may apply to the specific treatment and state.
If coverage or care is denied
Read the denial notice and follow its appeal instructions. Expedited review may be available when waiting for a standard decision could seriously harm health. A coverage appeal is distinct from challenging the termination of plan membership.
Frequently asked questions
Will an old authorization transfer? - Not automatically. Obtain a copy and ask the new plan what it requires. Can I keep an out-of-network specialist temporarily? - Possibly under a plan’s transition policy or applicable protection, but it is not automatic. Request a written determination. Who should coordinate the change? - Ask the treating provider’s billing or care-management team, both plans, Medicare, and SHIP to help. Official resources - Medicare appeals (https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals) · How to get Medicare services (https://www.medicare.gov/basics/get-started-with-medicare/using-medicare/how-to-get-medicare-services)