Continuity of Care: Why Staying With Your Provider Matters

If you’re thinking about switching your Medicare Advantage (MA) plan this Annual Enrollment Period (AEP), you’re not alone. And you’re probably wondering the same thing many of our patients ask every fall: will I have to find a new provider?

The good news is that switching Medicare Advantage plans doesn’t automatically mean switching providers. In many cases, you can choose a new plan and keep the same care team you already know and trust. This is often called continuity of care, and it’s worth understanding before AEP ends on December 7.

What “Continuity of Care” Really Means

Continuity of care simply means seeing the same provider or care team over time, instead of starting over with someone new every year.

When your care team stays the same, they already know your health history, your medications, and your goals. You don’t have to re-explain everything from scratch at every visit.

Why It Matters More As We Get Older

Continuity of care becomes more valuable as we get older, especially for anyone managing an ongoing health condition. Here’s why:

• Chronic condition management. A provider who already knows your history can spot small changes sooner.
• Medication safety. Your care team already knows what you take and why, which lowers the risk of dangerous interactions.
• Fewer repeated tests. You avoid redoing tests or re-explaining your history to someone new.
• Trust built over time. A relationship with your provider, built over years, is hard to replace.

Can You Switch Medicare Advantage Plans Without Switching providers?

Often, yes.

Whether you can keep your provider depends mainly on whether your provider is in-network with your new plan. Medicare Advantage plans generally use one of two network types:

• HMO (Health Maintenance Organization). You typically must use providers in the plan’s network, and you may need a referral to see a specialist.
• PPO (Preferred Provider Organization). You have more flexibility to see providers outside the network, usually at a higher cost.

If your new plan includes Palm Primary Care in its network, you can generally continue seeing the same provider without interruption.

If you’re switching back to Original Medicare instead of a new Medicare Advantage plan, network rules work differently. Original Medicare lets you see any provider who accepts Medicare, so continuing care with Palm Primary Care is generally straightforward.

There’s also a federal protection worth knowing about. Under CMS rules (42 CFR § 422.112(b)(8)), Medicare Advantage plans must generally provide a 90-day transition period for new members with a pre-existing or ongoing condition who are in the middle of an active course of treatment when they switch plans. During that window, the new plan generally can’t require prior authorization for that ongoing treatment, even if your provider isn’t yet in-network. That gives you time to either continue with your current provider or move smoothly to a new one.

How to Check Before You Switch

Before you make any changes during AEP, it’s worth taking a few minutes to check:

• Confirm we’re in-network. See our list of accepted Medicare Advantage plans to check whether your current plan, or one you’re considering, includes Palm Primary Care.
• Call our office if you’re unsure. Our team can help confirm your specific plan and location.
• Review your Annual Notice of Change. If you already have a plan, your insurer’s yearly notice will spell out any network changes for the coming year.
• Work through our Medicare Annual Enrollment Checklist for the rest of your AEP to-dos, including drug costs and specialist referrals.

If You Do Need to Change Providers

Sometimes a new plan’s network doesn’t include your current provider, and that’s okay. If that happens, your care doesn’t have to fall through the cracks.

Ask your current care team to help transfer your medical records to your new provider, and bring an updated medication list to your first visit so nothing gets missed in the transition.

A Note for Family Caregivers

Helping a parent or loved one with this?

You’re often the one reading the plan mail, comparing options, and asking the questions your parent might not think to ask. Two things worth doing together: pull up your parent’s Annual Notice of Change letter, and call the provider’s office directly to confirm network status for any plan you’re considering. A short phone call now can prevent a stressful surprise in January.

Frequently Asked Questions

Will switching Medicare Advantage plans affect my ongoing treatment?

Not necessarily. If you’re in the middle of an active course of treatment, federal rules generally require your new plan to provide a 90-day transition period before applying new prior authorization requirements. Ask your new plan directly how this applies to your situation.

What is the CMS continuity of care rule?

It’s a federal requirement, found at 42 CFR § 422.112(b)(8), that Medicare Advantage plans must provide at least a 90-day transition period for new members who are actively receiving treatment when they enroll, so care isn’t disrupted while they transition providers.

How do I know if Palm Primary Care is in my new plan’s network?

The easiest way is to check our accepted plans list or call our office directly. We’re happy to confirm before you make a decision.

Switching plans is a personal decision, and we’re not here to tell you which plan is right for you. But if keeping your care team is part of that decision, we’re happy to help you check. Call our office to confirm your plan, or schedule a visit to talk through your care needs before AEP ends on December 7.