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Continuity of Care

If Your Doctor, Medical Group, or Hospital Leaves Your Health Plan

You may receive a notice that your doctor or hospital is no longer in your health plan.

Usually this means that you must change doctors or hospitals. But in some cases you may be able to keep your doctor or hospital for a limited time. This is called "continuity of care."

In order to receive continuity of care, you must call your health plan to ask for continuity of care. Also, your doctor or hospital must agree to keep you as a patient.

Only people with certain kinds of health problems or conditions can get continuity of care:

Type of Problem or Condition How long you get continuity of care
Acute Condition (for example, pneumonia) As long as the condition lasts
Serious Chronic Condition (for example, severe diabetes or heart disease) No more than 12 months. Usually until you complete a period of treatment and your doctor can safely transfer your care to another doctor
Pregnancy During Pregnancy and immediately after the delivery (the post-partum period)
Terminal Illness As long as the person lives
Care of a Child under 3 years For up to 12 months
An already scheduled surgery or other procedure (for example, knee surgery or colonoscopy) The surgery or procedure must be scheduled to happen within 180 days of your doctor or hospital leaving your health plan

Check with your health plan to find out if you qualify for continuity of care. You will need to provide the name of your doctor or hospital, your medical condition, and the treatments you are receiving.

You can ask for a copy your health plan's policy on continuity of care at any time. If you have any problems asking for continuity of care or have any questions please contact the Help Center at 1-888-466-2219.

If Your Health Plan Changes and You Lose Your Doctor or Hospital

You may also qualify for continuity of care if your health plan changes and you are required to switch to a new plan. This is called "new enrollee" continuity of care. The rules are the same as the rules described above.