Continuity of Care

Continuity of care is a protection that lets you keep seeing your current doctor or continue an ongoing course of treatment, even if that provider leaves your plan's network or you switch to a new plan. It's meant to prevent dangerous disruptions in care during transitions.

This protection is especially important in a few situations: if you're in the middle of treatment for a serious condition (like chemotherapy), if you're pregnant and past your first trimester, if you're in the middle of a course of institutional care (like a hospital stay), or if you have a scheduled surgery. Abruptly switching providers in these situations could harm your health.

Many states have continuity of care laws that require insurers to continue covering your current provider, at in-network cost-sharing rates, for a transitional period, typically 60 to 90 days. The specifics vary significantly by state. Some states mandate continuity of care for any active treatment plan; others limit it to specific situations like terminal illness or pregnancy.

When you switch plans, check whether your current providers are in the new plan's network. If they're not, and you're in the middle of treatment, contact the new plan immediately to request continuity of care coverage. Having your doctor document the medical necessity of continuing uninterrupted treatment strengthens your case.

At the federal level, the ACA doesn't mandate a specific continuity of care standard, but many Marketplace plans offer transitional coverage voluntarily. Always ask, and get the arrangement in writing.