Navigating out-of-network Medicare Advantage and out-of-network Medicaid plans
What you need to know about out-of-network coverage
Not all Medicare Advantage and Medicaid plans are in-network with VCU Health, which affects the type of care you can receive at VCU Health.
Effective October 19, 2026, VCU Health will no longer schedule elective care appointments for patients with an out-of-network Medicare Advantage or an out-of-network Medicaid plan. Out-of-network Medicaid plans include:
- Out of state Medicaid plans
- Kaiser Medicaid Plan (except for contracted kidney transplant services)
VCU Health accepts all Medicare Supplemental Plans and participates with the five Virginia Medicaid Managed Care organizations, so if you are in one of these networks, you don't need to worry about extra out-of-network costs.
Use the links below for more information about which Medicare Advantage and Medicaid plans are in-network at each of our hospitals.
VCU Health will continue to provide emergency evaluation and treatment to anyone seeking care in our emergency departments, regardless of insurance coverage, network status, or ability to pay.
If you have questions about an upcoming appointment, call the VCU Health Patient Appointment Center at 800-762-6161.
Get more information about your plan
Out-of-network plans affect all our locations, services, and providers. If you are a Transplant or Behavioral Health patient, you may need to call your insurance provider to confirm coverage.
If you have general billing questions, call VCU Health Customer Service at 888-803-0082.
If your plan is out-of-network and you want to know your options, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
You can also call the Virginia Insurance Counseling and Assistance Program (VICAP) and talk to a trained volunteer at 1-800-552-3402.
During the Annual Enrollment Period between October 15 and December 7, you can switch to another Medicare Advantage plan. If you change your plan during this period, your new plan will start on January 1 of the following year.
During the Medicare Advantage Open Enrollment Period from January 1 to March 31, patients enrolled in a Medicare Advantage plan can switch from one Medicare Advantage plan to another or switch back to traditional Medicare. The start date of your new plan will depend on when you complete the enrollment process.
You may be able to sign up for a new plan during a special enrollment period. These special enrollment periods are evaluated on a case-by-case basis, such as if you have a major life change or if your plan changes its Medicare contract.
Frequently asked questions
Q: I have a Medicare Advantage or Medicaid plan that is out-of-network with VCU Health. What options are available so that I can continue to see my VCU Health provider?
A: There are several options available to patients, including:
- For Medicare Advantage patients: You can switch to another Medicare Advantage plan or return to traditional Medicare during the Annual Enrollment Period, which takes place annually between October 15 and December 7. New plans do not take effect until January 1 of the following year.
- Medicare Advantage also has an Open Enrollment Period from January 1 to March 31. During this time, patients enrolled in a Medicare Advantage plan can switch to another Medicare Advantage plan or switch back to traditional Medicare. Your new plan's start date depends on when you complete the enrollment process.
- Virginia Medicaid HMO patients can consider switching to another Medicaid HMO during Open Enrollment, which runs April 19-June 30 (for residents in Central Virginia).
- Continuity-of-care exception: In certain circumstances, existing patients may be able to secure an exception to continue care with VCU Health. Contact your insurance company to determine if you qualify for "Continuity of Care."
- Single case agreement: In certain circumstances, new patients may be able to secure an exception to access care at VCU Health. These exceptions are limited and condition based. Contact your insurance company for more information.
Q: I’m interested in switching to a Medicare Advantage or Medicaid insurance plan that is in-network with VCU Health during an open enrollment period. How can I find out which plans are in network?
A: To view a list of in-network plans, select a location below:
Q: I have a Medicare Advantage or Medicaid insurance plan that is out-of-network with VCU Health and I can’t / won’t change plans. Will my appointment be canceled?
A: No. We will honor existing scheduled appointments made on or before October 19, 2026. However, our team will work with you at your last scheduled appointment to transition care to another provider if you maintain out-of-network coverage.
Q: Can I schedule an appointment if I have a PPO plan with out-of-network benefits that match in-network benefits?
A: No. We do not schedule appointments for PPO plan members to protect them from unpredictable financial burdens and help ensure the long-term sustainability of the health system. As a not-for-profit health system, we rely on sustainable contracts with health insurance companies to deliver on our multiple missions.
Q: I have an out-of-network primary insurance plan through my employer or the insurance marketplace. Can I schedule an appointment?
A: Yes, we will continue to schedule appointments for elective patients with commercial out-of-network plans. Commercial insurance plans operate under different legal and billing frameworks than Medicare Advantage or Medicaid HMO insurance plans.
Q: Which VCU Health locations and providers does this apply to?
A: This applies to all VCU Health locations and providers; including all VCU Health hospitals, providers, therapy services, doctors’ offices, clinics, labs, clinicians, physicians, nurse practitioners, physical and occupational therapists, and behavioral health providers.
Q: Who can I call with other questions?
A: Help is available:
- If you have questions about an upcoming appointment, please call VCU Health Patient Appointment Center: 800-762-6161
- If you have general billing questions, please call VCU Health Customer Service: 888-803-0082
For questions about your insurance plan and coverage, please call the member services phone number listed on your insurance card.