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. 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: 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.
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For Medicare Advantage plans, there are certain situations where you might qualify for a special enrollment period, such as if you’re notified that there’s a significant change in your plan’s provider network. These special enrollment periods are evaluated on a case-by-case basis.
To discuss your options, call 1-800-MEDICARE 1-800-633-4227) (TTY:1-877-486-2048)
You can also contact the Virginia Insurance Counseling and Assistance Program (VICAP) at 1-800-552-3402. Trained volunteers can assist you with questions.
- 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. Our team will work with you at your last scheduled appointment to transition care to another provider if you maintain out-of-network coverage. In the unlikely event that one of these existing scheduled appointments needs to be cancelled because of provider availability we may not be able to reschedule to a new date, so we strongly encourage patients to review available plans during Medicare Open Enrollment to maintain care continuity.
Q: I have a United Healthcare or Anthem commercial plan, Virginia’s Insurance Marketplace exchange plan or Medicaid plan. Does this impact my access to VCU Health?
A: No, VCU Health remains fully participating with United Healthcare and Anthem commercial plans, Virginia’s Insurance Marketplace exchange plans and Medicaid plans.
Q: I have a United or Anthem Medicare Supplemental Plan, what does that mean for me?
A: VCU Health continues to participate with all Medicare Supplemental Plans, so the change in VCU Health’s participation with United Healthcare Medicare Advantage and Anthem Medicare Advantage will have no impact on your coverage or benefits through your Medicare Supplement plan.
Q: I have a VA Community Care Network plan (Veterans Affairs), and it is administered by United Healthcare. Does this impact my access to VCU Health?
A: No, VCU Health remains fully participating with VA Community Care Network.
Q: Which VCU Health locations and providers are affected by VCU Health going out of network with the impacted United Healthcare Medicare Advantage and Anthem Medicare Advantage plans?
A: All VCU Health locations and providers are affected by this change in network status. This includes all VCU Health hospitals, providers, therapy services, doctors’ offices, clinics, labs, clinicians, physicians, nurse practitioners, physical and occupational therapists, and behavioral health providers.
Q: What do I need to do if I obtain a new Medicare Advantage plan that is in network with VCU Health?
A: If you switch to a new plan, you should contact the VCU Health Patient Appointment Center as soon as possible to provide your new insurance information.
- VCU Health Patient Appointment Center: 800-762-6161
Q: If I want to keep my current out of network Medicare Advantage coverage, what do I do?
A: Patients should contact their insurance company to identify a list of in-network providers and begin transferring care to a new provider.
Q: What if I have an impacted Anthem Medicare Advantage plan and I’m a current patient in the middle of receiving ongoing complex care like chemotherapy treatments when VCU Health becomes out of network with Anthem on January 1, 2027? Can I continue to receive care at VCU Health?
A: Anthem Medicare Advantage members currently receiving treatment might qualify for a “Continuity of Care” exception that will allow you to temporarily maintain in-network benefits (after January 1, 2027) through the completion of your treatment course but no longer than 90 days. Patients are responsible for submitting the Continuity of Care request to Anthem, and Anthem must approve any requests. Patients need to contact Anthem to find out how to qualify for a Continuity of Care exception by calling the member services phone number listed on their insurance card.
Q: I am an out of network Medicare Advantage transplant patient at VCU Health . Does this mean I can no longer receive care from my transplant provider?
A: There may be options for impacted out of network patients to receive transplant services at VCU.
Please contact your VCU Health transplant financial coordinator or insurance company for additional details or if you have any questions.
Q: Can I schedule an appointment if I have a Medicare Advantage PPO plan with out-of-network benefits that match in-network benefits?
A: No. We do not schedule appointments for Medicare Advantage 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: 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.