Continuity of Care

Coverage when switching health plans.

Members who are actively receiving treatment when transitioning to a new Martin’s Point Generations Advantage plan may qualify for a 90-day continuity of care transition period. This protection helps ensure members can continue an active course of treatment as they transition to their new plan.

During the 90-day transition period, the new plan cannot require prior authorization for an active course of treatment that began before the member’s enrollment in the plan.

What happens after the 90-day transition period?

Once the 90-day transition period ends, coverage for ongoing services may change. The plan may reassess medical necessity, apply applicable prior authorization requirements, and enforce out-of-network coverage limits in accordance with your annual plan benefits.

For example, if you are receiving care from an out-of-network provider, your plan may require you to transition to an in-network provider after the 90-day period. Continued services from an out-of-network provider may not be covered, depending on your plan benefits and applicable coverage requirements.

What should you do?

If you are considering enrolling in a Martin’s Point Generations Advantage plan for 2027 and currently receive ongoing care from an out-of-network provider, we encourage you to discuss your treatment plan with your provider and develop a plan to transition to an in-network provider, if needed.

Planning ahead can help you understand your coverage, minimize disruptions to your care, and prepare for a smooth transition into your new plan.