How Do I Find Out If My Doctor Is On My Insurance Plan's List

How do I find out if my doctor is on my insurance plan’s list? What should I do if I thought my doctor was included, but really isn't?

If you’re not sure if your doctor participates in your insurance plan, there are few ways to find out. 

Marketplace rules require plans to publish an online directory of participating doctors on Healthcare.gov. It’s important to check those lists before you buy insurance to find out if your doctor is in the plan you want. You also can call your insurance company to check if your doctor is in the plan. Or, the information might be included in the welcome packet you got when you first enrolled.  

You might have heard about some confusion over whether the insurance plan lists online are up to date. So if you aren’t sure, call your doctor directly to find out if he or she is participating in the plan you choose. 

If your current doctor is not in your plan, you have a few options:  

  • If you decide to keep your doctor and he or she is not in your plan, you may have to pay the full cost of your medical bills.
  • You can choose another doctor within your plan. 
  • Or, even if your coverage already started and you paid your premium, the federal government recently said that you might be able to pick another plan with your doctor, as long as the plan is with the same insurance company and in the same “metal” level as the one you signed up for in the first place. (See What different kinds of insurance can I buy?) You must contact your insurance company to make the switch, and you most likely have to do this before March 31. Otherwise, you’ll have to wait until the next sign-up period in the fall. (See I haven’t signed up yet. Is it too late?)   

And if you do decide to switch, be sure to ask your doctor first which plans he or she takes.  

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