Fall is when insurance changes. Your employer sends new plan options. Medicare mailers pile up. Your marketplace premium jumps and you start shopping.
Most people compare premiums and deductibles. Few check whether their doctor comes along. Then January arrives, a refill runs out, and the office says, “We’re not in network with that plan.”
This guide shows you how to keep your primary care doctor through a plan change, what to do if you can’t, and which deadlines matter for 2027 coverage in Texas.
Fall 2026 Enrollment Dates That Matter
| Coverage Type | Enrollment Window | Key Deadline |
| Medicare Annual Enrollment (Advantage and Part D) | October 15 to December 7, 2026 | Changes start January 1, 2027 |
| ACA Marketplace (HealthCare.gov in Texas) | November 1, 2026 to January 15, 2027 | Pick by December 15 for January 1 coverage |
| Medicare Advantage Open Enrollment | January 1 to March 31, 2027 | One switch allowed if you’re already in an Advantage plan |
| Employer plans | Set by your employer, often October to November | Check your HR portal |
What’s Different for 2027 in Texas
- Enhanced subsidies ended after 2025. Households above 400% of the federal poverty level no longer receive marketplace premium tax credits. Many people are re-shopping because of it.
- Insurers are leaving the marketplace. Cigna is exiting the ACA marketplace in every state where it sells individual plans, including Texas, at the end of 2026. Employer-sponsored Cigna coverage is not affected. If you have an individual Cigna marketplace plan, you must choose a new plan.
- Premiums are rising. Texas insurers proposed significant average increases for 2027, which pushes more people toward high-deductible plans.
Step 1: Ask Your Doctor’s Office Before You Pick a Plan
Insurance company directories are often out of date. Calling the office is the most reliable check.
Ask these exact questions:
- “Do you accept [insurance company] [exact plan name] on the [network name] network for 2027?”
- “Is that true for both employer and marketplace versions of the plan?”
- “Are you accepting new patients on that plan?”
- “For HMO plans, can I list you as my primary care provider?”
The same insurance company often sells several networks. A clinic can be in network for one employer plan and out of network for that company’s marketplace plan. The carrier name alone tells you very little.
Review the insurance plans we accept, then call to confirm your exact plan.
Step 2: Understand Your Plan Type
| Plan Type | Do You Pick a Primary Care Doctor? | Out-of-Network Coverage | Referrals to Specialists |
| HMO | Yes, required | None except emergencies | Usually required |
| EPO | Sometimes | None except emergencies | Often not required |
| PPO | No | Partial, at higher cost | Not required |
| POS | Yes | Partial | Usually required |
| Original Medicare | No | Any doctor who accepts Medicare | Not required |
| Medicare Advantage HMO | Yes | Limited | Usually required |
The HMO Rule That Catches People Off Guard
With an HMO, you must list a specific clinic as your primary care provider (PCP). If you visit a different clinic, the claim may be denied, even if that clinic is “in network.”
At Absolute Urgent Care, HMO members, including all Medicaid plan members, need us listed as their PCP for visits to be covered. We don’t accept out-of-state Medicaid. PPO members don’t need a PCP designation.
When you enroll, enter the clinic name and address exactly. Choose primary care in Gainesville or primary care in Providence Village, whichever you’ll actually use.
Already enrolled and listed the wrong clinic? Call your insurer’s member services. Most HMO plans let you change your PCP, often effective the first of the next month.
Step 3: Check Your Prescriptions
Your doctor being in network doesn’t help if your daily medications aren’t covered.
- Find the plan’s 2027 formulary (drug list).
- Look up each medication, its tier, and any prior authorization or step therapy rules.
- Ask for a 90-day refill in December so you have a buffer into the new plan year.
- For brand-name drugs, ask your doctor about a covered alternative before January.
Step 4: Ask About Transition Coverage If You’re Mid-Treatment
If you’re pregnant, in active treatment for a serious condition, or recovering from surgery, ask your new plan about transition of care. Many plans offer temporary coverage with your current doctors while you switch.
There’s also a federal protection that works differently. If your doctor leaves your existing plan’s network mid-year, the No Surprises Act generally allows continuing-care patients up to 90 days of in-network coverage with that doctor. This applies when the contract ends, not when you choose a new plan.
Step 5: Check Labs and Imaging
Your clinic being in network doesn’t guarantee its lab partner is too. Ask whether blood work drawn in the office is billed by the clinic or sent out. Using in-house labs at an in-network clinic usually keeps things simple.
Step 6: Use Your Current Plan Before December 31
If you’ve already met your deductible this year, schedule the care you need before your plan resets:
- Annual physical and preventive labs
- Medication refills
- Follow-ups for chronic conditions
- Any procedure you’ve been postponing
Preventive care is usually free on either plan, but follow-up visits and sick visits cost less once your deductible is met. Our guide to the benefits of regular primary care visits explains why staying on schedule saves money.
If You Can’t Keep Your Doctor
Sometimes the math doesn’t work. Your employer drops the plan, or the in-network option costs hundreds more.
Option A: Use Direct Primary Care as a Bridge
Direct Primary Care (DPC) is a monthly membership with your primary care clinic, separate from insurance. At Absolute Urgent Care, our Direct Primary Care membership starts at $99 a month for adults and includes unlimited office visits, televisits, an annual physical with blood work, and basic labs. Family members receive discounted rates. There’s no long-term contract; cancellation needs 30 days’ notice.
DPC is not insurance. Pair it with a plan that covers hospital stays, specialists, and emergencies.
A 2026 federal change makes this easier. Starting in 2026, DPC memberships up to 150amonthforindividuals(300 for families) no longer disqualify you from contributing to a Health Savings Account, and you can pay DPC fees with HSA funds. Bronze and catastrophic marketplace plans also became HSA-eligible in 2026.
| Setup | Best For |
| In-network PPO or HMO with your current clinic | People with chronic conditions who see the doctor often |
| High-deductible or bronze plan plus DPC | Healthy families wanting predictable primary care costs |
| Catastrophic plan plus DPC | Adults under 30 or those with a hardship exemption |
| Original Medicare plus Medigap | Seniors wanting the widest doctor choice |
Option B: Find a New Primary Care Doctor
Use this checklist so you don’t end up switching again next year:
| Factor | What to Check |
| Network status | Confirmed by phone for your exact 2027 plan |
| Location and hours | Close to home or work; evening and weekend options |
| Walk-in access | Same-day care without waiting weeks |
| On-site services | Labs, X-ray, minor procedures in one place |
| Ages treated | One clinic for the whole household |
| Provider training | Internal medicine, family medicine, or nurse practitioners |
Read about our clinicians on the meet our providers page. If you’re moving the whole household, family medicine keeps children and adults under one roof.
Moving Your Medical Records
- Sign a records release at your new clinic; they request records directly.
- Ask for the last 2 to 3 years of visit notes, labs, imaging reports, immunizations, and your medication list.
- Bring your current medication bottles to the first visit.
- Book that first visit before your refills run out.
North Texas Factors to Weigh
| Local Factor | Why It Matters | What to Do |
| Plans built around big DFW hospital networks | Local clinics in Cooke and north Denton counties may be left out | Confirm your local clinic is in network, not just the big hospital |
| Texas didn’t expand Medicaid | Many working adults fall into a coverage gap | Look at marketplace plans and DPC |
| Long drives to specialists | Referral rules on HMOs add trips | Weigh PPO flexibility if you see specialists often |
| Walk-in care needs | Kids’ fevers and injuries don’t wait | Check urgent care copays, not just primary care |
If You Have a Gap in Coverage
Between jobs or waiting for a plan to start? You can still get care. Our walk-in urgent care in Providence and Gainesville clinics can quote self-pay pricing upfront.
Frequently Asked Questions
How do I know if my doctor is in network for 2027?
Call the office and give your exact plan and network name. Then confirm with your insurer’s member services.
Can I keep my doctor if I switch to Medicare Advantage?
Only if your doctor is in that specific plan’s network. Original Medicare lets you see any doctor who accepts Medicare.
My Cigna marketplace plan is ending. What should I do?
Choose a new marketplace plan by December 15, 2026 for January 1 coverage. Check that your doctor is in network before you enroll.
Is Direct Primary Care the same as insurance?
No. DPC covers primary care services only. Keep a plan for hospital, specialist, and emergency costs.
Make One Phone Call Before You Enroll
Five minutes on the phone now can save you a denied claim in January. Contact our front desk with your exact 2027 plan name: Gainesville at 940-301-5000 or Providence Village at 940-686-7500. We’ll tell you whether we’re in network, and if we’re not, we’ll walk you through your DPC options.
