What is transition of care and why is it important when a member changes plans?

• A. Coordinating care and medications during a plan transition to avoid gaps in treatment.
• B. Rescheduling all doctor visits to the end of the year.
• C. Ending all medications when switching plans.
• D. Reassessing eligibility for benefits during transition.

Answer: (A)

Transition of care means coordinating a member’s medical care and medications when they move from one plan to another, so there are no gaps in treatment. When plans change, details like provider networks, formularies, and authorization requirements can shift, and critical information may not transfer automatically. By actively managing the handoff—sharing current diagnoses and treatment plans, reconciling medications, arranging timely follow-ups, and ensuring any necessary authorizations carry over—the member can continue their therapy safely and without interruption. This focus on continuity helps prevent gaps in treatment, reduces the risk of adverse events or hospitalizations, and supports a smooth transition between plans.

Rescheduling all doctor visits to the end of the year, ending all medications, or focusing mainly on eligibility during the transition don’t address the core need: keeping care and medications continuous during the plan change.