I changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?

Question

Bruce Kern · Accepted Answer

The agent should have checked all of her doctors before they switched their policy. The client should of been aware of all of the benefits the new policy afforded her.

Alondra Arce · Answer

I totally get your frustration! The Open Enrollment period is meant to help you review your plan and make sure it fits your needs, but sometimes changes like doctor networks can be tricky. If your new plan doesn't include your specialist, you can appeal the decision or look into switching plans again during the next enrollment period, or even during a Special Enrollment Period if you qualify.

Answered by Alondra Arce on May 9, 2025

Agent Licensed in CA, AL, AR & 14 other states

Answered by Alondra Arce Medicare Insurance Agent

Diana Garner · Answer

If you changed your plan on your own, there should have been a tool on the company's website to verify that your doctors were in their network.

If you worked with an agent or broker, they should have verified that all of your doctors were in the network.

It could be as simple as the doctor falling out of network after you signed up, or the company website showing the doctor in network when the doctor isn't.  I have had both of these scenarios happen to a few of my clients

Frank Adkisson · Answer

So many questions.

WHO changed your plan?  You?  Or did an agent assist?  

I'm not sure what you are referring to as a "review period."  Are you talking about the Jan/Feb/Mar enrollment window?

Without some clarification, I'm afraid I can't help more than asking more questions back.

Steve Brauer · Answer

Nice question....OK, if you're talking about a Medicare Advantage Plan and the "Open Enrollment" you're speaking of is the Annual Enrollment Period between October 15th and December 7th, then yes, you have what is actually called the "Open Enrollment Period" at the first of the year, between January 1st and the end of March. Between that time, if you want to change your Medicare Advantage Plan you can do that, but only once, during that time.

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Robert Simm · Answer

You're going to get a lot of responses that are going to be completely different from one agent to the next we will all have different answers to the same question. 

I'm assuming you gave the person that you were speaking with about your healthcare information on your specialist's. And this person said "they are in network". And off you go completing the application thinking that everything is perfect and then when you go to the doctor's office you show on the card, and unfortunately they do not accept it. 

What do you do? You can get that person on the phone to see if they can help you, you can try the insurance company to see if they can help you, or you can pick any of the five+ brokers who have answered your question. 

You have an answer faster with the 5 plus brokers then with your insurance company, and then on top of trying to get a hold of that guy that signed you up back in AEP.

Tony Hardwick · Answer

That's correct. The agent of record should have asked for that information to be sure that the options they provided to you had your primary in the network. If your plan is a PPO, you may still be able to see your PCP as long as they accept Medicare payments and accepts your carrier. The downside to that, if they're not in network you'll have a co-payment.

Answered by Tony Hardwick on April 28, 2025

Agent Licensed in GA, AZ, CA & 15 other states

Answered by Tony Hardwick Medicare Insurance Agent

Karen Ansell · Answer

The Annual Enrollment period is the time to compare plans and to make sure you get the plan that covers your doctors and medications at the best copays.

Ellen Diehl · Answer

Did you go with a dis-Advantage plan that has bells and whistles but not really good benefits? Sounds like you lured in with frees stuff and extras. Bad mistake. Sounds like the agent who sold you did not look up your providers and was only out for their own commission not what was good for you.

Answered by Ellen Diehl on April 5, 2025

Broker Licensed in GA

Answered by Ellen Diehl Medicare Insurance Agent

Larry Pereiro · Answer

Every agent is trained to review the consumer’s physician as it relates to in network coverage. This prevents this type of issue and the agent is accountable to both the carrier and CMS when this issue is encountered.

Answered by Larry Pereiro on April 28, 2025

Agent Licensed in IN

Answered by Larry Pereiro Medicare Insurance Agent

Fran Lovelace · Answer

Yes. Anytime you change a plan you should verify that all providers are in network. However, providers can opt out during the year, in which case, you would need to find a plan in the next enrollment period with them in network or change providers.

Answered by Fran Lovelace on May 4, 2025

Agent Licensed in NC, SC & VA

Answered by Fran Lovelace Medicare Insurance Agent

Sophia Davis · Answer

This is definitely part of the review process. At OIS, we always ask our clients to make sure to give us the name of ALL Doctors they are currently seeing and have previously seen. With that said, sometimes sacrificing a doctor is what is needed in order to have the best possible coverage for you for that year. Make sure to look at the bigger picture.

Answered by Sophia Davis on May 1, 2025

Agent Licensed in OH

Answered by Sophia Davis Medicare Insurance Agent

I changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?

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I changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?

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