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?
Answered by 73 licensed agents
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.
Yes, open enrollment runs from January 1 to March 31, providing you with a one-time opportunity to switch to another Medicare Advantage (MA) plan. The agent reviewing your plan should have confirmed whether your PCP or medical group is included in the MA network. It's crucial to fully understand how any changes to your MA plan might impact your drug coverage.
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.
Yes but plans can add or Drop doctors at any time during the year, in aome cases you will have an sep to change plans, One of the new proposals is that if a provider leaves a plan it will give you an Sep to change plans
You're right to feel frustrated, this is a common misunderstanding about Medicare’s Annual Enrollment Period (AEP) and Open Enrollment Period (OEP). First, it is important to know which enrollment period we're discussing. During AEP (Oct 15–Dec 7), you can change your Medicare Advantage or Part D drug plan. However many plans change on December 31st so a provider that was in the plan when you enrolled may no longer be in the plan on January 1st. This is when the Open Enrollment Period OEP (Jan 1 - March 31st), is in effect. If you made a change to your Advantage plan during AEP, you get a chance to change again during the OEP. This is when you can find a new plan that your provider does accept. Keep in mind that after March 31st, there are no more chances to change due to network issues. The only way to change after the OEP is to use a Special Enrollment Period (SEP) which depends on individual circumstances and is a whole other topic.
Well it would seem to me that you went from Original Medicare coverage to a Medicare Advantage plan, of which your specialist doesn’t accept! This is MA in action!!!
MA is front loaded on savings, but will cost you in the end mostly. But because Medical professionals are paid later and less with MA plans, many, and especially your best practitioners would prefer not to accept it.
If you want to have acceptance anywhere, with your choice of Doctors, facilities, and Specialty hospitals, you keep original Medicare and add a supplement if desires(which also makes sense)!
There is a one time change available to current Medicare Advantage customers between January 1- March 31 where you can make a one-time change in this instance. Additionally, there may be other special election periods you qualify for. Contact your local agent for help.
As a matter of fact yes, that is what the enrollment period is all about to make sure if you move or change plans that you keep your doctors if you want to. Very sorry to hear that there are agents out there who seem to care more about a puny commission than ensuring that their client is in the best most beneficial plan.
That’s definitely frustrating, and you’re not alone — a lot of people assume Open Enrollment is meant to prevent exactly this kind of issue. The truth is, while the Open Enrollment period (Oct 15 – Dec 7) is designed to give you a chance to review and change your coverage, it doesn’t automatically ensure your doctors or specialists will still be covered under a new plan.
When you switch Medicare Advantage plans (or Part D prescription plans), the network of providers can change. So even if your new plan looks good on paper, it might not include your regular specialist — especially if that doctor isn't in the plan’s network. That’s why it’s really important to double-check the provider list and drug formulary before making any changes.
Here’s what might have happened:
Your new plan may have a different network, and your specialist isn’t part of it.
Some plans also require referrals or prior authorizations that your previous plan didn’t.
What you can do now:
If you're in a Medicare Advantage plan, there's another enrollment period from January 1 to March 31 where you can make a one-time switch to a different Medicare Advantage plan or go back to Original Medicare.
Depending on your circumstances, you might qualify for a Special Enrollment Period — like if you were given incorrect info or recently moved.
Going forward: Always check whether your doctors and prescriptions are covered by a new plan before you switch. It’s not always easy to compare everything, but it can save you a lot of headaches later.
Absolutely, it's meant to do that. However, if you didn't confirm your doctor will take the plan next year than that's a problem. Aside from the review, sometimes doctors can decide to stop taking a plan but they must give you notice.
Because plans are subject to change every year, this period is available so you can evaluate any changes in your current plan and network. You do need to make sure you review all providers to make sure any new plan will cover them. The plan benefits and costs should also be reviewed. Having a good agent you trust should avoid these situations where you end up in a plan that doesn't quite work the way you expected. However, agents are only human and therefore subject to making mistakes. Thankfully, there is a Medicare Advantage Open Enrollment Period that runs from January 1st - March 31st each year. During that period, you can make ONE change to a different plan. Essentially, this allows for any of these "mistakes" to be corrected without making you wait until the following year.
Yes and no, but the agent who enrolled you should of checked to make sure all your Doctors and prescriptions were accepted by the plan. You can change up to dec15th of open enrollment and you will also have opportunities to change again, just once. From 1/1 to 3-31 of the following year after AEP
During Annual Open Enrollment from October 15th to December 7th you can change your Advantage plan. If you are working with a broker, I would suggest reaching out to them to confirm if your specialist is in the network. Short answer is yes, this should have been discussed and reviewed with your broker during Annual Open Enrollment.
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.
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.
DOCTORS CAN DECIDE NOT to accept a Medicare Advantage plan that they previously accepted. Work with a independent trusted Medicare advisor/broker when doing your reviews.
Because of this issue, CMS created the Open Enrollment Period (Jan 1 - Mar 31) where you can once again make a change to your Medicare Advantage plan.
If you made your initial change during the Open Enrollment Period then you will need to wait until end of the year during the AEP (Annual Election Period) to make a change for the following year.
If you changed your plan during the Annual Election period which runs from October 15 to December 7 each year and have a Medicare Advantage plan, you also have an Open Enrollment period that runs from January 1 to March 31 to make a one time change to your Medicare Advantage plan. You can either switch to a different Medicare Advantage plan or drop your Medicare Advantage plan and return to Original Medicare and choose a Stand Alone Drug plan (Part D). If you changed your plan in the Open Enrollment period (January 1 to March 31) and the plan you switched to has not taken effect, you may be able to contact the carrier and withdraw the application. This will allow you to then use your Open Enrollment opportunity to switch to a plan that accepts your specialist.
Yes. I always recommend that people work with an agent when doing their reviews. An agent will check all of your doctors and medications and make sure that you are in the plan that best suits your needs.
Personally, I never recommend plans focused on ancillary benefits. I always make sure that my clilent's doctors and medications are covered.
Yes, that is something your agent should check before changing your plan. Sometimes, things do fall through the cracks and mistakes are made. Contact your agent to see if there is another SEP that can be used to change your plan again or if the mistake is caught in time, the application can be withdrawn.
Unfortunately, when you make a change during open enrollment, also known as OEP, you get to make one change if you’re on a Medicare Advantage plan. If you were on a Medicare supplement plan that changed during your birthday month, your agent that you’re working with should educate you on how you obtain the correct information and know what you need to do when you need to do it.
The industry is constantly changing, so your agent must stay up-to-date on all other happenings in this specific industry.
Yes, as agents, we do our best to check any and all medical professionals and facilities to ensure they are in network. However, the databases are updated frequently due to changes, which may cause such issues. I always recommend a verification be made by contacting the provider and to ask if they accept the specific plan chosen. Often times, people ask if they accept a particular carrier, but they may not cover all plans. If this situation arises, and is caught in time, you can switch to a different medicare advantage plan during the open enrollment periods of January 1st through March 31st or wait until October 15th through December 7th. The option to move to a five star medicare advantage plan is also an option during the year.
During the open enrollment period your agent should view all your Doctor and Medications
to make sure they are still working with your Medicare advantage plan. Unfortunately, at any time during the year the Doctor can choose to leave the plan. They are not required to finish out the year.
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
The open enrollment period is to give a chance to change plans for any reason your are happy with the plan you have if that be network issues or just find another plan that suits your needs better.
Yes. SO unfortunately if that agent did not take you through the whole process, that can happen. You can change now, during the AEP , or OEP. And always ask for them to look up your doctors.
Yes, but only if you’ve done your due diligence and checked to make sure that every doctor that you want to see is included in the plans network. If you work with an agent, the agent should help you to do that, but the agent can only help you by looking up doctors that you ask them to look up. If you do not tell them that you need a specific doctor, they cannot provide information about whether or not that practice participates in the plan that you are choosing. even with a highly experienced, licensed Medicare insurance agent, you are working in a partnership to get the best available plan that will meet your needs.
Additional details are necessary to fully understand the particular issue at hand. Did you first verify that the specialist you want to see is "in network" with the plan you switched to? More details needed. Sorry to not be able to answer your concern.
You may change from one "like" Medicare Advantage Plan plan to a "like" Medicare Advantage plan one time from January 1st until March 31st. There may be other special enrollment opportunities for you if you have a chronic condition like Heart problems or diabetes.
It sounds like the agent you were working with was not aware of your specialist network. It's important to mention all your physicians and prescriptions during the Open Enrollment review so you are recommended to the plan that best meets your needs. You still are able to make changes until December 7th.
Yes, you are correct. Before choosing a plan your agent should check to make sure all of your doctors take the plan and that all of your medications are covered. If you are not happy with your plan you have the Oct 15th - Dec 7th to pick a plan for the following year. If you have a Medicare Advantage plan you also have Jan 1st - March 31st to change to another Advantage plan.
Before you ever change your plan, make sure the agent checks to see if all your providers accept the new plan. This is a very common mistake that beneficiaries make in switching plans.
While the Open Enrollment Period is designed for you to review coverage options, it does not automatically guarantee that your previous doctors will be included in the new plan's network. It's important to verify provider networks before finalizing a plan change. You may have a special enrollment available, depending on your situation if you need to make a plan change.
It's understandable that you're frustrated after changing your plan during Open Enrollment and now finding that your specialist is out-of-network.
While Open Enrollment allows you to choose or change your plan, it doesn't guarantee that your preferred doctors or specialists will be in-network with every available plan.
Here's a breakdown of why this can happen:
1. Network Changes:
Insurance plans have networks of doctors and hospitals they contract with.
These networks can change from year to year, meaning a doctor who was in-network last year might not be this year, or vice versa.
Even if a plan has the same name as last year, its network might have changed.
2. Plan Choices:
During Open Enrollment, you have the opportunity to review different plans with varying networks and coverage options.
Choosing a plan with a different network than your previous one might mean that your specialist is no longer considered "in-network".
3. The Purpose of Open Enrollment:
Open Enrollment is designed to allow you to evaluate and choose a plan that best fits your needs and budget, but it requires you to research and compare options carefully.
It's a time to consider your overall healthcare needs and preferences, including whether having a specific doctor in-network is a priority for you.
What can you do?
Contact your insurance company: Confirm if your specialist is in-network or out-of-network with your current plan and understand the cost differences.
Look for a new in-network specialist: You may need to find a new specialist who is part of your plan's network.
Consider a plan change during the next Open Enrollment: Evaluate plans based on your healthcare needs and provider networks before making a decision for the following year.
In some cases, you might be able to request an exception to see your specialist if they are out-of-network but provide unique care.
If you can't see your special, it's because you purchased Sarah went on a $0 premium Medicare advantage plan. Anytime you change plans that are Medicare advantage plans, you need to verify that your providers are in network. Do not assume they are not
If you purchase a Medicare supplement plan, then you don't have to worry about that because Medicare supplement plans to work with anyone who takes Medicare. Therefore, they cannot tell you that they're not taking your plan because you're out of network. There is no such thing
This is why I recommend Medicare supplement plans if you can afford them
You are correct. And that was the job of the agent who changed your plan to check on each of your Dr's to see if they took your new plan. Did you use a prior agent who knew you? Or did you call a telephone number from a TV ad? Regardless, you cannot change your plan now. You must wait until the Annual Enrollment Period (AEP) from Oct 15 to Dec 7, to change your plan, with an effective date of Jan 1st, 2026.
Sometimes, agents will switch you to benefit themselves, so you need to make sure that if you switch, it will benefit YOU to. Open enrollment is usually the last time before the Annual enrollment period that you will be able to change plans unless you move or have a special election period. Make sure everything is right for you when you switch and you aren't switching just to get some benefits like some extra dental or vision if you need to see a specialist.
Your agent should have checked that for you. Why did you change? What type of plan do you have now. You can’t change until open enrollment again this year.
Yes, open enrollment is the time to review changes with your current plan and allows you to look at other options. If you work with an agent, they should be reviewing your doctors, preferred facilities, and prescriptions to ensure that you have proper coverage within your plan.
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.
If you moved from a medigap plan to a medicare advantage (MAPD) for the FIRST TIME, you have a trial right to go back to your Medigap plan within the first 12 months, guaranteed issue. Often this is why a doctor would have been covered previously and not now since Medigap is accepted by all providers who accept Medicare, but MAPDs use specific provider networks. If you’ve had a MAPD previously, the trial right does not apply.
Since you mention Open Enrollment (OEP - which is January 1 - March 31) it sounds like you moved from one MAPD to another and your doctor isn’t in the new plan’s network. OEP is designed to address this situation, as many people make changes in Annual Enrollment (AEP) the previous fall, and once that plan goes into effect in the new year they find out they’re not happy with it. OEP gives them a do-over to either pick a new, different MA plan or go back to the old plan. If you made a change during OEP, in general, once the new plan goes into effect you’re in that plan until AEP in the fall. At that point you can switch to a plan your doctor DOES accept. This change would go into effect on January 1st next year.
You MAY qualify for other special election periods (SEP), so consulting a broker would be a good thing to do since they will know how to check eligibility for any SEPs. However, unfortunately, you most likely are in this plan through the end of the year.
Unfortunately, providers have a right to continue to participate or choose to no longer participate with carrier networks. If the Agent that assisted you during Open Enrollment checked your current physicians against the plan of your choice and the physician's name was listed then their participation changed. To rectify the situation you can contact the carrier and to ask if there is another specialist that you can see or ask the carrier to help rectify your issue.
Yes. It's very important to make sure your agent,if you have one, know if your specialist is in-network before you enroll into the plan. If they didn't, it's a disservice to you.
It sounds like either the agent who enrolled you didn't verify that your doctor was in network or your doctor possibly could have fallen out-of-network. Unfortunately, you're probably not going to be able to change your plan snce OEP allows only one change and whatever plan you're in on April 1st you're typically in the remainder of the year, unless you have some other type of exception, called a special enrollment period.
A conscious licensed agent should put your interests first and make sure that your health care preferred providers are in the plan's network. Sometimes happens that your preferred Doctor is in the Network when you apply for the plan, but then he/she leaves the Network during the year, and this is out of the carrier's control. For most plans, you can continue seeing your preferred specialist out-of-network for a higher co-pay.
The Agent/Broker or Telesales Agent that assited you should have reviewed your list of regular Specialists and made sure all of your physicians were in your Insurance Carrier's Network.
You have until the end of the Open Enrollment Period which is March 31st of each year to chose either to keep the new plan you're in and find new Specialists that are in Network, or return to the plan you had or a new plan that all of your Specialists are in Network.
No. Open Enrollment allows you to, after reviewing your ANOC letter back in September( Annual Notice Of Changes), perform your due dilligence and check your providers and medications in the proposed plan you are considering changing to for an effective date of 01/01/2026 , in this case.
Keep in mind that you can select a new Medicare Advantage plan that does include your primary before December 7th, and this process will automatically disenroll you from the one you selected previously.
It is meant to prevent those types of issues, especially with providers and drug formulary changes. I would recommend using a licensed agent that's knowledgeable in the field. They can check the providers carrier directories as well, but keep in mind that contract and provider negiotiations happen all the time. It's not always preventable.
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.
Changing your plan during Open Enrollment allows for adjustments in coverage, but it's crucial to verify that your preferred providers are within the new plan's network. The review period is indeed meant to prevent such issues, emphasizing the importance of thorough plan comparison and network checks before making a change.
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.
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.
Your agent or whoever helped you with the enrollment had an opportunity to list your doctors and medications to see if all are covered. I do that with everyone that I help. That helps you to make an informed decision.
I will best answer this based upon what information is in the question. If you changed to another medicare advantage plan during AEP and you found out after that you can’t see your specialist—out of network I’m guessing, then you can always change an MA Plan during the Medicare Advantage Open Enrollment period of January 1st - March 31st. But if that timeline has passed then you can see if you qualify for a SEP (Special Enrollment period) so that you can change your plan. This SEP would be based upon that you received inaccurate information. You can call 1-800-Medicare to explain your situation and ask about a SEP.
The agent that you spoke with should have checked the network of your specialist and if they did not or the network of The specialist changed prior to the new year, then that is out of the agents hands
Yes it should have. I’m not sure if you did this over the phone or not. You can do something about it. If this specialist is one that you rely on and is instrumental in your health, you can ask your carrier for an exception. Or you can ask your doctor to contract with your carrier. Usually the latter is the easiest way.
You need to speak to a local agent to see if there are any special enrollment periods you can utilize to switch to something else. You can also contact CMS directly.
First I want to acknowledge how frustrating that can be. I'm not sure if you changed your plan on your own or with an agent, but it is the agent/brokers job to let you know if your specialist is in network or not.
If you changed plans during Open Enrollment Jan-Mar, then you are not able to change plans again unless you have what is called a valid election period which would be if you loss employer coverage, lost or gained Medicaid or LIS, or moved out of the county, to name just a few.
If this change was done during Annual Enrollment Period then you are able to change your Medicare advantage plan 1 time during Jan-Mar.
I recommend calling your insurance company to see if they can do anything for you especially if you are receiving ongoing treatment from your specialist. I would also call the specialist to see if they can offer any kind of discount/aid if you have to pay out of pocket.
Last option could be to call CMS/Medicare and let them know the situation to see if they are able to change your plan back to your previous one.
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.
For Medicare, it is called Annual Election Period, which begins on 10/15 and end on 12/7. During this period, one can enroll many plans and only the last one will be effectuated. The new plan will be effective on 1/1.
Medicare Open enrollment is from 1/1 to 3/1 for those who enroll in a Medicare advantage plan. They will have one time chance to switch to the new plan. Once used, it will become unavailable. This is for someone who switch to a new Medicare Advantage plan during the Annual Election Period to see if it works for them and provide them a chance to amend.
Medicare makes changes starting the 1st of January every year. If you have an agent, they would be reaching out to you to discuss your options and make the necessary changes to see if your doctors will be in network,or find a plan where you can still see your doctors if you didn't want new ones. I would be glad to assist you in looking at all your options.
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.
The annual enrollment period is your opportunity to review your plan and see if it still meets your needs, as well as confirm that your providers are in-network, and medications are on the formulary. Providers can cancel their contracts at any point during the year, so it is very important to confirm both on your chosen plan's online provider directory, as well as with the provider's office, that they are in the network for the plan you are choosing. Using a local agent is also a good way to help ensure that these items are reviewed fully with you.
It absolutely was supposed to be a review of your plan and comparing the other plans to them. Unfortunately for us agents we don't get a memo that says after open enrollment ends the doctors choose to cancel certain carriers for their new year which happens often. You do have the option to call and cancel that plan and stay on the one that you are just call the Carrier to do so or call the agent that assisted you and they can help do that with you on the phone. If there is another plan that you would prefer that would offer to cover your primary care doctor and specialists, then you could enroll in a new plan in January and it would start on February 1st. Hope this helps!
There are two enrollment periods to change plans Annual Enrollment Oct 15-Dec 7th and Open Enrollment Jan1-Mar 31 (this is a little more limited to what changes you can make but you can change from one Advantage to another Advantage Plan, in this time period) You said you can't see your regular specialist. I'm not sure what you mean by your regular specialist? Do you mean your primary or are you referring to a specialist you have been seeing for some time? Several things can happen: When you changed plans did you or an agent check the network to see if your Dr was in the new plan you were changing to? Advantage Plans have networks and Drs have to contract to be in them. Or, was your Dr in the network and now has left? If that is the case there really is no way to foresee that happening when you got on to the plan. The Annual Enrollment will be happening soon, so that will be your opportunity to look again.
First of all, I know how frustrating it can be to find out that a specialist isn't a part of your new plan. However, there might be a few things that you might want to try to see if you can still see them.
First, try contacting your provider to see if there are any exceptions or if they can offer any alternatives for seeing your specialist. Also, call your specialist office to see if they would accept an out-of-network rate. Some providers may allow you to visit at a higher cost. The last thing you can do is call your agent to see if they have any access to Medicare advantage plans or Supplement plans that may have your specialist in their network.
Learn from this mistake in the next open enrollment period and make sure that all of your doctors and specialist are covered before signing up.
The annual review process helps to compare, but it can't prevent or predict every network tweak afterwards. Provider network directories aren't always 100% up to date and contracts can change any time of year. Plans often give some protections, like a short transition period for ongoing care if your qualify so you aren't cut off mid treatment. Carriers and provider groups will also mail out notifications directly to patients and members notifying of network disruptions.
