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.

Gary Church · Answer

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.

Answered by Gary Church on May 31, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Jennifer McDonnell · Answer

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.

Robert Moore · Answer

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.

Answered by Robert Moore on May 28, 2025

Broker Licensed in IN, AL, IL & 11 other states

Answered by Robert Moore Medicare Insurance Agent

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

Hope Suhr · Answer

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.

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

Steven Lovell · Answer

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.

Answered by Steven Lovell on May 27, 2025

Broker Licensed in GA, CA, FL & 7 other states

Answered by Steven Lovell Medicare Insurance Agent

Steve Houchens · Answer

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.

Alicia Hoilman · Answer

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.

Answered by Alicia Hoilman on June 11, 2025

Broker Licensed in VA, DE, FL & MD

Answered by Alicia Hoilman Medicare Insurance Agent

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.

Fred Manas · Answer

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.

Gary Henderson · Answer

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

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

Andrew Kramer · Answer

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.

Answered by Andrew Kramer on May 23, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Mike Henry · Answer

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.

Sam Silva · Answer

Agents may push Medicare Advantage plans due to higher commissions. Always compare both options to see which best fits your needs.

Todd Bostic · Answer

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.

Answered by Todd Bostic on June 2, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic 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.

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

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.

Andre Cabral · Answer

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.

Answered by Andre Cabral on June 20, 2025

Agent Licensed in NJ

Answered by Andre Cabral Medicare Insurance Agent

William Scott · Answer

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.

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

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

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

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

Broker Licensed in OH & PA

Answered by Sophia Davis Medicare Insurance Agent

Charles Mai · Answer

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.

Kimberly Griego · Answer

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.

Answered by Kimberly Griego on June 10, 2025

Agent Licensed in WA, AZ, CA & 5 other states

Answered by Kimberly Griego Medicare Insurance Agent

Joshua Price · Answer

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.

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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