MHI – Q: Can I change my Medicare Advantage plan if my doctor is dropped from the network outside the Open

Posted by MedEd at MHI
A: Possibly, but not likely. Medicare Advantage plans can change their networks during the plan year. In most instances, this will not provide an opportunity for you to switch plans outside the October 15 – December 7 Open Enrollment Period.
In rare instances, the Centers for Medicare and Medicaid Services (CMS) will grant a three-month Special Enrollment Period (SEP) for members to switch Medicare Advantage plans or return to Original Medicare.
The catch? CMS determines whether your provider’s exit from the network is “significant based on the affect or potential to affect current plan members”. You can’t just call up Medicare and request the SEP. If CMS decides you are entitled to the SEP, they’ll let you know.

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