By Susan Stewart, Licensed Insurance Agent
Medicare Open Enrollment has ended for 2025, and one of the biggest challenges I’ve seen across all 37 states I’m licensed in this year is providers, including primary care providers, specialists, and hospitals, leaving their networks with little to no notice.
How can I tell? One of the neat things about my job is that I have a tool to look up providers across the country and determine what networks they belong to. Think about that for a minute. This tool includes all the physicians’ assistants, nurse practitioners, medical doctors, specialists of every description, dentists, optometrists, rural clinics, and so on. Providers’ contracts are subject to change at any time, which causes the tool to fail and requires us to search for provider information on carrier websites (I like to double-check the website anyway). This year, I’ve noticed the tool fails as a result of network changes much more often than last year.
When providers leave a network with little notice, it leaves patients and beneficiaries in the lurch and suddenly without someone important. I put one beneficiary on a plan about a month ago. He called me two weeks later to tell me he'd gotten a call from an insurance agent from a doctor's office. This agent told him to change to this plan so he could keep that one doctor who would be gone from the plan at the end of the month. That’s risky. The beneficiary had someone trying to put him on another plan with no consideration for the other benefits or providers that could be important.
Why is this happening? Why are providers leaving their networks? As an expert in the field, my educated guess is that it comes down to dollars and cents. Providers can't be paid for their services with chickens and homemade blankets anymore. Maybe carriers are too slow to pay, and agreed fees for service are too low even to cover provider costs. Perhaps fair and agreed-upon pricing alone isn't sufficient for providers with profit margins to meet. It's a complex issue with no straightforward solution or clear culprit.
So, what can you do to help your insurance keep up with your providers’ changing networks? Here's the key takeaway:
Help your agent help you. While your agent seems to be fumbling around trying to figure out providers, be patient. Know about your providers. Names and addresses are essential. Have them written down so you can spell them. The more information you have about a provider, the easier it will be for me to place you in a plan that will allow you to keep them.
If you get a letter from your doctor or hospital that they no longer participate in your plan or carrier, do not wait to do something about it. Be diligent and savvy on your own behalf. Arm yourself with the knowledge to create the best outcome you can. Be your own best advocate.
