The #1 AEP Mistake That Could Cost You Your Doctor

If you assume your doctor will still take your plan next year — you might be in for a surprise. Every fall, insurance companies and hospital systems renegotiate contracts right in the middle of AEP. That means even if your plan card stays the same, your doctor or hospital could quietly disappear from your network by January.

Translation: You could lose your doctor, your preferred hospital, and maybe your confidence in your plan — all because of one overlooked step.

• Don’t assume your doctor will stay in-network. Networks change every fall during contract negotiations.

• Hospitals drop plans that don’t “pencil out.” If your plan isn’t profitable for them, it’s on the chopping block.

• Provider directories are often outdated. What you see online in October could already be wrong.

• Call your doctor’s billing office — not the front desk. They’re the ones who actually know next year’s contracts.

• Document what you’re told. Write down the name, date, and details of your conversation for backup.

• Being proactive beats being surprised. Waiting until January can mean paying out-of-network prices or losing access altogether.

Every fall, insurance carriers and hospital systems lock into Q4 negotiation mode. Hospitals that want higher reimbursement issue termination notices just as AEP begins — a pressure tactic to get carriers to settle fast. Meanwhile, some carriers drop providers they see as too expensive or non-compliant.

The result? You, the member, are left out of the loop.
Your plan looks the same, your ID card looks the same, but your doctor may quietly vanish from the network come January 1.

This isn’t personal — it’s math. Hospitals often lose money on certain Medicare Advantage contracts.
If a plan doesn’t bring enough local members (or if it’s a Medicare-only carrier without employer group business), hospitals sometimes walk away.

They’d rather focus on plans that deliver steady patient volume and higher reimbursements. Unfortunately, that business decision can completely change your access to care.

If you’re comparing plans — or even thinking about keeping your current one — take these steps before you lock in your decision:

Call your doctor’s billing office (not the receptionist).
Ask: “Will you still be in-network for [Carrier Name] [Plan Type] next year?”

Be specific.
“Do you take Medicare Advantage?” isn’t enough. Even within the same carrier, networks differ between plan types.

Write it down.
Note who you spoke with, the date, and what they said.

Double-check before December 7.
That’s when AEP ends — and the last application you submit before that date is the one that counts.

Provider directories are always behind. They’re updated after contracts are finalized — and those negotiations often run right through the holidays. The billing department knows more than the carrier website ever will in October or November.

So don’t trust a “current as of September” listing when your healthcare access depends on it.

Be your own advocate this AEP.

• Verify your doctors.

• Confirm your hospital network.

• Don’t assume — ask.

If you feel overwhelmed or unsure where to start, schedule a consultation with a licensed, independent Medicare advisor who can help you compare your real options — not just what looks good on paper.