Earlier this month, we highlighted significant upcoming updates to the Medicare Plan Finder (MPF) in anticipation of the Fall Open Enrollment period, particularly the integration of Medicare Advantage (MA) provider directories. The Centers for Medicare & Medicaid Services (CMS) has recently announced additional steps to enhance this integration, which will improve the accuracy and accessibility of vital information.
The Biden-Harris administration had previously proposed a rule requiring MA plans to submit directory information for MPF incorporation by late 2024. This proposal garnered strong support in our feedback, especially regarding necessary measures like mandating plans to affirm the accuracy of their directory data. Notably, the Trump administration had initially opted against finalizing such provisions.
In August, CMS stated that it would allow beneficiaries to search by provider and access directory information through MPF. Some types of plans would automatically be included without submission, while others could provide directory information voluntarily. However, there was no mention at that time of the attestation requirement from the proposed rule.
In recent developments, CMS has responded to our calls for stricter measures by finalizing the MPF provisions. All MA plans are now obligated to submit their directory information in a format compatible with MPF, keep their directories updated within 30 days of any changes, and affirm yearly that their data is accurate.
To complement these updates, CMS has introduced a new temporary “Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information.” This period aims to assist beneficiaries who relied on inaccurate MPF directories when selecting a plan but later found discrepancies.
This temporary Special Election Period will apply to individuals who made MA enrollments effective between January 1, 2026, and December 1, 2026, and enables them to switch to a different MA plan or revert to Original Medicare, adding a Part D plan if necessary.
To be eligible for this period, individuals must:
– Depend on MPF provider directory information.
– Enroll in an MA plan via MPF.
– Discover within three months of starting coverage that their preferred provider was not included in the MA plan’s network.
– Contact 1-800-MEDICARE for assistance.
We commend these measures and believe they will facilitate better access to necessary care. We encourage CMS to consider making the Special Election Period permanent, as inaccuracies may continue to persist, and even monthly updates might not sufficiently keep pace with network changes. It’s important to note that the Special Election Period does not extend to individuals enrolling in MA plans through other channels, even if they rely on inaccurate directories.
The changes highlight the essential role of State Health Insurance Assistance Programs (SHIPs). SHIP counselors provide valuable, unbiased, and individualized services to help people navigate their Medicare coverage options. Their utilization of MPF during enrollment counseling underscores the need for continued accuracy within the MPF system.
These recent improvements signal a positive direction in ensuring beneficiaries have the information necessary for informed healthcare decisions. As CMS moves forward, the focus on accuracy and accessibility in Medicare information remains paramount.