Final Rule and New Special Enrollment Period Will Aid Those Misled by Provider Directories

Earlier this month, we flagged important changes coming to Medicare Plan Finder (MPF) for the upcoming Fall Open Enrollment period, including the addition of Medicare Advantage (MA) provider directories. Now we commend the Centers for Medicare & Medicaid Services (CMS) for recently announced steps to further integrate the directories and MPF. These improvements will do more to ensure the information is accurate and accessible.

Background on Directory and MPF Integration

In late 2024, the Biden-Harris administration proposed a rule requiring MA plans to submit directory information for incorporation into MPF. We strongly supported this change in our comments, as well as related guardrails, like requiring plans to attest to the accuracy of the directory information. The Trump administration initially declined to finalize these provisions.

First Set of Changes

In August, CMS announced that it would update MPF to allow beneficiaries to search by provider and see directory information on the site. Some plan types would be included automatically (with no submission necessary), while others would be permitted, but not required, to provide directory information. At that time, CMS made no mention of the attestation provision from the original proposed rule.

New Final Rule

In our initial report, we urged CMS to go further and require plans to do more to ensure the directories are accurate. We are pleased that CMS has now done so, in the newly finalized MPF provisions in the proposed rule. All MA plans will now be required to submit directory information to CMS in a format that can be integrated into MPF, to keep their directories up to date within 30 days of a known change, and to attest at least annually that their data are accurate.

All MA plans will now be required to submit directory information to CMS in a format that can be integrated into MPF.

Important New Special Enrollment Period (SEP)

To go along with these changes and the likelihood that people will rely on the directories in MPF to make crucial enrollment decisions, CMS has created a new temporary “Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information.” This SEP will offer relief for people who trust the MPF directory information to choose a plan but later discover that the directory was wrong.

This temporary SEP will be available to individuals who made MA enrollments with effective dates of 1/1/26 through 12/1/26.

To qualify for the SEP, individuals must

Rely on MPF provider directory information,

Enroll in an MA plan through MPF,

Within 3 months of coverage starting, discover that their preferred provider was not actually in the MA plan’s provider network, and

Call 1-800-MEDICARE for help.

People using the SEP will be able to switch to a new MA plan or return to Original Medicare (adding a Part D plan if necessary).

Keep Moving Forward

We applaud these steps and believe they will help ensure people get access to the care they need. We urge CMS to make the SEP permanent. The directories are likely to still contain some errors, and even monthly updates may not keep up with network changes. The SEP also does not apply for people enrolling in MA plans through other avenues, even if they also rely on inaccurate directories.

We urge CMS to make the SEP permanent.

These changes make State Health Insurance Assistance Programs (SHIPs) even more important. SHIP counselors provide trained, objective, and one-on-one services to help people learn about their Medicare coverage options and make the right enrollment decisions for their circumstances. Critically, they often utilize MPF sessions when helping beneficiaries with enrollment selections, underscoring the necessity of MPF accuracy.