Special Enrollment Periods (SEP) Explained: Keep Your Doctor During Network Changes

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With hospital–insurer contract fights flaring up, many Medicare Advantage members are seeing doctor/hospital network changes—from Rhode Island (e.g., UnitedHealthcare vs. Brown’s system) to other regions.

Here’s what a Special Enrollment Period (SEP) is, how it works, and how to protect your care if your hospital goes out of network.

What you’ll learn (fast):
• 🧭 What an SEP is: A time-limited window to switch plans mid-year when you’re directly affected by certain changes.

• 🏥 Who usually qualifies: Members who recently received care from the affected hospital/provider.

• 📨 The letter issue: Insurers may mail notices, but outreach can be inconsistent—eligibility can be case-by-case.

• ⏳ Typical timing: Many SEPs run about 60 days from notice—don’t wait.
• 🩺 Without an SEP: Changes usually must wait until AEP (Oct 15–Dec 7) for a Jan 1 effective date.

• ☎️ Final say: If you’re denied, 1-800-MEDICARE can review and may grant an exception.

Your action plan:
🔎 Verify network status for your hospital & key doctors (today).
🧾 Check mail/portal for an SEP letter; note dates & deadlines.
🧭 Compare plans that keep your providers in-network.
📓 Document every call (date, rep, reference #).
☎️ Call 1-800-MEDICARE if you didn’t get a letter or were told you’re not eligible—ask for an SEP review/exception.
🧠 Continuity of care: If you’re mid-treatment, ask your plan about temporary in-network exceptions.

Chapters:
00:00 Introduction to Special Election Periods
00:20 Current Issues in the Medicare Space
01:01 Insurance and Hospital System Conflicts
01:40 Understanding Value-Based Payments
02:41 Impact on Consumers and Special Election Periods
03:44 Navigating Special Election Periods
04:16 Steps to Take if Affected
05:08 Conclusion and Final Advice

For any questions or inquiries regarding this video, please reach out to [email protected]
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“This is for educational purposes only and not to be taken as advice to act on. always consult with a licensed Medicare broker in your area.”