Key Takeaways
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Provider network changes can affect your care and schedule for the upcoming year, so reviewing them during AEP helps you avoid surprises.
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Paying attention to updated directories, service locations, and referral rules helps you stay informed before booking appointments.
Understanding The Purpose Of This Review
The Annual Enrollment Period running from October 15 to December 7, 2025 offers a chance to review how your plan may change for 2026. Provider networks often shift from year to year, and your goal is to understand these updates before they affect your appointments. Reviewing this information now ensures you stay connected to your preferred doctors and medical facilities.
Why Provider Networks Change
Provider networks can expand or shrink for several reasons. Plans may adjust based on new contracts, changes in facility participation, updated service agreements, or shifts in healthcare costs. Although these adjustments can offer new choices, they can also limit access to certain doctors if you do not review the changes early.
Changes can include:
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A doctor leaving the network
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A clinic no longer accepting your plan
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Specialists becoming out of network
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Updated referral or authorization requirements
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New hospitals or urgent care centers added to the network
Understanding the reasons behind these changes helps you approach your AEP review with clarity.
How To Start Reviewing Your Provider Network
Before diving into the details, gather the documents and information you need. Start by locating your plan’s updated materials for 2026. Many plans publish their updated network information during AEP, allowing you to compare this year’s network to what will be active next year.
Make sure you review:
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Updated provider directories
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Summary of Benefits
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Annual Notice of Change
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Any mailed updates or online notifications about network adjustments
This gives you a complete picture of how your access to care may shift when the new year begins.
What Information Should You Check First
When reviewing provider networks, your first step should be confirming whether your primary doctor is still included. Your main doctor plays a key role in coordinating your care, so their participation affects your overall experience.
Check the following details first:
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Participation status of your primary doctor
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Office locations and updated hours
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Whether the practice accepts new patients under your plan
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Any changes in referral rules for specialists
Once you confirm your primary doctor’s status, move on to your specialists and nearby facilities.
What About Your Specialists
Specialists are often the most affected by network changes. You should check whether each specialist you see remains in your plan’s network for the 2026 coverage year.
Review the following:
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Specialist participation status
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Whether a referral is required for future visits
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Updated co-pays or cost sharing
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Any changes in appointment availability
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Whether telehealth visits remain covered
This helps you prepare for any shifts in how you receive ongoing care.
Should You Worry About Hospital Changes
Hospital participation is another key area to review. A hospital leaving your network can affect your access to emergency care, planned surgeries, lab services, and imaging. Even if your doctors remain in network, they may not continue practicing at the same facilities.
Look at:
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Which hospitals remain in your network
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Emergency department access
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Outpatient testing locations
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Updated service areas for imaging or lab work
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Coverage for urgent care centers within your city
If you rely on a specific facility, confirm it will still be available in 2026.
How To Check For Telehealth Changes
Telehealth became a major part of healthcare in recent years. Networks may update which telehealth providers they include or how virtual visits are billed.
Review the plan materials to see:
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Whether your doctors offer telehealth in 2026
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Updated rules for virtual appointments
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Any new or removed telehealth platforms
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Changes in cost sharing for telehealth
This allows you to plan ahead for virtual care options.
How To Catch Changes In Referral Requirements
Referral rules can shift from year to year. During AEP, check whether you need a referral for 2026 when visiting specialists or receiving certain treatments.
Make sure you understand:
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Referral requirements for specialists
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Referral expiration timelines
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Authorization rules for high cost services
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Steps for requesting approvals
Clear knowledge of these rules prevents delays in your care.
How To Compare Old And New Network Information
Comparing your 2025 and 2026 provider networks side by side helps you see changes quickly. Use updated directories or online tools to perform this comparison.
Focus on:
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Doctors who stayed in network
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Doctors who left the network
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Newly added providers
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Distance from your home to care locations
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Availability of preferred pharmacies
Taking time to compare details protects you from unwanted surprises later.
Why Timing Matters
Reviewing provider network changes early is important. AEP only runs for 53 days, and once it closes on December 7, your next chance to update your coverage may be limited. If you discover after January 1, 2026 that your doctor is no longer in network, you may face higher costs or need to change providers.
During AEP, use your time effectively by reviewing network details as soon as updated materials become available.
What If Your Doctor Leaves The Network
If you find that your doctor will no longer be in your 2026 network, you have several options to consider. You can:
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Look for another network doctor with similar experience
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Compare plans to find one that still includes your preferred provider
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Ask your medical office about continuity of care rules
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Check whether temporary transition coverage applies
Taking action early gives you more control over the outcome.
How To Prepare For Appointment Scheduling
Once you confirm your providers for 2026, begin scheduling appointments for the new year. Some offices book weeks or even months in advance, especially after network changes.
Prepare by:
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Calling your providers to confirm participation
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Asking about next year’s scheduling availability
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Reviewing office policies for 2026
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Planning follow up visits or screenings ahead of time
Proactive planning helps you stay ahead of the new year’s care schedule.
Keeping Yourself Organized Throughout AEP
To stay organized during AEP, create a simple checklist. Include your primary doctor, specialists, pharmacies, preferred hospitals, and telehealth services. Checking these items one by one makes the entire process feel manageable.
You can also:
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Write down any questions you want to ask
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Track updates on a calendar
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Set reminders to revisit your review as new materials are released
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Keep all documents together in one folder
Staying organized saves time and reduces stress.
Staying Informed After AEP Ends
Once AEP ends on December 7, 2025, you should still stay alert for any updates. Occasionally, providers update their participation status at the start of the year. Review your plan materials again in January 2026 to confirm nothing has changed.
You can also:
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Create a list of your preferred providers
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Verify contact information for each office
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Save your new plan documents for quick reference
Being informed helps you navigate any adjustments smoothly.
Moving Forward With Confidence
Before booking your appointments for 2026, understanding your provider network ensures you feel confident in your coverage. Pay close attention to updated directories, specialist changes, and referral rules during the AEP window. Staying informed protects your access to the doctors and services you rely on.
If you want help reviewing provider changes or comparing your options, reach out to any of the licensed agents listed on this website for guidance.
