New CMS Rules Enhance MA Provider Directories, Introduce Temporary SEP
In a recent update to the previously finalized CY 2026 Medicare Advantage and Part D rule, CMS finalized proposals related to provider directories. This update ensures that those who use the Medicare Plan Finder can more easily access and compare Medicare Advantage plans’ provider directories when choosing a plan.
CMS finalized requirements for Medicare Advantage Organizations (MAOs) to:
- Share provider directory information with CMS to be published on a CMS/HHS website;
- Notify CMS of any updates to the provider directory within 30 days of any changes; and
- Attest at least annually that the data is accurate.
All MAOs must submit their directory information to CMS by January 1, 2026.
To address potential inaccuracies in the newly integrated provider directory date on MFP, CMS will offer a Special Enrollment Period (SEP) in 2026. This SEP allows beneficiaries who enroll in an MA plan via MFP and realize, within three months, that their preferred provider is not in-network to change their plan. This SEP requires CMS approval.
Eligible beneficiaries are those who previously made a 2026 MA plan election through MFP during any election period between January 1 and December 1, 2026. The SEP is available for three months after the effective date of the MA plan election via MPF. This SEP is temporary, for the first year of the MFP MA provider directory. Eligible beneficiaries may switch to another MA (MA-Only or MA-PD) plan; disenroll and return to Medicare fee-for-service (FFS); or enroll in a PDP return to Medicare FFS with Part D coverage. All elections made under this SEP are prospective, taking effect on the first day of the month following the application date.