Open Enrollment Changes for Private Practices: 6 Easy Steps
Open enrollment changes for private practices start before the new plan year does. Medicare’s annual enrollment runs October 15 to December 7, and Marketplace enrollment runs November 1 to January 15. Some of your patients will arrive in January with a new plan, a new member ID or a new deductible. This post covers Medicare and private insurance. It does not cover Medicaid.
Open enrollment dates that matter to your practice
Patients choose plans on different calendars. These are the federal dates we checked on 10/26/26.
- Medicare annual enrollment (private practices see this first): October 15 to December 7. Changes take effect January 1, per Medicare.gov.
- Medicare Advantage open enrollment: January 1 to March 31 for people already in a Medicare Advantage plan, who can make one change. Changes take effect the first day of the month after the plan gets the request.
- Marketplace (ACA) plans: November 1 to January 15. Applying by December 15 gives January 1 coverage. Applying by January 15 gives February 1 coverage, per HealthCare.gov.
- Employer plans: each employer sets its own window, usually in the fall.
Open enrollment changes for private practices: what to expect
A plan change can break a claim that worked in December. The member ID may change. The payer may change. Your network status may not carry over. A patient who moves from a copay plan to a high-deductible plan may owe far more per visit, and you need to know that before the session, not after the claim. The deductible also resets on a new plan year.
- New payer or new ID: claims sent to the old payer are rejected.
- Network status: check the in-network vs out-of-network status under the new plan.
- Authorizations: approvals on the old plan may not carry over.
- Secondary insurance: a change on either plan can change who pays first. See coordination of benefits.
Open enrollment changes for private practices: your checklist
- Ask patients in November and December whether their plan is changing.
- Re-run eligibility verification for every active patient in the first week of January.
- Update the insurance on file before the first January claim.
- Confirm you are in network under each new plan.
- Explain deductible resets to patients before their first January visit.
- Watch filing limits. Confirm each limit during benefits verification.
Private plans, Medicare and state rules
- Private plans: each insurer sets its own network, rates and filing limits. Use our insurance contact guides by state to find the right provider contact.
- Medicare: federal rules apply, and Medicare Advantage plans act like private plans for network and claims.
- State rules: insurance rules differ by state. Confirm with your state insurance department. This is operational guidance, not legal advice.
How MCM South helps in January
MCM South built its January service around open enrollment changes for private practices: we offer insurance verification for all active patients at the beginning of January. We check the new plan year before claims go out, so you find out about a changed ID or deductible early. Our insurance verification service is built for psychotherapists and psychiatrists, and we also bill out-of-network claims if a patient’s new plan is out of network. If a patient has two plans, our secondary claims service handles the second claim.
Where MCM South works
MCM South serves psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We bill for solo and medium-size mental and behavioral health practices only.
The short version
- Medicare annual enrollment ends December 7. Marketplace enrollment ends January 15.
- Open enrollment changes for private practices can change the payer, the ID, the deductible and your network status.
- Verify every active patient in the first week of January.
- Keep Medicare, private and state rules in separate checks.
- See our private practice management guides for more on running the business side.
Sources checked (10/26/26)
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Related reading
Frequently asked questions
Frequently asked questions
When does Medicare open enrollment end?
Medicare annual enrollment runs October 15 to December 7, and changes take effect January 1.
When does Marketplace open enrollment end?
HealthCare.gov lists November 1 to January 15. Applying by December 15 gives January 1 coverage, and applying by January 15 gives February 1 coverage.
What should a practice do about open enrollment changes for private practices?
Update the insurance on file, re-verify benefits, confirm network status, and explain any new deductible before the visit.
Does this post cover Medicaid?
No. This post covers Medicare and private insurance only. Medicaid enrollment follows different rules in each state.
