The Navigator Resource Guide has not been updated for 2025 Open Enrollment. For more current information please visit:
cms.gov/marketplace/in-person-assisters/information-partners.
QUESTION

I just learned my primary care doctor is not in the plan’s network. Can I change plans?

Individuals with coverage | Individual and Marketplace Health Coverage |
ANSWER

Generally, no. You can only change plans after open enrollment if you qualify for a special enrollment period. Not having your doctor in your new plan’s network does not qualify you for a special enrollment opportunity. (45 C.F.R. § 155.420).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues