4 steps to send your rate letter during open enrollment

Medicare Advantage plans enroll members for 2027 from October 15 to December 7, HealthCare.gov plans from November 1 to January 15.

Nate Peereboom
Co-founder, JotPsych

Your rate letter to a health plan is drafted: raise the rates, or your practice leaves the network. The plan will sell 2027 coverage with your clinicians in its network.

1. Find your contract's termination window. Read each contract. Mark the notice period and the dates when notice counts. Payers don't make termination windows easy to find, said Doral Jacobsen, a payer contracting consultant. "It's like the fourth full moon, two hundred ninety three days notice, but you can only do it in May."
2. Name one owner for each payer. "If everyone's responsible, nobody's responsible," Jacobsen said. One person has to "own the payer contracting relationship," in her words. List each payer with its renewal date, its termination window, and the name of the person who owns the payer.
3. Count each Medicare Advantage plan's members your clinicians saw in the past three years. Under a federal rule, the plan must write to each of those members at least 45 days before your clinicians leave its network. Start your count with your active patients in the plan.
4. Send your letter during the plan's open enrollment. Jacobsen ties termination windows to open enrollment: payers "hate getting letters at that time. So use it." Medicare.gov's steps for joining a plan tell people to ask their doctors and pharmacies if they're in network with the plan before they join. HealthCare.gov members need a life event to change plans later.

Put your count in each letter to a Medicare Advantage plan. For specialties other than primary care and behavioral health, the plan writes to members seen in the past three months, not three years.