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It's Medicare Advantage Plan Open Enrollment Period: What You Need to Know Thumbnail

It's Medicare Advantage Plan Open Enrollment Period: What You Need to Know

Insurance Planning

Medicare Advantage Open Enrollment period runs from January 1st through March 31st and it allows people already enrolled in a Medicare Advantage plan an opportunity to change to another Medicare Advantage Plan or return to Original Medicare.  So, if you are thinking about switching plans, this post will help you think about the pros and cons of Medicare Advantage and whether or not you should make a change during this time period.

Like most things in life, Medicare Advantage plans have their good and bad sides. Let’s take a closer look so you can decide if Medicare Advantage or original Medicare is right for you.

When Should You Consider Switching Plans?

Making the decision to change Medicare Advantage Plans or switch from Medicare Advantage to original Medicare is not an easy one.  However, if you are experiencing one or more of the issues below, now might be the time to think about making a change.

1. Your Current Plan’s Costs Are Increasing

  • If your premiums, copays, deductibles, or out-of-pocket maximums are going up, it’s a good time to compare other plans to see if you can get similar coverage for less money.

2. Your Doctors or Hospitals Leave the Network

  • Medicare Advantage plans have network restrictions, and if your preferred doctors or hospitals are no longer covered, you may want to switch to a plan that includes them.

3. Your Prescription Drug Coverage Changes

  • Medicare Advantage plans with Part D (drug coverage) update their formularies (covered drug lists) every year.
  • If a medication you need is no longer covered or has moved to a higher pricing tier, another plan may offer better coverage.

4. You Develop a Serious Health Condition

  • If you need specialist care, frequent treatments, or access to top-tier medical facilities, check whether another Medicare Advantage plan offers better coverage.
  • Some plans require prior authorizations or limit out-of-network care, which can delay or restrict your access to treatment.

5. You Plan to Travel or Move

  • If you’re moving to another state, your plan may not be available in your new location.
  • If you travel frequently, a plan with better nationwide coverage may be a better fit.

6. Extra Benefits No Longer Meet Your Needs

  • Many Medicare Advantage plans offer perks like dental, vision, hearing, and fitness benefits.
  • If another plan offers better extras, it might be worth switching.

The Advantages of Medicare Advantage Plans

1. All-in-One Coverage

One of the biggest benefits of a Medicare Advantage plan is that it combines hospital, medical, and sometimes drug coverage into a single plan. Instead of juggling separate policies, you have everything in one place.

2. Extra Benefits Not Found in Original Medicare

Unlike Original Medicare, Medicare Advantage plans often come with extra perks like:

  • Vision coverage (eyeglasses and eye exams)
  • Dental coverage (cleanings, exams, and sometimes even dentures)
  • Hearing aids and exams
  • Fitness programs (like SilverSneakers)
  • Over-the-counter medication allowances

These extras can save you money if you need them.

3. Potentially Lower Out-of-Pocket Costs

Many Medicare Advantage plans have lower monthly premiums than Original Medicare plus a separate drug plan. Some even have $0 premiums. They also have an annual out-of-pocket maximum, which Original Medicare doesn’t. Once you hit that limit, the plan covers 100% of your Medicare-covered services for the rest of the year.

4. Coordinated Care

Many Medicare Advantage plans work within a network, meaning your doctors and hospitals communicate with each other. This can lead to better, more efficient care, especially if you have ongoing health conditions.

5. Prescription Drug Coverage

Most Medicare Advantage plans include Part D prescription drug coverage, so you don’t need to buy a separate drug plan. This can be convenient and sometimes cheaper than standalone Part D plans.

The Disadvantages of Medicare Advantage Plans

1. Limited Provider Networks

Unlike Original Medicare, where you can see any doctor or specialist who accepts Medicare, Medicare Advantage plans usually have networks. This means:

  • You might need to choose doctors and hospitals within the plan’s network.
  • Out-of-network care can be expensive or not covered at all (except in emergencies).
  • You may need referrals to see specialists in certain plans.

If you travel a lot or split time between different states, this could be a hassle.

2. Prior Authorization and Restrictions

Many Medicare Advantage plans require prior authorization before covering certain tests, procedures, or medications. This means:

  • Your doctor might need to get approval before providing treatment.
  • Some treatments might be denied or delayed by the insurance company.

This can be frustrating, especially if you need immediate care.

3. Costs Can Add Up

While Medicare Advantage plans often have lower monthly premiums, you’ll still have copayments, deductibles, and other costs. Depending on how much healthcare you need, your out-of-pocket costs could end up being more than Original Medicare.

4. Less Flexibility

Original Medicare lets you add Medigap (Medicare Supplement Insurance) to help cover extra costs like deductibles and coinsurance. Medicare Advantage plans don’t allow Medigap. This means you’re responsible for copays and other costs as you go.

5. Plan Choices Can Change Every Year

Medicare Advantage plans are run by private insurance companies, and they can change their benefits, provider networks, and costs each year. This means you need to review your plan annually during Medicare Open Enrollment (October 15 – December 7) to make sure it still meets your needs.

Who Might Like a Medicare Advantage Plan?

  • Someone who wants one simple plan that covers everything.
  • Someone who values extra benefits like dental, vision, or gym memberships.
  • Someone who doesn’t travel much and is comfortable with network restrictions.
  • Someone looking for potentially lower monthly premiums.

Who Might Be Better Off with Original Medicare?

  • Someone who wants the freedom to see any doctor who accepts Medicare.
  • Someone who travels often and needs coverage in different states.
  • Someone with significant health needs (or family history of certain illnesses like cancer) who wants Medigap for extra cost protection.
  • Someone who doesn’t want to deal with prior authorizations and network restrictions.

Final Thoughts

Medicare Advantage plans can be a great option for many people, but they are not one-size-fits-all. It’s important to weigh the pros and cons based on your healthcare needs, budget, and lifestyle. If you’re considering switching to another Medicare Advantage plan, take the time to compare plans, check provider networks, and understand the costs involved.  If you think switching from Medicare Advantage to original Medicare makes the most sense for you, be sure you can qualify and afford a Medigap policy before make the switch.

Still unsure? It might be a good idea to talk to a Medicare advisor like the Health Insurance Counseling and Advocacy Program (HICAP) who can help you navigate the choices. After all, the goal is to get the coverage that gives you peace of mind and meets your health needs without straining your financial resources.

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This content is developed from sources believed to be providing accurate information, and provided by Attune Financial Planning. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for specific information regarding your individual situation. The opinions expressed and material provided are for general information, and should not be considered a solicitation for the purchase or sale of any security.