Medicare Advantage Open Enrollment: All your questions answered
Starting January 1, if you are one of 33 million Americans with Medicare Advantage, you can change your plan to a different Medicare Advantage plan or switch back to Original Medicare.
Medicare Advantage Open Enrollment only lasts until March 31, so it’s important to understand why you might want to switch plans and what to expect during this open enrollment period. Medicare can be complex, here’s a glossary of health terms that might come in handy.
Understanding Medicare Advantage Open Enrollment
Medicare Advantage Open Enrollment Period (sometimes called MA OEP) is an annual opportunity for people who already have a Medicare Advantage plan to change their health insurance coverage. This enrollment period runs from January 1 to March 31 each year. You only can change your plan one time during this open enrollment if you already have a Medicare Advantage plan.
Who can change their plan during Medicare Advantage Open Enrollment?
If you have Original Medicare, you are not eligible to change your plan during the Medicare Advantage Open Enrollment period.
If you have Original Medicare and want to change your plan, you can see if you qualify for a special enrollment period or wait until the Annual Enrollment Period (October 15 to December 7), when everyone with Medicare is eligible to change their plans. Duals (people who are on both Medicaid and Medicare), have their own quarterly special enrollment period.
What can I do during Medicare Advantage Open Enrollment?
For those who do have a Medicare Advantage plan, starting January 1, you can choose to:
- Switch to a different Medicare Advantage plan: You can choose from an average of 43 Medicare Advantage plan options in your area and select one that has the benefits, costs, and providers you're looking for.
- Switch to Original Medicare: If you want the flexibility of Original Medicare, you can leave your Medicare Advantage plan and switch to Original Medicare. You can also join a separate Medicare Part D plan. There are, on average, 21 stand-alone drug plan options in a given county.
Original Medicare vs. Medicare Advantage
With so many options during Medicare Open Enrollment it's important to understand the basic differences between Medicare Advantage and Original Medicare.
Original Medicare is a government-run health insurance program for people aged 65 and older, as well as some younger people with disabilities. It helps cover the costs of many healthcare services, including doctor visits, hospital stays, and certain preventive services. Original Medicare is divided into two parts:
- Part A (Hospital Insurance): Helps cover the costs of inpatient care, like hospital stays.
- Part B (Medical Insurance): Helps cover the costs of outpatient care, like doctors’ visits.
Medicare Advantage, also called Part C, is an alternative to Original Medicare. When you choose a Medicare Advantage plan, you're selecting a private insurance plan that's approved by Medicare. Like Original Medicare, Medicare Advantage plans cover Part A and B. However, there are key differences—take a look at the table below.
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Monthly premiums | You will pay $0 for Part A and $185 per month for Part B in 2025. If you have a higher income, you may pay more. Individuals on both Medicare and Medicaid (also known as Duals) may pay nothing for Part B. | You will also pay $0 for Part A and $185 per month for Part B in 2025 (or potentially $0 if you’re a Dual). If you have a higher income, you may pay more. About 60% of Medicare Advantage plans have a zero-dollar premium in 2025, so you will not incur additional monthly costs. Plans that do have a monthly premium typically charge $20+/month. |
| Additional costs | You will not have copays, but there may be coinsurance and an annual deductible. | You will have copays, coinsurance, and deductibles. |
| Prescriptions | Medicare drug coverage (Part D) is not included. You can join a separate Medicare drug plan and pay a monthly premium to get drug coverage. The average Part D premium in 2025 is $64.96. Actual premium costs will vary depending on the plan you choose. | Medicare drug coverage (Part D) is included in most Medicare Advantage plans at no additional cost. |
| Provider network | You can use any doctor or hospital that takes Medicare, anywhere in the U.S. | You can only use doctors who are in the specific plan’s network or risk high out-of-pocket costs. |
| Medicare Supplement (Medigap) eligibility | You can enroll in a Medigap plan to help with covering out-of-pocket costs associated with Original Medicare. | You are not eligible for Medigap plans. |
| Coverage limitations and referrals | You do not need to get approval from Medicare to access certain drugs and specialty services. | You might need to get approval from your plan before it covers certain drugs or specialty services. |
| Additional benefits | Doesn’t include extra health benefits. | May include coverage for extra benefits like dental, vision and hearing care, over-the-counter medications, gym memberships and others. |
How do I know if I need to change my Medicare Advantage plan?
You should think about making a change if your current health plan doesn't meet your needs. Some common reasons for changing Medicare Advantage plans are:
- Preferred doctors and specialists: You want a plan that has your preferred doctors and specialists in-network. The main reason people change plans is because their doctor is not covered.
- Lower costs: You want a plan with lower monthly premiums, deductibles, or copays.
- Better benefits: You want a plan that offers additional benefits like vision, dental, or gym memberships, among others.
- Prescription drug coverage: You want a plan that covers your medications or covers your medications at lower costs.
- Changing health needs: You have experienced changes in your health care needs such as a new or worsening chronic condition.
- More flexibility: You want a plan that lets you see specialists without a referral from your primary care doctor, covers more providers and clinics, or covers medications without approval.
If any of those sound like they apply to you, you should think about changing your health plan during the Medicare Advantage Open Enrollment Period.
With so many health plan options, the best way to know what you want in a new plan is to look at your current plan and determine what you like and don't like. You should look at your current health plan and check the following:
1. Your plan's Annual Notice of Change
Medicare plans can change coverage from year to year, even if the costs stay the same. Be sure to review your plan’s “Annual Notice of Change,” which is an update you should receive every fall, to catch any changes that may affect you.
Pay attention to higher monthly costs, new approvals needed for medications, higher copayments for specialist visits and hospital stays, changing provider networks, less coverage for extras such as dental care, and higher out-of-pocket maximums for medical care.
2. Your Summary of Benefits
The Summary of Benefits is just a long list of your plan's covered services, including doctor visits, hospital stays, and prescription drugs. Note details about specific services, like whether they include mental health, dental, and vision coverage.
While reviewing covered services, write down any limits or uncovered services. You can make sure to look for new plans that cover these services when you are exploring options.
3. Whether your doctors are in-network
Most Medicare Advantage plans have a searchable online directory on their website. You can contact your plan's customer service for a provider directory. Or, contact your doctors' offices directly to ask if they accept your specific Medicare Advantage plan.
4. Which prescriptions are covered
Review your plan’s “formulary,” which is a list of all the prescription drugs covered under your plan. You can also ask your pharmacist or doctor to check your medication coverage and see if your current prescriptions are covered.
5. Your payments
You should review your monthly premiums, deductibles, and copays so you can compare savings with other plans and understand your expected out-of-pocket costs.
How do I compare health plans during Medicare Advantage Open Enrollment?
If you have Medicare Advantage, you have lots of options to pick from. You can pick from multiple Medicare Advantage plans and Part D stand-alone prescription drug plans (PDPs) or switch back to Original Medicare.
You can find and compare Medicare Advantage Plans online or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877 486-2048.
During Medicare Advantage Open Enrollment, you can only change plans once so it’s important to review all your options before picking a new plan.
What should I expect if I change my health plan during Medicare Advantage Open Enrollment?
If you switch your health plan during this special period, your new plan will begin the month after the change request is received. After making a change, share your new health plan with your doctors and pharmacies as soon as possible.
Also, make sure to check your mail for important information from your new health plan. This may include your member ID card and other documents.
Need help with your Medicare coverage?
Contact your Medicare case manager (if you have one) or contact your State Health Insurance Assistance Program (SHIP) counselor for free advice.
