Is it time to change your Medicare Advantage coverage?
If you’re enrolled in a Medicare Advantage plan and you’re not happy with it, you do have annual opportunities to switch to a different plan, including Medicare Open Enrollment in the fall and the Medicare Advantage Open Enrollment Period. As was the case for 2025, some Medicare Advantage insurers are shrinking their coverage areas or scaling back their plan offerings for 2026. That will mean that some enrollees will have to switch plans because their 2025 policy will not be available for renewal.
But even if your plan can be renewed for 2026 – which is the case for the majority of Medicare Advantage enrollees – keeping your existing coverage might not be the best option. Here are a few good reasons why it could pay to change your coverage when you have the opportunity.
1. Your preferred providers are no longer in-network
One downside to Medicare Advantage is that, unlike Original Medicare, it limits you to a specific network of providers. If you have a trusted doctor or facility that’s no longer considered in-network, you may want to shop around for new coverage. There might be an affordable alternative that allows you to continue seeing the providers who know your medical history and make you the most comfortable.
2. Your medications got more expensive
Like stand-alone Medicare Part D, all Medicare Advantage plans with integrated Part D coverage (MA-PDs) have a formulary that categorizes prescription drugs by tier. The lower the tier, the lower your out-of-pocket costs under that plan.
If a medication you take regularly has recently moved from a lower tier to a higher tier under your Advantage plan, then that could be reason enough to switch. This especially holds true if your prescriptions land you in a specialty tier – the most expensive option on the table for brand-name drugs, and, occasionally, generic drugs as well.
Or maybe the drug is still in the same tier, but the out-of-pocket costs – copay or coinsurance – have increased. It could also be the case that you’ve recently been prescribed a new drug that isn’t on your plan’s formulary, or that’s in a high tier, and you’re able to find another plan that covers it with lower out-of-pocket costs.
3. There are cheaper alternatives
Maybe your Medicare Advantage plan didn’t get more expensive from the previous year, or reclassify your medications so that they cost more. But that doesn’t mean there’s not a cheaper option available that might still meet your coverage needs.
Medicare has a comprehensive Plan Finder you can use to search for Advantage plans in your area and compare them by premium and drug costs. If you find a plan with lower total premium and drug costs – and other medical coverage that’s roughly equivalent to what you have now – switching could be a huge money-saver.
Just be sure to pay attention to details such as the provider network and out-of-pocket costs. You’ll also want to ask whether the plan will require new prior authorization or step therapy for any medications or ongoing care you need, or whether any other coverage issues might hinder your access to care.
4. You want a plan with extra benefits
One big reason so many seniors opt for Medicare Advantage over Original Medicare is to gain access to additional benefits the latter won’t cover. But if your current Advantage plan doesn’t offer the perks you’re after, you might want to consider other available plans.
Between 2021 and 2022, the number of Medicare Advantage health plans offering supplemental benefits grew in 35 out of 41 categories. By 2024, nearly all Medicare Advantage plans offered dental, vision, and hearing coverage, as well as fitness benefits. And many plans also offered other extra benefits, such as telehealth, over-the-counter benefits, and acupuncture coverage.
For 2025, however, extra benefits on Medicare Advantage plans are not as widespread as they were in 2024.
For 2026, CMS has added some restrictions to the benefits that Medicare Advantage plans can provide as “Special Supplemental Benefits for the Chronically Ill” (SSBCI). The new rules are designed to ensure that any such benefits “have a reasonable expectation of improving or maintaining the health of a chronically ill enrollee.” As such, CMS has clarified that certain benefits, such as life insurance, funeral planning services, and membership-style programs that provide non-health-related benefits, cannot be offered under SSBCI.
If your plan doesn’t offer extra benefits that are useful to you, finding one that does could save you money. Or you might find that the extra benefits are more robust on another plan – perhaps higher benefit limits on dental coverage, for example. Since extra benefits have been reduced somewhat in recent years, some enrollees may find that they need to switch plans to continue to receive an extra benefit that was previously offered by their plan. But it’s important to consider all of the plan details, including premiums, out-of-pocket costs, provider networks, and drug coverage, before picking a plan based on extra benefits. The extra benefits can be thought of as the frosting, but it’s important to make sure the underlying cake — the medical and drug coverage the plan provides, the plan’s prior authorization requirements, etc. — will meet your needs.
Opportunities to change plans
There are plenty of good reasons to move from one Medicare Advantage plan to another, so if you’re currently enrolled in an Advantage plan, you have from October 15 to December 7, and also from January 1 through March 31 each year, to switch to a different plan.
Remember, too, that if you’re unhappy with your current plan but can’t find a suitable alternative, there’s always the option to switch to Original Medicare and sign up for a Part D plan. This especially holds true if you’re traveling more often than you initially anticipated, and you want the option to see a doctor anywhere in the country.
Before switching back to Original Medicare, be sure to check whether you’re able to purchase a Medigap plan to protect yourself against Medicare’s out-of-pocket costs (Original Medicare doesn’t have an out-of-pocket spending limit for health services). Medigap enrollment is subject to medical underwriting in most states after your initial enrollment window and trial right period have ended. But if you have a guaranteed issue right – which is available if you’re enrolled in a Medicare Advantage plan that’s terminating at the end of the year and can’t be renewed – you’ll have access to certain Medigap plans without medical underwriting.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
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