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Four reasons to change your Medicare Advantage coverage

Network limits, changing medication tiers, cheaper coverage alternatives and richer benefits are reasons to change plans while you have the opportunity

Maurie Backman | August 17, 2022

Reviewed by our health policy panel.

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Is Original Medicare coverage enough?

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If you shun private coverage, can you get by on Original Medicare without purchasing supplemental coverage (Medigap and Part D prescription coverage) or using a Medicare Advantage plan?

If you’re enrolled in a Medicare Advantage plan and you’re not happy with it, you do have opportunities – including Medicare open enrollment – to switch out of that coverage each year. But do you need to switch?

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, it pays to find out if there’s 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 Medicare Part D, all Medicare Advantage plans 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.

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.

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, in the course of that search, you see that there’s a less expensive plan that offers equivalent coverage to what you have now, switching could be a huge money-saver.

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, then it pays to look into finding a new one.

Between 2021 and 2022, the number of Medicare Advantage health plans offering supplemental benefits grew in 35 out of 41 categories. Vision services were offered by 97% of plans, while 94% offered hearing and fitness benefits, and 91% offered dental care. If your plan doesn’t offer these features, finding one that does could save you money.

There are plenty of good reasons to move from one Medicare Advantage plan to another, so if you’re currently enrolled in Advantage, you have from January 1 through March 31 each year to change your coverage.

Remember, too, that if you’re unhappy with your current plan but can’t find a suitable alternative, there’s always the option to revert back to Original Medicare and sign up for a Part D plan. This especially holds true if you’re traveling more often that you initially anticipated, and you want the option to see a doctor pretty much 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 alone doesn’t come with an out-of-pocket spending limit for health services.)

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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