If you’re steamed to discover your favorite doctor is no longer in your Medicare Advantage plan’s network, now is the time to make a change.
Medicare Advantage enrollees can switch plans or transfer to original Medicare during the open enrollment period ending March 31. You cannot, however, jump from a traditional Medicare plan to a Medicare Advantage one. You’ll have to wait for the fall enrollment period for that move.
“I call this the 'buyer's remorse' enrollment period,” Philip Moeller, a Medicare expert and the author of “Get What’s Yours for Medicare,” told chof360 Finance.
“Reviewing Medicare Advantage coverage and possibly switching makes sense this year,” he said. “There were many changes to 2025 plans, including to drug plans and reductions by some plans in their coverage of routine dental, hearing, and vision care.”
This can be alarming if you’re not paying attention.
Medicare Advantage plans are an alternative health insurance program to traditional Medicare for those 65 and older. They’re run by private insurance companies such as UnitedHealthcare and Humana and have been soaring in popularity in recent years.
Enrollment in 2025 is projected to be 35.7 million — more than half of all people enrolled in Medicare.
A big draw of Medicare Advantage plans is that they include coverage for benefits not included in traditional Medicare, such as drug coverage (Part D), eyeglasses, dental coverage, and fitness classes. Plus, they often have very low or even no premium costs.
That can be enticing. This year, original Medicare’s monthly Part B premiums are $185, and the annual Part B deductible, which most people must pay before their Medicare coverage begins, is now $257.
There are disadvantages. Unlike original Medicare, depending on the Advantage plan, you’re limited to a specific network of doctors and other healthcare providers, and those networks are ever-changing.
It’s not unusual to be referred to a specialist who is not part of your Medicare Advantage plan network. In those cases, you need prior authorization to make an appointment, or simply be prepared to pony up and pay the bill out-of-pocket.
Therein lies the No. 1 motivation for people to jump plans: to have access to the healthcare providers they currently use or plan to.
“A reason people should review their plan options is they might not have realized that one of their providers is now out of network, and they've lost access to (their) preferred doctor, or maybe they didn't realize that a copay for a regularly scheduled visit increased for this year,” Meredith Freed, a senior Medicare policy manager at KFF, told chof360 Finance.
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What’s more: Hospitals and healthcare providers are terminating agreements with Medicare Advantage insurers, citing too many denials and delays in approving care.
Last year, the Centers for Medicare & Medicaid Services (CMS) announced new rules that will require Medicare Advantage insurers to rule on prior authorization requests more quickly, but the change won’t take effect until 2026.
The rule also requires a specific reason for denying a prior authorization request, which will help with resubmission of the request or an appeal when needed.
Advantage plans also make changes that affect drug coverage and costs, including changes to formularies and preferred pharmacies, Freed said.
“So taking a look at drug coverage is one important thing that people may want to consider for this year and making sure that their prescription drug plan is the best value for them, depending on the drugs that they take,” she said.
Importantly, enrollees may also not be aware of changes that have gone into effect due to the Inflation Reduction Act and how that might affect their prescription drug costs, Freed added.
The big one: People with Part D plans through traditional Medicare or Medicare Advantage won't pay more than $2,000 a year in out-of-pocket costs for their prescription medications, or for co-pays or coinsurance for the prescription drugs their plan covers.
It used to be that many Advantage plans had no deductible, Diane Omdahl, a Medicare expert and founder of 65 Incorporated, told chof360 Finance. Not anymore.
In 2025, Advantage plans with a deductible are charging four times more than in 2024 — $225 vs. $59 — according to KFF.
For those considering shifting to traditional Medicare, that choice takes some legwork.
“Regular Medicare does not come with built-in caps on a variety of out-of-pocket costs, so you don't want to be enrolled in it without supplemental protection,” said Mark Miller, a retirement expert and author of “Retirement Reboot.”
For that you need a Medigap health insurance policy sold by private insurance companies that pays part or all of certain leftover costs. Medigap can cover outstanding deductibles, coinsurance, and co-payments and may also cover healthcare costs that Medicare does not cover at all like medical care received when traveling out of the US.
“In most states, the guaranteed right to buy a Medigap is limited to the time when you first sign up for Medicare Part B,” Miller said.
That’s because Medicare does not permit Medigap plans from rejecting you or charging a higher premium because of a pre-existing condition during that period. In most states, your premium, however, will vary depending on factors such as your age, gender, and where you live.
The Medigap guarantee policy is also good if you joined an Advantage plan during your first year of Medicare but disenrolled within a year and switched to traditional Medicare. After that, though, Medigap plans in most states can flat-out reject you if you have a pre-existing condition, such as diabetes. The exceptions are New York, Connecticut, Maine, and Massachusetts.
If you’re mulling moving back to traditional Medicare or changing Advantage plans, you might start by contacting your State Health Insurance Assistance Program network (SHIP), which provides free one-on-one counseling in every state. You can find your local SHIP here.
The Medicare Rights Center offers a free consumer helpline: 800-333-4114. You can also contact Medicare directly at 800-633-4227.
You can research your options via the Medicare Plan Finder. Enter the drugs you take and it will show you if they’re covered by the Advantage plan. When you look at the various plans available where you live, you'll see annual estimates of the cost of that plan based on the drugs you've entered into the tool.
If you have a limited income, you might be eligible for Medicare’s Extra Help, which covers Part D premiums and deductibles and caps drug costs.
Keep in mind, too, that there could be alternatives for the drugs you're taking, so it's always good to ask your physician if there’s one covered by your plan.
Medicare Star Ratings can help you see how different plans compare. Star ratings, which focus on health plan quality based on measurements of customer satisfaction and the quality of care a plan delivers can be found using Medicare’s Plan Finder tool.
If you do decide to make changes to your coverage during this time, they would take effect the first of the month after you make the change.
“The Medicare Advantage open enrollment period offers you an opportunity to switch to a different plan if you're not happy with the one you're in, but be sure to do your homework before leaping,” Miller said.
Kerry Hannon is a Senior Columnist at chof360 Finance. She is a career and retirement strategist, and the author of 14 books, including "In Control at 50+: How to Succeed in The New World of Work" and "Never Too Old To Get Rich." Follow her on Bluesky.
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