Should I Switch Medicare Plans This Year?
Most people don’t need to switch Medicare plans every year, but almost everyone should check every year. The reason is simple: your plan can change its costs, its covered drugs, and its provider network from one year to the next, and staying put means accepting whatever it changed to. So the honest answer to “should I switch?” is that it depends on what your current plan is doing next year versus what else is available — and you can’t know that until you read a couple of documents that arrive in the fall.
This article walks through how to make that decision without guessing, and, just as importantly, when you’re actually allowed to make a change.
Start with what changed, not with whether you’re happy
The mistake to avoid is deciding based on how this year went. What matters is next year’s terms. Every fall, your Medicare Advantage or Part D plan sends you an Annual Notice of Change, or ANOC, that arrives around September and lays out, side by side, what you pay now and what you’ll pay starting in January. That document is the strongest reason to open your mail carefully in the fall, and it’s also the document most likely to get tossed because it shows up in the same week as a stack of plan advertising.
Four things in the ANOC decide whether a switch is worth considering:
- Premium and deductible. The obvious numbers, and the ones people check first.
- The drug list. A medication you take can move to a higher cost tier, pick up a prior-authorization requirement, or drop off the covered list entirely. This is the change that quietly costs people the most.
- The provider network. A doctor who is in-network this year is not guaranteed to be in-network next year. If keeping a specific doctor matters, confirm it every year.
- Extra benefits. Dental, vision, hearing, and over-the-counter allowances on Medicare Advantage plans aren’t standardized, so they change more freely than anything else.
If the ANOC shows nothing meaningful changing and your doctors and drugs are still covered, doing nothing is a perfectly reasonable decision. The point is to make that decision on evidence, not by default.
Good reasons to look hard at switching
There are a few situations where a review usually turns into a change.
Your prescriptions changed, or your plan’s drug list did. If you started a new medication this year, or your plan moved one of your drugs to a worse tier, the plan that fit you last year may no longer be the one that costs you the least across the whole year.
Your doctor is leaving the network. Medicare Advantage plans use networks, and provider lists shift annually. If a doctor or hospital you rely on won’t be in-network next year, that’s a concrete reason to compare.
Your plan is leaving your area. If your plan isn’t renewing its contract where you live, you’ll get a notice, and you’ll need to pick something else or be moved to Original Medicare. That’s a forced decision, not an optional one.
Your health or your budget changed. More doctor visits, a new diagnosis, or a tighter budget can all change which structure — lower premium with more cost-sharing, or higher premium with more predictable costs — actually works better for you.
When you do compare, compare on total expected cost for the year, not on premium alone. A lower premium paired with a different drug-tier structure, a smaller network, or a higher out-of-pocket maximum is not automatically cheaper for you. Medicare’s Plan Finder at Medicare.gov lets you enter your specific prescriptions and estimate your yearly cost under each plan, which is the comparison that actually answers the question.
When you’re allowed to switch
Wanting to switch and being able to switch are two different things. Medicare only lets you change at set times.
| When | Who it’s for | What you can do |
|---|---|---|
| Open Enrollment: October 15 – December 7 | Anyone with Medicare | Join, drop, or switch a Medicare Advantage plan; switch between Original Medicare and Medicare Advantage; join, drop, or switch a drug plan if you’re on Original Medicare. Changes start January 1. |
| Medicare Advantage Open Enrollment: January 1 – March 31 | Only people already in a Medicare Advantage plan | Switch to a different Medicare Advantage plan, or drop it and return to Original Medicare with a separate drug plan. One change only. |
| Special Enrollment Periods | People with a qualifying life event | Varies by event — see below. |
The fall Open Enrollment window is the main one, and it’s the broadest: whatever your situation, you can make a change, and it takes effect January 1 as long as the plan receives your request by December 7. That’s a receipt deadline, not a postmark deadline, which matters if you’re mailing a paper form.
The January-through-March window is narrower than people think. It’s only for people who are already in a Medicare Advantage plan on January 1, it allows just one change, and coverage starts the first of the month after the plan gets your request. You cannot use it to move from Original Medicare into a Medicare Advantage plan, and if you’re on Original Medicare you can’t use it to pick up a standalone drug plan.
Special situations that open a door outside those windows
Some circumstances let you change coverage off the normal calendar:
- You moved out of your plan’s service area, or to an area with new plan options. This generally opens a window that runs through the two full months after your move.
- You have Medicaid or qualify for Extra Help. You can change your drug coverage once a calendar month, with the change taking effect the first of the next month. This is a big deal and often overlooked.
- A 5-star plan is available in your area. You can use a one-time Special Enrollment Period between December 8 and November 30 to switch to a plan with an overall 5-star quality rating, if one serves your area. Be careful with the mechanics: moving from a Medicare Advantage plan with drug coverage to a standalone drug plan disenrolls you from the health plan and returns you to Original Medicare.
- Your plan has scored below 3 stars for three years running. You can leave it for a better-rated plan at any time.
If you think a life event applies to you, 1-800-MEDICARE can confirm whether you qualify and how long the window lasts.
One trap to know before you switch
If you have a Medicare Supplement (Medigap) policy alongside Original Medicare and you’re thinking about switching to a Medicare Advantage plan, understand the timing before you drop anything. In most cases, once you drop a Medigap policy you won’t be able to get it back — whether you can, at what price, and with what health questions, depends on your state’s rules and your specific situation. Your Medigap policy also can’t pay any of a Medicare Advantage plan’s deductibles, copayments, coinsurance, or premiums, so keeping both rarely makes sense. In much of the country this is closer to a one-way door than a switch. Learn your state’s Medigap rules before you cancel a policy, not after.
The short version
Check every year; switch only when the check gives you a reason to. Read the ANOC when it arrives in September, confirm your drugs and doctors are still covered next year, and if something important changed, compare on your total expected yearly cost rather than premium alone. Then make your change during Open Enrollment, October 15 through December 7, so it takes effect January 1.
If you’d rather not sort through it alone, your State Health Insurance Assistance Program offers free, unbiased counseling, and 1-800-MEDICARE is available around the clock.
Sources: Medicare.gov, “Open Enrollment” (medicare.gov/health-drug-plans/open-enrollment); Medicare.gov, “Joining a plan” (medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan); Medicare.gov, “Special Enrollment Periods” (medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods); Medicare.gov, “Can I switch or drop my Medigap policy?”; CMS Product No. 11220, “Your Yearly Medicare Review” (medicare.gov/publications).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
This content is for general educational purposes and is not a complete description of benefits. Contact the plan for more information. Medicare Compare Agency, 2201 Providence Park, #150, Birmingham, Alabama 35242.