Deadline Approaching for Medicare Advantage Plan Changes

Seniors enrolled in Medicare Advantage plans face an approaching deadline of March 31 to make changes if their selected plan does not meet their needs. After this date, changes cannot be made until the next open enrollment period, except under certain special circumstances.

The Medicare Advantage Open Enrollment Period, which spans from January 1 to March 31, allows beneficiaries to either switch to a different Medicare Advantage plan or revert to Original Medicare. Many seniors only realize the limitations of their current plans—such as network restrictions, higher costs for specialists, or drug coverage changes—after having had time to use their benefits in the initial months of the year.

Common complaints include unexpected network changes where providers deemed "in-network" in prior terms may no longer participate, affecting access to primary care physicians and specialists. Some policyholders also face adjustments to their prescription drug benefits, such as new requirements for prior authorizations, increased copays, or medications being dropped from the plan's formulary. These issues tend to surface with the first drug refills or medical appointments.

Those who rely heavily on brand-name or specialty medications are particularly susceptible to unanticipated costs, prompting a need to reassess whether their current plan aligns with their healthcare and financial needs. Additionally, benefits like dental, vision, and hearing allowances, which can lure seniors during the enrollment period, may appear more limited than initially advertised.

High out-of-pocket costs for specialist visits, imaging services, and other diagnostics often become apparent at the year’s start, leading to surprise expenses. Evaluating these financial impacts is critical to determining whether a plan change is warranted before the March 31 deadline arrives.

Switching back to Original Medicare is an option during this period, but seniors must consider the absence of automatic drug coverage and a cap on out-of-pocket expenses unless supplemental policies, such as Part D and Medigap, are also obtained. However, availability and conditions of Medigap policies vary by state.

Professionals in the insurance field should be aware of these dynamics to effectively guide policyholders through their options and ensure they choose coverage suited to their needs and financial situations. It is imperative that seniors make informed decisions based on their experiences early in the year to ensure continued and adequate healthcare coverage for the remainder of 2026.