With the deadline for Medicare Advantage plan changes fast approaching on March 31, enrollees are urged to review their current plans and consider alternatives if needed. This year’s enrollment period brings along significant updates, particularly with changes affecting drug coverage, routine care, and out-of-network providers.
Medicare Advantage plans, an alternative to traditional Medicare, are run by private insurers and have become increasingly popular among those aged 65 and older. The appeal lies in their additional benefits such as drug coverage, vision, dental, and even fitness classes, often at low or no extra cost. In 2025, enrollment is expected to reach 35.7 million.
However, one of the main challenges with Medicare Advantage plans is the restriction to specific networks of doctors and providers. These networks are subject to change, causing frustration when a preferred doctor or specialist becomes out of network. As a result, enrollees might face increased out-of-pocket costs if they don’t switch plans. The Centers for Medicare & Medicaid Services have introduced new rules to speed up prior authorization requests, but these changes will only take effect in 2026.
An essential aspect to review this year is drug coverage under Medicare Advantage plans. Changes in formularies and preferred pharmacies are common, and the Inflation Reduction Act introduces a new cap on out-of-pocket drug costs at $2,000 annually for Part D plans. This represents a shift from previous years where some plans had no deductible.
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For those contemplating a switch to traditional Medicare, it’s crucial to understand that it does not inherently limit out-of-pocket costs like Medicare Advantage does. Enrollees may need a Medigap policy to cover additional expenses that Medicare does not, such as overseas medical costs.
Experts advise engaging with your State Health Insurance Assistance Program for personalized guidance. The Medicare Rights Center and the Medicare Plan Finder are also valuable resources for comparing plans and understanding coverage details, keeping in mind that any changes during this enrollment period will take effect the following month.
The Medicare Advantage open enrollment period is a limited opportunity for enrollees to ensure their health coverage aligns with their needs. With adjustments in networks, drug costs, and plan benefits, it’s wise to reassess options and make an informed decision before the deadline.
