The Medicare Advantage Open Enrollment Period

The annual Open Enrollment Period ended December 7 and on January 1, another one began.

First, the Basics

The Medicare Advantage Open Enrollment Period runs from January 1-March 31 and is just for those who elected Medicare Advantage.

During this period, they can:

• Switch to another Medicare Advantage plan with or without prescription drug coverage, or
• Drop the Advantage plan and return to Part A and Part B automatically with the option to enroll in a stand-alone Part D prescription drug plan. They can also apply for a Medigap policy (Medicare supplement insurance). However, they may be subject to medical underwriting.

Those who want to make a switch simply need to enroll in the new Medicare Advantage plan. They can do this by enrolling online through their medicare.gov account or contacting the plan or an independent agent and completing the enrollment process. They will be disenrolled automatically from their current plan and the new plan will take effect the first day of the next month.

If the current plan is the best, no action is necessary; it will renew automatically.

Here’s what can’t be done during this period.

• Enroll in a Medicare Advantage plan, if not already enrolled in one.
• Enroll in a Part D prescription drug plan.
• Change to a different Part D drug plan.

Pay Attention

Here are some of the more significant changes those who have Medicare Advantage can face.

Networks

Recent reports about plan members not being able to find a provider in network and healthcare systems refusing to contract with Advantage plans have raised concerns about the adequacy of plan networks.

What you can do:

Drug deductible

Plans can charge any amount up to the standard deductible, which is $590 this year. According to KFF, only 20% of Medicare Advantage plans charged a deductible last year. This year, 60% of members will face one.

What you can do: Check the Medicare Plan Finder for the plan’s deductible and how that affects your medications. Some drugs are not subject to it and, if they are, the Plan Finder will indicate when you should reach the deductible.

Annual out-of-pocket spending limit

The maximum limits for 2025, established by the Centers for Medicare and Medicaid Services, are $9,350 for in-network care and $14,000 for in- and out-of-network combined. Just as with the drug deductible, plans can set any limit up to the maximum.

What you can do:

• Check your plan’s 2025 information for the limit.
• Then guesstimate how much you will pay for your medical care. If your costs will be high, a plan with a lower maximum might work better.

Cost sharing for medications

Many Advantage plans charge a copayment for Tier 4, non-preferred brand drugs. I have seen several plans that now charge a coinsurance. One example: A nonsteroidal treatment for dry eye had a $100 copayment in 2024. This year, that will be a 50% coinsurance, increasing the monthly cost to $275.

What you can do: Identify how your plan treats your medications. If your plan now has a coinsurance, perhaps a different plan might not.

Star ratings

The quality of Medicare Advantage plans is decreasing. The number of plans receiving 2 or 2.5 stars increased from two (0.03%) in 2022 to 24 (4.6%) in 2025. On the other end of the spectrum, there were 74 5-star plans or 27% of the contracts in 2022 and, in 2025, there are only seven, 1.3%.

What you can do:

• Realize it may be difficult to find higher-quality plans that meet your medical and cost needs.
• Go beyond the overall star rating to the quality of specific items of concern, such as ease of getting needed care and seeing specialists or ease of getting prescriptions filled.

Supplemental benefits

Since 2019, Medicare Advantage plans have been able to offer supplemental benefits for services not covered by Medicare. The primary purpose of these benefits is to maintain health by including a wide range of services: dental, vision, hearing, transportation, fitness, over-the-counter supplies, and more.

Many plans felt a financial pinch in 2024 so pundits predicted there could be changes. The number of benefits that plans offer has declined in some cases but there are also other changes. For instance, one plan with a $2,000 dental benefit covers only 50% of dentures, down from 100%. One of my acquaintances is upset because her favorite place to get glasses is no longer in her plan’s network.

What you can do: Once again, review what other plans have to offer. But remember, your most important concern should be how your plan treats your medical issues.

Other things to check

• The monthly premium: The 2025 average monthly premium for Advantage plans is $17. But premiums can range from zero up towards $200.
• The drug plan formulary: During the fall Open Enrollment Period, I noted many drugs that clients have taken for a long time were not included in their plan’s formulary for 2025.
• Coverage rules for medical services and medications: There is no escaping prior authorization for medical care but check it out for your drugs.
• Pharmacy networks: You may find a significant difference in cost between preferred and standard pharmacies.

A Second Chance

Those who have Part D drug plans get only one chance to review drug coverage and make a change. It is early in January but I have already heard from three who did not pay attention and now face “premiums that have skyrocketed” and drugs that are not covered.

Those who have Medicare Advantage plans get a second opportunity so don’t blow this chance. Dig out the Annual Notice of Changes your plan sent last fall and figure out what to do with your plan before the end of March.