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One of the great things about Medicare is that you’re never locked into a single form of coverage. Twice a year, you’re able to make changes.
The next “change period” is coming up—Medicare’s Special Enrollment Period, which starts on October 15 and ends on December 7.
As we do at this time every year, let’s take a look at what you can change during this timeframe.
Note that any decisions you make will go into effect on January 1, 2026.
Move from Original Medicare to Medicare Advantage
If you’re an Original Medicare subscriber, meaning that you’re separately enrolled in Medicare Parts A and B and optional Medicare Part D prescription coverage and Medigap coverage, you can switch to a Medicare Part C plan—also called Medicare Advantage.
Why would you do this? For two reasons: Convenience and costs.
Medicare Advantage plans are offered by private health insurance companies in your state. These bundled plans cover some (but not always all) out-of-pocket medical care and prescription drug costs not covered by Medicare Part B.
With a Medicare Advantage plan, you’ll still pay your monthly Medicare Part B premium. But your additional Medicare Advantage monthly premium could be significantly less than if you paid for separate Medicare Part D and Medigap coverage. With some plans, some of your co-pays may be lower as well.
The main tradeoff for choosing a Medicare Advantage plan is that you may be limited to using only the physicians and facilities in the insurer’s network.
This could be an issue if your primary care physician or a specialist they recommend isn’t part of the network. It could also be a problem if you spend part of the year in a different part of the country where your health insurer doesn’t have a network.
In these situations, Medicare Part B may cover some of your medical costs, but your Medicare Advantage plan may not “fill in the coverage gaps.”
Switch Medicare Advantage providers
During this enrollment period, you can switch from one Medicare Advantage provider to another. Common reasons you might do this:
- Other Medicare Advantage plans have lower monthly premiums.
- Other plans offer lower co-pays or deductibles.
- Other insurer networks offer access to physicians you want to see.
- Another plan has a network in a state where you plan to spend part of the year.
Keep in mind that while Medicare Advantage providers generally can't prevent you from signing up for a plan if you have a pre-existing condition, they may reserve the right to deny coverage for treatment of that condition. If you have a pre-existing condition. take the time to see what’s covered by any insurer you’re considering.
Move from Medicare Advantage to Original Medicare
During this enrollment period, many Medicare Advantage subscribers choose to drop their plan and switch over to separate Medicare Parts A and B and Medicare Part D coverage.
As mentioned above, the most common reasons people make the switch:
- They want to be able to receive medical care from any physician and facility that accepts Medicare payments.
- They intend to live somewhere else for part of the year.
- They’re unhappy with the general Medicare Advantage concept.
Add, change or drop Medicare Part D coverage
If you’re enrolled in Original Medicare, you can sign up for a Medicare Part D prescription drug plan during this time or change your current plan. Part D coverage is provided by private insurers, and coverage levels and premiums vary.
Why would you make the switch?
- Your current Part D provider no longer covers some of the costs of your prescription medication.
- You add a new prescription that isn’t covered by your current provider.
- Another Part D provider offers better coverage of your medication.
If you’re switching from Medicare Advantage to Original Medicare, you can sign up for Medicare Part D coverage during this time.
You can also choose not to sign up for Medicare Part D (or cancel your Part D coverage entirely). But this is generally not advisable, because if you’re not enrolled you may end up paying a lifetime enrollment penalty if you decide to sign up for Part D coverage later on.
Add Medigap coverage
If you choose Original Medicare when you initially enroll, you can also purchase supplemental Medigap insurance provided by private insurers.
This insurance pays for some but not necessarily all costs that aren’t covered by Medicare Parts A and B.
But there may be issues if you don’t sign up for Medigap right away (or sign up for it after moving from Medicare Advantage to original Medicare).
That’s because if you initially enroll in Original Medicare, rather than Medicare Advantage, Medigap providers cannot deny coverage or charge higher premiums if you have a preexisting condition.
But if you sign up for Medigap at any time after your initial enrollment period, or you switch from Medicare Advantage to Original Medicare plus Medigap, you may be denied coverage by one or more health insurers because of preexisting conditions.
Whether Medicap providers can deny this coverage depends on state regulations. For example, Connecticut, Massachusetts, Maine, and New York don't allow Medigap insurers to deny coverage based on preexisting conditions under any circumstances.
Understanding your options
Even though you can change your Medicare coverage every year, doing so isn’t something you should treat lightly. It’s important to fully understand the implications of switching.
If you need to weigh the pros and cons of making a change, consider contacting a member of your State Health Insurance Assistance Program (SHIP). These local volunteer consultants can work with you at no charge to guide you through this process. To find a SHIP counselor in your area, visit https://www.shiphelp.org.
This material has been provided for general informational purposes only. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a qualified Medicare consultant for specific Medicare-related assistance.
This article was authored by Chris Gullotti and Jeffrey Briskin. Chris is a financial advisor and Partner with Canby Financial Advisors, a SEC-registered investment adviser. SEC registration does not constitute an endorsement by the SEC nor a statement about any skill or training. Chris can be reached at 508.598.1082 or cgullotti@canbyfinancial.com. Jeffrey Briskin is Director of Marketing at Canby Financial Advisors.
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