If you're enrolled in a Medicare Advantage plan and it hasn't been working for you this year, you don't have to wait until fall to do something about it. The Medicare Advantage Open Enrollment Period runs January 1 through March 31 every year, and the deadline is eight days away. This window lets you make one coverage change, whether that's switching to a different Advantage plan or dropping Advantage entirely and returning to original Medicare.
Miss the deadline and you're locked in until October 15, when the fall Annual Enrollment Period opens. Any plan you pick during that fall window doesn't take effect until January 1, 2027. That's a long time to stay in a plan with a network that doesn't include your specialist, or drug coverage that doesn't cover your medications.
Whatever change you make before March 31 takes effect on the first of the following month. So a switch made by March 31 means new coverage starting April 1.
Medicare Advantage vs. original Medicare: what's actually different
Original Medicare is the federal program. It consists of Part A, which covers hospital stays, and Part B, which covers doctor visits and outpatient care. You can see any doctor or visit any hospital in the country that accepts Medicare, with no referrals and no network restrictions. The standard Part B premium is $202.90 per month in 2026, and most people pay nothing for Part A if they worked and paid Medicare taxes for at least 10 years.
The downside of original Medicare is that there's no cap on what you can owe out of pocket. Part A has a hospital deductible of $1,736 per benefit period, and Part B covers 80% of approved costs after you meet the annual deductible, leaving you responsible for the remaining 20% with no yearly limit. A serious illness can run up real costs fast. Most people on original Medicare buy a separate Medigap supplemental policy to cover those gaps, plus a standalone Part D plan for prescription drugs. That adds monthly premiums but provides much more predictable spending.
Medicare Advantage, also called Part C, is sold by private insurance companies approved by Medicare. These plans must cover everything original Medicare covers, and most bundle in Part D drug coverage as well. Many also include extra benefits that original Medicare doesn't touch, like routine dental, vision, and hearing care. In 2026, 98% of individual Medicare Advantage plans offer some vision, dental, or hearing coverage. The trade-off is that you're working within a specific provider network. Most plans require referrals to see specialists, and going out of network can mean significantly higher costs or no coverage at all depending on the plan type.
Advantage plans also come with an annual out-of-pocket maximum, which original Medicare doesn't have. In 2026, that cap is $9,250 for in-network care and $13,900 for combined in- and out-of-network spending. Once you hit it, the plan covers 100% of covered services for the rest of the year. Whether that ceiling feels like a safety net or a scary number depends entirely on your health situation and the specific plan you're in.
The four types of Medicare Advantage plans
Not all Advantage plans work the same way. The most common type is the HMO, or Health Maintenance Organization. HMO plans generally require you to choose a primary care physician who coordinates your care, get referrals before seeing specialists, and stay within the plan's network to receive coverage. In most cases, going out of network means paying the full bill yourself. These plans often have the lowest premiums of any Advantage plan type, which is part of why they're popular.
PPO plans, Preferred Provider Organizations, give you more flexibility. You can see out-of-network providers and usually don't need a referral to see a specialist. You'll pay less if you stay in-network, but out-of-network visits are covered at a higher cost rather than being excluded entirely. PPO plans typically carry higher premiums than HMOs. They're a reasonable choice if you travel frequently, have providers you want to keep who may not be in every network, or just prefer not to route everything through a gatekeeper.
Private Fee-for-Service plans, or PFFS, work differently from both. Rather than a traditional network, the plan sets its own payment rates. You can see any Medicare-approved doctor who agrees to the plan's payment terms, but not all providers will. PFFS plans don't require you to pick a primary care physician or get referrals, but the trade-off is uncertainty about which providers will actually see you. These plans are less common than HMOs and PPOs and tend to cost more.
Special Needs Plans, or SNPs, are designed for people with specific circumstances: a chronic condition like diabetes, heart disease, or HIV/AIDS; eligibility for both Medicare and Medicaid; or residence in a long-term care facility. All SNPs must include Medicare prescription drug coverage as part of the plan. If you qualify for a SNP, the benefits are often more precisely tailored to your condition than a standard Advantage plan would be, including access to the relevant specialists and more targeted drug coverage.
What to check before you switch plans
The most important thing to verify before enrolling in any plan is whether your current doctors and hospitals are in-network. This sounds obvious, but networks change from year to year. A plan that covered your cardiologist in 2025 may not cover the same doctor in 2026. Call the plan directly to confirm, not just the provider's office. The provider may say they take Medicare but not know which specific Advantage plans they're currently contracted with.
Prescription drug coverage is the second thing to check. If your plan includes Part D, pull up the plan's formulary and look up every medication you take regularly. The formulary lists which drugs are covered and at what tier, which affects your copay. If a medication you depend on moved to a higher tier or was dropped from the formulary entirely this year, that affects your out-of-pocket costs significantly. The 2026 annual out-of-pocket cap for prescription drugs is $2,100 under both standalone Part D plans and Medicare Advantage plans with drug coverage.
Total cost matters more than the monthly premium. Plans with $0 premiums frequently have higher deductibles, copays, and out-of-pocket limits. A plan with a modest monthly premium might cost you less overall if you use healthcare regularly. Add up the premium, your likely copays based on how often you visit the doctor, and what your medications will cost under each plan you're considering before making a comparison.
The catch when switching back to original Medicare
Returning to original Medicare is allowed during this enrollment period, but there's a complication that trips up a lot of people. Original Medicare has no annual out-of-pocket cap, so most people leaving Advantage want to pick up a Medigap supplemental policy to limit their exposure. The problem is that outside of specific protected windows, Medigap insurers can refuse to sell you a policy based on your health history.
Federal law gave you a one-time, six-month window when you first enrolled in Medicare Part B to buy any Medigap plan without medical underwriting. If that window has closed, you generally no longer have a guaranteed right to Medigap coverage. The list of conditions Medigap insurers may deny coverage for includes Alzheimer's disease, asthma, cancer, diabetes with complications, high blood pressure, and stroke. Insurers are increasingly checking prescription drug history as the primary driver of underwriting decisions, meaning your medication list may matter as much as your diagnosis history.
There are some exceptions. People who enrolled in Medicare Advantage when they first became eligible at 65 can switch to original Medicare within that first year and still purchase a Medigap plan, a protection sometimes called the trial right. If your Advantage plan leaves the Medicare program or stops serving your area, you also have guaranteed-issue rights to a Medigap plan. And residents of Connecticut, Massachusetts, and New York can buy a Medigap policy at any time without underwriting. Everyone else should contact Medigap insurers in their state to understand their options before they disenroll from Advantage. If you need unbiased help, the State Health Insurance Assistance Program, known as SHIP, offers free counseling in all 50 states. You can find your local SHIP office at shiphelp.org.
How to make a change before March 31
You can only make one coverage change during this window. That means switching to a different Advantage plan, or dropping Advantage and returning to original Medicare with or without a Part D plan. You cannot use this period to move from original Medicare into an Advantage plan.
The easiest way to make a switch is through Medicare's Plan Finder tool at medicare.gov, which lets you compare plans in your area by premium, network, and drug coverage. Changes made this way have an added protection in 2026: if you enrolled based on plan directory information that turned out to be incorrect, you'll qualify for a Special Enrollment Period to make another change. Calling 1-800-MEDICARE (1-800-633-4227) is also an option if you prefer to work with someone directly.
If you contact a plan directly rather than through the official Medicare channels, submit your disenrollment from the old plan and enrollment in the new one at the same time. Doing one without the other can create gaps in coverage.
Whatever change you make, coverage starts April 1. After March 31, you're locked in until the fall enrollment period opens in October.
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