If you’re a senior enrolled in a Medicare Advantage (Part C) plan, the Medicare Advantage Open Enrollment Period (MA-OEP) is a crucial time to review your healthcare needs and make adjustments to your plan. Running from January 1 to March 31, this period offers you an opportunity to refine your coverage and ensure it aligns with your health and financial situation.

What Is the Medicare Advantage Open Enrollment Period?

If you are currently enrolled in a Medicare Advantage Plan, you can use the MA-OEP to make a one-time change to your coverage. It is not for individuals in Original Medicare (Part A and Part B) who want to switch to a Medicare Advantage plan for the first time.

During the annual MA-OEP window, those already enrolled in a Medicare Advantage plan can:

  • Switch to another Medicare Advantage plan (with or without prescription drug coverage).
  • Return to Original Medicare and add a stand-alone Prescription Drug Plan (Part D), if needed.

Any change you make during the MA-OEP takes effect on the first day of the month after your request is received. For example, a change made in January becomes effective February 1st.

Unlike the Annual Enrollment Period (October 15 to December 7), the MA-OEP does not allow beneficiaries to:

  • Switch from Original Medicare to a Medicare Advantage plan.
  • Enroll in a Part D prescription drug plan if they have Original Medicare without drug coverage.

Why Is This Period Important?

Life changes, and so do your healthcare needs. The MA-OEP gives you a second chance to evaluate whether your current Medicare Advantage plan is still the best fit for you. Here are some common reasons seniors take advantage of this enrollment period:

  • Changes in Health Needs: Perhaps you’ve been prescribed new medications or require different specialists who aren’t covered under your current plan. 
  • Dissatisfaction with Current Plan: Maybe you’ve encountered higher costs, reduced benefits, or limited provider networks that no longer meet your expectations. 
  • Newly Available Plans: Sometimes, new or improved plans become available in your area that better suit your needs.

How to Make the Most of MA-OEP

1. Review Your Current Plan

  • Examine your plan’s coverage, costs, and network of providers.
  • Look at the "Explanation of Benefits" or the Annual Notice of Change (ANOC) from your insurer. 

2. Evaluate Your Healthcare Needs

  • Consider any changes in your health or medications since you first enrolled.
  • Think about your anticipated healthcare usage for the year ahead.  

3. Compare Options

4. Seek Professional Advice

  • Reach out to a Medicare counselor at your local State Health Insurance Assistance Program (SHIP).
  • Contact your current plan’s customer service team to clarify benefits and network details. 
  • Contact the team at Flagship Health for support – as a primary care provider, we frequently assist patients in navigating the complexities of health plans.

5. Act Before March 31

  • Make any necessary changes promptly. New coverage will start on the first day of the month after your plan change is processed. 
  • Delaying changes could mean staying locked into a plan that no longer meets your needs or paying higher out-of-pocket costs for care and medications that could be better covered by a different plan.

Important Medicare Advantage Changes for 2026

As you’re evaluating your current plan and considering your options, take these key Medicare Advantages changes for 2026 into account:

  1. More Medicare Advantage Plan Cancellations
    An estimated 1 million seniors will be losing their Medicare Advantage plan in 2026. More of these contracted plans are getting cancelled by insurance companies in the coming year due to tighter regulations, new federal rules, and increasing costs. It’s essential to check your annual notice of change to know whether your current plan will be offered in 2026. 

  2. Part D Out-of-Pocket Cap Increase
    The maximum amount you will pay out-of-pocket for covered Part D prescription drugs in 2026 is capped at $2,100 (up from $2,000 in 2025). Once you reach this cap, you will have no further copayments or coinsurance for covered Part D drugs for the rest of the year.

  3. Updates to Insulin Costs
    The Part D deductible will not apply to covered insulin products, ensuring you can access your insulin without first meeting your plan's deductible. The monthly cost-sharing cap remains at $35 per month for a one-month supply of covered insulin products.

  4. Behavioral Health Cost-Sharing Parity
    Medicare Advantage plans are now required to match or improve upon the cost-sharing limits in Original Medicare for certain behavioral health services, such as mental health and substance use disorder services. This is intended to ensure you do not pay more for these services in an MA plan than you would under Original Medicare.

  5. Automatic Renewal for Prescription Payment Plans
    If you are enrolled in the Medicare Prescription Payment Plan (MPPP), which allows you to spread out-of-pocket drug costs into monthly payments, your participation will now automatically renew for 2026 unless you actively opt out.

Key MA-OEP Tips for Seniors

  • Avoid Gaps in Coverage: If you’re switching plans, confirm that your new plan starts before your old one ends.
  • Check Prescription Coverage: Ensure your medications are included in the plan’s formulary.
  • Understand Costs: Review premiums, deductibles, co-pays, and out-of-pocket maximums.
  • Verify Providers: Confirm that your preferred doctors, hospitals, and specialists are in the network. 

How Flagship Health Can Help

At Flagship Health, we understand the unique healthcare needs of seniors. Our team is here to provide guidance by helping you compare plans, clarify benefits, and navigate your options during the MA-OEP. It's what we do for all patients who need such support. Whether you’re considering switching plans or simply need clarification, we’re here to support you every step of the way.

Contact us today to learn more about how we can assist you in optimizing your Medicare Advantage plan for the year ahead.