Frequently Asked Questions
When can I switch Medicare plans?
The main window to switch Medicare plans is Annual Enrollment Period (AEP), October 15–December 7 each year, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period (January 1–March 31) allows one additional change if you are already in Medicare Advantage. Certain life events trigger Special Enrollment Periods outside these windows.
Can I switch from Medicare Advantage to Original Medicare?
Yes — you can switch from Medicare Advantage back to Original Medicare during AEP (October 15–December 7) or during the MA Open Enrollment Period (January 1–March 31). However, when switching back to Original Medicare after your initial enrollment period, Medigap insurers in most states can deny coverage or charge more based on health conditions.
What happens if I don't review my Medicare plan each year?
If you do nothing during AEP, you automatically stay in your current plan — but your plan may have changed its premiums, drug formulary, provider network, and copays for the coming year. Not reviewing can mean your medications are no longer covered at acceptable cost, your doctors are no longer in-network, or significantly better options are now available.
Can I switch Part D plans every year?
Yes — you can switch to any available Part D plan in your area every year during AEP (October 15–December 7). Changes take effect January 1. Given that Part D plans change their formularies and pricing annually, reviewing and potentially switching your Part D plan every October is one of the highest-value Medicare actions you can take.
Your Medicare plan is not a set-it-and-forget-it decision — it requires annual review just like your investment portfolio. Plans change their networks, formularies, and cost structures every January. The plan that was perfect for you last year may have added your specialist to an out-of-network tier, dropped your most expensive medication, or significantly increased its premium. Here are 8 signs it is time to switch.
8 Signs You Need to Switch
Sign 1 — Your Drug Costs Increased Significantly
If your out-of-pocket costs for specific medications increased substantially from one year to the next — or a medication you rely on was moved to a higher formulary tier — this is the clearest signal to compare Part D plans. A different plan may cover the same drugs at dramatically lower cost.
Sign 2 — Your Doctor Left the Network
If your primary care doctor, cardiologist, or other specialist is no longer in your Medicare Advantage plan's network, you are paying higher out-of-pocket costs for their care — or forcing yourself to switch doctors. During AEP, verify your key doctors are still in-network for next year before deciding to stay.
Sign 3 — You Were Denied Care You Expected to Be Covered
Prior authorization denials, step therapy requirements, or care that was covered last year being denied this year are signals that your plan's coverage policies may have tightened. If you experienced multiple denials in the past year, compare plans with less restrictive prior authorization requirements.
Sign 4 — Your Health Needs Changed
If you were diagnosed with a new chronic condition, had major surgery, started expensive new medications, or anticipate significant healthcare utilization next year, your optimal plan may have changed. A plan that was ideal when you were healthy may not be optimal now that you have complex needs.
Sign 5 — Your Plan's Premium Increased More Than 5%
Some premium increases are normal — but increases above 5% warrant comparison shopping. Medicare Advantage plans sometimes increase premiums significantly when their loss ratios indicate the plan was underpriced. Your Annual Notice of Change letter (mailed each September) details all premium and benefit changes for the coming year.
Sign 6 — You're Paying IRMAA but Not Getting Value From Medicare Advantage
Higher-income seniors paying IRMAA surcharges are already paying significantly more for Medicare. If you are in a Medicare Advantage plan that restricts your provider network and requires prior authorizations on top of IRMAA premiums, switching to Original Medicare plus Medigap Plan G may provide better value and fewer restrictions.
Sign 7 — You're Traveling More or Relocated
Medicare Advantage HMO plans provide emergency coverage only outside their service area. If you travel frequently, spend winters in another state, or relocated, your HMO coverage may be inadequate. A Medicare Advantage PPO — or Original Medicare — provides much better coverage flexibility for those who are geographically mobile.
Sign 8 — A Better Plan Is Available in Your Area
New Medicare Advantage and Part D plans enter markets regularly. The best plan in your zip code may not have existed when you first enrolled. Use Medicare.gov Plan Finder every October to see all available plans — a newer plan may cover your doctors, include your drugs, and cost less than your current plan.
Action — What to Do in October
- Read your Annual Notice of Change letter — it arrives in September and details every change to your plan
- List your current doctors, hospitals, and medications
- Go to Medicare.gov Plan Finder and compare all available plans with your actual needs
- Call your SHIP counselor for free, unbiased comparison help
- If a better plan exists, switch by December 7