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Open Enrollment for Medicare Advantage Plans: What You Need to Know

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When Does Medicare Advantage Open Enrollment Happen?

Medicare Advantage open enrollment is the annual window when beneficiaries can join, switch, or drop a Medicare Advantage plan. The period runs from October 15 through December 7. Coverage under any new or changed plan begins on January 1 of the following year. During this time, you can also return to Original Medicare if you are leaving a Medicare Advantage plan.

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If you miss this window, your options are limited. You generally must wait until the next open enrollment period unless you qualify for a special enrollment period due to a move, loss of employer coverage, or other qualifying event.

Who Can Make Changes During Open Enrollment?

Anyone enrolled in Medicare Part A and Part B can use the open enrollment window. This includes people who are new to Medicare, those who are dissatisfied with their current Medicare Advantage plan, and individuals who want to switch between different Medicare Advantage plans or move to Original Medicare with a standalone Part D prescription drug plan.

Special Situations

  • New Medicare beneficiaries turning 65 must enroll during their initial enrollment period, which is separate from open enrollment.
  • People who move to a new service area may qualify for a special enrollment period outside the standard dates.
  • Those who lose employer or union coverage may also have a special window to make changes.

What Can You Do During the Open Enrollment Period?

During open enrollment for Medicare Advantage plans, you have several choices:

  • Join a Medicare Advantage plan if you are on Original Medicare.
  • Switch from one Medicare Advantage plan to another.
  • Drop your Medicare Advantage plan and return to Original Medicare, adding a Part D drug plan if needed.
  • Change from a Medicare Advantage plan with drug coverage to a plan without it, or vice versa.

Key Factors to Compare Between Plans

Medicare Advantage plans vary widely in premiums, networks, and benefits. Before the open enrollment deadline, compare these core attributes:

AttributeDetailContext
Monthly PremiumVaries by plan; some have $0 premiumYou still pay the Part B premium
Network TypeHMO, PPO, PFFS, SNPHMOs usually require referrals; PPOs offer more flexibility
Out-of-Pocket MaximumSet by Medicare, changes annuallyLimits your yearly cost sharing
Prescription Drug CoverageIncluded in many plans, some require standalone Part DCheck the formulary for your medications
Star Rating1 to 5 stars from CMSHigher ratings often reflect better quality and service

How to Enroll or Change Your Plan

You can make changes during Medicare Advantage open enrollment through several channels. The Medicare Plan Finder at Medicare.gov lets you compare plans side by side by entering your zip code and current medications. You can also call 1-800-MEDICARE, contact your plan directly, or work with a licensed insurance agent or State Health Insurance Assistance Program counselor.

Have your Medicare number and current plan information ready before you start. Reviewing your Evidence of Coverage and Summary of Benefits documents helps you confirm provider networks, drug formularies, and cost-sharing details.

What Happens After Open Enrollment Ends?

Changes made during the open enrollment period take effect on January 1. Once the December 7 deadline passes, you generally cannot make changes until the next open enrollment period. The only exceptions are special enrollment periods triggered by qualifying events such as relocation or loss of other coverage.

Planning Ahead for Next Year

Insurers update Medicare Advantage plan details each year, which means premiums, networks, and drug formularies can shift. Even if you are happy with your current plan, reviewing it during open enrollment ensures it still meets your needs. Pay attention to changes in pharmacy networks, prior authorization requirements, and covered benefits for the upcoming year.

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