You may be reading this because your current Medicare coverage isn’t feeling quite right anymore. Maybe your doctor left the network. Maybe your medications changed. Or maybe your health costs have crept up, quietly but steadily.
The thought of switching plans can feel overwhelming, but it doesn’t have to be.
In this guide, we’ll walk you through the seven key checks to make before you switch plans. Do this well, and you’ll avoid surprises. You’ll learn what really matters (not just shiny perks), when you can make a change, and how to carry out a switch with confidence.
Why People Switch Medicare Plans
When people explore new Medicare plans, it’s almost always because something in their current plan no longer fits. Here are the most common motivators:
- Rising Costs: Your premium might jump. Deductibles or coinsurance may shift. What once felt manageable may start to feel burdensome.
- Diminishing or Altered Benefits: Plans can change formularies, drop benefits, or limit services. A drug you’ve relied on may move to a higher cost tier—or be removed.
- Provider Network Changes: If a trusted doctor, specialist, or hospital is dropped from your plan, that’s often what pushes people to look for a new option.
- Relocation or Travel Needs: If you move, or split time between locations (for instance, snowbirds), your plan might not cover you well in the new area—or at all.
- New or Evolving Health Needs: You may require services you didn’t before (physical therapy, home health, specialized care). Your current plan may not support those well.
Switching isn’t about chasing a “shiny plan.” It’s about finding something that works better for your real life now.
Timing Windows: AEP, MA OEP, SEPs, and Medigap Underwriting
Knowing when you can switch is the most important part of the process. If you miss your window, you could be stuck with your current plan for another year..
Annual Election Period (AEP)
This occurs each year from October 15 through December 7. During AEP, beneficiaries can change Medicare Advantage plans, move between Original Medicare + Part D, or enroll in or switch a drug plan. Changes made during AEP typically take effect the following January 1.
Medicare Advantage Open Enrollment Period (MA OEP)
From January 1 through March 31, those already in a Medicare Advantage plan can make one change: either switch to another Advantage plan or drop Advantage and return to Original Medicare (and enroll in a drug plan). This period applies only to current Advantage enrollees.
Special Enrollment Periods (SEPs)
If certain life events occur—like moving, losing other health coverage, or your current plan being terminated—you may qualify to change plans outside the usual windows. The rules and duration depend on the particular event.
Medigap/Medicare Supplement Underwriting & Enrollment
When you first become eligible for Medicare Part B, you get a six-month Medigap open enrollment period, during which insurers must offer you Medigap policies without health questions. After that, switching Medigap plans may require medical underwriting, meaning insurers could charge more or reject you based on health. Some states or situations grant “guaranteed issue” rights in special circumstances.
Network Fit: PCPs, Specialists, and Hospitals
A plan’s provider network can make or break your experience. Here’s what to check:
- Understand what “in-network” means: providers that accept the plan’s negotiated rates.
- Use provider directories, call your doctor’s office, and verify hospital affiliations under the new plan.
- Be wary of narrow networks or plans that drop providers midyear.
- Find out whether you’ll need referrals or prior authorizations.
If you travel or have a second home, check whether the plan provides coverage outside your primary area.
Drug Coverage: Formularies, Tiers, Prior Authorization, and Pharmacies
Drug coverage is as important as medical coverage. Key items to examine:
- Check whether your current medications are on a plan’s formulary (drug list) — and which tier they fall in (lower tiers cost less).
- Watch for restrictions like prior authorization, step therapy, or quantity limits, which may require extra approvals.
- Confirm your pharmacy is in-network; if not, costs may be higher or coverage may not apply.
- Be careful about timing—switching plans at the wrong time can interrupt drug coverage or introduce gaps.
- Use your full medication list with doses and pharmacies when comparing candidate plans.
True Total Cost: Premium + Copays + Coinsurance + MOOP
“Low premium” doesn’t always mean low cost. To see the real picture:
- The monthly premium is only part of the cost (you’ll also pay Medicare Part B).
- Deductibles must often be met before the plan begins to share costs.
- Copays / coinsurance apply after deductibles are satisfied.
- Maximum Out-of-Pocket (MOOP): Medicare Advantage plans must limit the in-network cost you’ll pay in a year. Once you hit that cap, covered services cost you nothing further (but be careful: out-of-network costs may not count).
- Don’t forget hidden costs like lab tests, imaging, outpatient care, or durable medical equipment.
- Project costs using your past usage rather than relying on averages.
Extras vs. Essentials: Don’t Chase Shiny Benefits
Many Medicare Advantage plans advertise extras—like gym memberships, vision or dental, wellness perks. While pleasant to have, extras are not a good substitute for solid foundational coverage.
- Extras change more often and are less stable.
- Your core coverage—hospital care, doctors, medications—must come first.
- Only after the essentials check out should extras influence your decision.
Step-by-Step Switching Medicare Plans Checklist
Use this process when considering a switch:
- List your healthcare providers (PCP, specialists, facilities).
- Compile your full drug list with doses and pharmacies.
- Review your current plan’s annual changes (premiums, network, formulary).
- Use trusted comparison tools to find candidate plans.
- Verify network compatibility by contacting doctors and checking hospital affiliations.
- Project your expected costs under each plan.
- Assess how stable a plan’s benefits have been over prior years.
- Confirm you qualify under a valid enrollment window.
- Submit your enrollment change with timing that minimizes a coverage gap.
- Confirm the effective dates and arrange for termination or overlap of your old plan if needed.
When Medigap + Part D Beats Medicare Advantage (and Vice Versa)
Pros of Medigap + Part D / Original Medicare
- Access to any provider that accepts Medicare (nationwide).
- More predictable coverage with fewer surprises.
- No referrals needed, and better protection against cost spikes.
Cons of Medigap + Part D / Original Medicare
- You pay separate premiums (Medigap + Part D).
- After your initial open enrollment window, switching Medigap plans may require underwriting.
Pros of Medicare Advantage
- Many plans offer low or zero additional premium beyond Part B.
- Bundled coverage—Part A, Part B, Part D, and often extras (vision, dental, wellness).
- Plans must cap in-network out-of-pocket costs for covered services.
Cons of Medicare Advantage
- Network restrictions—some providers may not participate.
- More oversight: prior authorizations, referrals, utilization controls.
- Benefits, formularies, and networks may change annually.
- Out-of-network or out-of-area costs could be high or excluded.
You cannot have a Medigap policy and a Medicare Advantage plan simultaneously. Which option works better depends on your health, usage pattern, geography, tolerance for provider changes, and preference for predictability.
How Brickhouse Helps You Compare
You don’t have to do this alone. Brickhouse supports you by:
- Considering your full personal profile—doctors, medications, travel, lifestyle.
- Creating side-by-side comparisons so you can see trade-offs.
- Explaining terminology and features in clear, everyday language.
- Assisting with timing, paperwork, enrollment logistics, and confirmation.
- Monitoring your plan year to year and advising when it’s time to revisit.
You deserve coverage that fits you. We’re here to help.
FAQs
What is the “trial right” period for Medicare Advantage?
If you first enroll in Medicare Advantage when you’re first eligible for Medicare, you generally have a 12-month trial period during which you can switch back to Original Medicare and enroll in a Medigap plan without underwriting in many cases.
What happens to my existing plan when I make a switch?
A new plan typically begins on a set effective date. You should wait until the new plan is confirmed before terminating or letting your old plan lapse, so you don’t end up uninsured during a coverage gap.
If a drug was covered under my old plan, does that guarantee it’s covered under a new one?
No — a drug that was in a favorable tier under your old plan may be placed in a higher cost tier, be subject to restrictions, or even be excluded under the new plan’s formulary. Always check formularies carefully when comparing.
Should I pick a plan just for its extras (vision, dental, gym)?
Extras are nice, but they shouldn’t outweigh the fundamentals. Prioritize core coverage — doctors, hospitals, medications — before allowing perks to influence your decision. Extras can change from year to year, so they are less reliable.
If I switch to Medicare Advantage, can I still see any doctor I choose?
Not always. Medicare Advantage plans usually have networks. If your provider isn’t in-network, your out-of-pocket costs may be higher or services may not be covered. Some plans allow limited out-of-network care, but terms vary widely.
How do I estimate which plan will cost me the least?
Look beyond the monthly premium. Add in deductibles, copayments, coinsurance, and the maximum out-of-pocket (MOOP). Use your personal history of healthcare usage (doctor visits, tests, prescriptions) to compare realistically.
Will my new Medicare plan stay the same each year?
No — many plans revise benefits, costs, formularies, or networks annually. That’s why it’s wise to review your plan during each enrollment period to ensure it still meets your needs.
Talk Through Your Options with Brickhouse
Don’t stay stuck in a plan that no longer serves you. Reach out, and we’ll walk through your options together—no pressure, just clarity. Schedule a free consultation, complete a plan comparison form, or contact us directly.
Let’s work together to find the Medicare coverage that truly fits you—today and for the years ahead.
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Written by Niki Feret
Licensed Independent Medicare Insurance Agent
Founder, Brickhouse Agency & Chicagoland Medicare
As a female agency owner in a space that’s often dominated by call centers and cookie-cutter advice, I started Brickhouse to do things differently.
We’re a boutique Medicare agency—real people helping real people. No scripts, no pressure, and no one-size-fits-all recommendations. Just thoughtful, personalized guidance that helps you make confident Medicare decisions. If you’re ready to feel supported—not sold—
Schedule a free consultation here. There’s no cost and no obligation to enroll. Ever.
