By Susan Stewart, Licensed Insurance Agent
The Open Enrollment Period (OEP) runs from January 1st to March 31st. The purpose is to provide a one-time chance to change your Medicare Advantage plan without precise special circumstances. This way, beneficiaries unhappy with the plan they chose during the Annual Enrollment Period (AEP) from October 15th to December 7th of last year, can pick a new one. It also provides an opportunity to reconsider a long-standing Advantage plan. Doctors and facilities can go out-of-network. Sometimes there were misunderstandings about benefits. That happens easily when you have multiple discussions with multiple agents. There are several very good reasons a plan change is a good idea. OEP is meant to get folks where they need to be for the year.
I believe change continues to come with Medicare. Both Medicare and the carriers of Advantage plans want to see less plan changing. Let’s say I changed your plan in February. That change passes through many hands before it reaches Medicare. They review and approve the change. It goes back to the carrier to issue documents and cards. Healthcare providers have their records to update and determine network, billing, and benefits. When a person can change their plan as often as monthly or every 3 months, keeping up becomes a source of chaos for carriers, healthcare providers, and beneficiaries alike. It’s extra work and costs from all angles. Medicare is trying to discourage multiple plan changes. Healthcare is at its best when a beneficiary understands their plan, and it meets their needs. I often speak with beneficiaries who have no idea what their plan is or what its benefits are. That’s not conducive to confident healthcare.
I’m not suggesting you stay in a plan that isn’t right for you. Just the opposite. But if you count on an agent, doctor’s office, or hospital to do this for you, you’ll likely be disappointed. I advise you not take as gospel the advice of your neighbor, the pharmacist, or even your doctor about your plan. The job of a good agent is to look at ALL the plan benefits that matter to you. What works for your neighbor and what they are eligible for may be completely different from what you need or are eligible for. Your pharmacist knows about drugs, but not your hospital network/copay, or if the specialist that’s so important is in network. Your doctor may know which plans pay them the best or the fastest but may not be aware of the other benefits you’re getting. Do you have a good agent? Keep that number! If you don’t, find one.
If you haven’t used your 2026 plan yet, check with your doctors and facilities to confirm their networks now. Read your benefits. Ask if you have questions. You need to understand your plan. Be proactive in speaking to your doctor about drugs that aren’t in formulary or require pre-authorization. Be proactive with your doctor if your plan requires proof of a chronic health condition. Don’t wait until something goes wrong to pay attention. Be accountable for your own health and healthcare plan by being ready for OEP to close.