Choosing Your Medicare Plan

In my last piece, I talked about the critical choices regarding Medicare that need addressing during the initial enrollment or the annual public offering period, which runs from October 15, 2025, to December 7, 2025. The decisions you make will influence your health insurance costs and coverage for all of 2026.

Today, I want to dive deeper into how to select or change Advantage plans or revert to Original Medicare. Remember, these changes are only possible during the current open enrollment or in the first quarter of next year. Missing this window can lead to serious financial consequences and restrict your access to care for the upcoming year. Just because your coverage was fine this year doesn’t mean it will be next year if you choose to ignore this opportunity.

Original Medicare: Changes to Premiums

If you’re on Original Medicare with Supplements, there isn’t a lot of action required from year to year. With Original Medicare, you have the freedom to visit any provider who accepts Medicare—most do—and your supplements will help with costs, regardless of where you reside. It’s a great option, though certainly on the pricier side.

However, the costs associated with Original Medicare keep climbing each year. An announcement regarding 2026 is anticipated in early November, suggesting that monthly premiums could rise from $185 to $206.50 in 2025. That’s an 11.6% increase and the most significant surge in several years. Unfortunately, increases in the Medicare Part B premium may offset the estimated 2.7% cost-of-living adjustment in Social Security benefits.

Also, for higher-income individuals, there may be increased monthly Part B premiums, known as IRMAA surcharges, which could add considerable expense to your monthly budget. Further details are forthcoming along with the announcement of Part B Premiums.

Supplement prices are also expected to rise, likely between 7% and 9%. With all these costs going up, sticking with your current supplements is advisable as long as their service meets your needs. You can compare supplement costs on Medicare.gov. If prices become unmanageable, you might need to consider a lower-cost plan with less coverage for copayments and other out-of-pocket expenses, but this is contingent upon your health qualifications.

Rising expenses can be a substantial burden for many seniors, which is why nearly half choose Advantage plans that offer lower out-of-pocket costs.

Switching Between Advantage Plans

For the last four years, I’ve shared insights into the limitations of Advantage plans, which are basically managed care options. In recent months, service delays and claim denials have become more frequent. Your Advantage Plan can work well as long as you’re healthy, but once you fall ill and seek specialized care, you might run into obstacles within the plan’s provider network and face approval delays.

This year’s dilemma is heightened, as many healthcare providers have chosen to leave last year’s plans due to licensing issues and inadequate reimbursements.

That’s why reviewing your Medicare Advantage plan right now is critical. The current open enrollment period and the Advantage open enrollment in the first quarter of next year are the only times participants can make alterations, whether that’s switching to a different Advantage plan or reverting back to Original Medicare.

Pay attention to notifications from your current plan, especially regarding price changes and the list of participating doctors and hospitals. If your healthcare provider isn’t part of the plan anymore, reach out to them immediately to find out what local Advantage options they are part of.

You can start your search at Medicare.gov, where you can investigate Advantage plans and utilize each plan’s provider directory to locate suitable doctors, specialties, or hospitals. It can be a bit tedious, and it’s hard to predict which specialists you might need if something goes wrong next year.

Free assistance is available, funded through commissions included in the cost of your plan. For advice from agents who sell Advantage plans in your area, check out eHealth.com or BoomerBenefits.com. You can also explore state health insurance assistance programs at ShipHelp.org.

Returning to Original Medicare and Supplements

When people become ill and prefer to take charge of their care, many seek to switch from an Advantage plan to Original Medicare. This transition is possible during open enrollment, but bear in mind that in many states, acceptance for the most comprehensive supplements is not guaranteed due to pre-existing conditions. To enjoy the provider flexibility of Original Medicare, you may end up with less out-of-pocket coverage, which could mean higher direct costs.

It’s frustrating, to say the least, that seniors must navigate this process each year to ensure their insurance is both affordable and thorough. Yet, we can’t afford to overlook this step. That’s just the harsh reality.

Next week’s column will focus on reviewing Part D drug plans, which is crucial to tackle right now.