What to Review in Your Medicare Advantage Plan Each Year

Review your plan every fall during the open enrollment period, because coverage and costs change yearly and your health needs may have shifted

Medicare Advantage plans change their coverage, costs, and provider networks every January 1st. The window to switch plans or return to Original Medicare runs from October 15 through December 7 each year. If you do not review your current plan against what is available, you may stay in a plan that no longer fits your situation — one where your doctor dropped out, your medications cost more, or your out-of-pocket maximum climbed.

This checklist walks you through what to examine and when, so you can decide whether to stay put or make a change before the deadline.

Key Takeaways

• Open enrollment runs October 15 through December 7 each year, and any changes you make take effect January 1st.
• Start your review by checking whether your doctors, specialists, and hospitals are still in-network for the coming year, because provider networks shift annually.
• Compare what you actually paid out of pocket last year against what your current plan charges, then check what competitors charge for the same services.
• Verify that your regular medications are covered at the same cost tier, because formularies (the list of covered drugs) change and sometimes drugs move to higher tiers.
• If you switch plans, your coverage ends December 31st and new coverage begins January 1st, so time any needed procedures accordingly.

Check your doctors and hospitals are still in-network

Medicare Advantage plans contract with specific networks of doctors, specialists, and hospitals. Those networks change every year. A doctor you saw all last year may have left the network, or a hospital may have dropped out. If you need care from an out-of-network provider, you typically pay much more or the plan may not cover it at all.

Pull up your plan's provider directory on its website or call the plan directly. Search for each doctor and specialist you see regularly, plus the hospital where you would go for emergency care or surgery. Write down their names and note whether each one shows as in-network. If a key provider is no longer listed, call that provider's office to confirm — sometimes the directory lags behind reality. If your provider truly left the network, you have two choices: switch to a different plan that includes them, or find a new in-network provider.

Do this step first, because if your main doctor is no longer covered, that alone may settle your decision to switch plans.

Compare your out-of-pocket costs from last year

Pull together what you actually paid in 2024 — copays at doctor visits, coinsurance percentages, deductibles you met, and any costs for specialists or hospital stays. Add it all up. This is your real cost baseline.

Now look at what your current plan charges for 2025. Check the plan's Summary of Benefits document (your plan mails this in September, or you can find it on the plan's website). Write down the deductible, the copay for a primary care visit, the copay for a specialist visit, and the out-of-pocket maximum. Then look at what you expect to need in the coming year — if you know you will have surgery, a hospital stay, or regular physical therapy, estimate those costs using the plan's cost-sharing amounts.

Compare that estimate to what you paid last year. If costs are climbing and you have options, this is the time to shop. Also check whether your plan has a $0 deductible or whether you have to meet a deductible before coverage kicks in — plans vary widely on this.

Verify your medications are covered at the same cost

Medicare Advantage plans use a formulary — a list of covered medications organized by cost tier. A drug you paid $10 for last year might move to a higher tier and cost $40 this year. Some drugs get removed from the formulary entirely, meaning your plan will not cover them at all.

Go to your plan's website and search the 2025 formulary for each medication you take regularly. Note the tier (usually Tier 1 is cheapest, Tier 5 is most expensive) and the copay amount. If a drug moved to a higher tier or is no longer covered, contact your doctor. They may be able to request an exception from the plan, or they may switch you to a different medication that is covered at a lower cost.

If your plan will not cover a medication you need and will not grant an exception, switching to a plan that does cover it may be worth the change. This is especially important for chronic conditions where the medication is not optional.

Look at what other plans cost for your situation

Once you know what your current plan will cost you in 2025, spend 30 minutes comparing it to other Medicare Advantage plans in your area. Medicare.gov has a plan comparison tool where you can enter your doctors and medications, and it will show you what each plan charges for your specific situation.

You do not have to switch to save money — sometimes your current plan is still the best deal. But if a competitor plan covers your doctors, covers your medications at lower tiers, and has lower out-of-pocket costs, the math may favor switching. Write down the names and plan IDs of any plans that look better, so you have them ready if you decide to make a change.

Check whether your plan has dental, vision, or hearing coverage

Many Medicare Advantage plans include dental, vision, or hearing benefits that Original Medicare does not cover. These benefits vary widely — some plans offer a cleaning and exam once a year, others cover more. Some plans cover hearing aids, others do not.

If you use dental, vision, or hearing services, check your plan's Summary of Benefits to see what is covered and what you pay. If your current plan covers these services and you are thinking of switching, make sure the new plan covers them too, or you may lose that benefit. If your current plan does not cover something you need, check whether a competitor plan does.

Make your decision and switch before December 7th

Once you have reviewed your current plan and compared it to alternatives, decide whether to stay or switch. If you want to switch, you have two routes: you can call your new plan directly and they will walk you through enrollment, or you can go to Medicare.gov and enroll there. Either way, your new coverage starts January 1st and your old coverage ends December 31st.

If you are having surgery or a major procedure, think about timing. If you switch plans, you may have a new deductible to meet starting January 1st. If you can schedule elective surgery before the end of December, you may save money by doing it under your current plan's deductible. If you are unsure, call both your current plan and your new plan to ask how costs would work.

Mark December 7th on your calendar as your deadline. After that date, you are locked into your plan for the year (with rare exceptions for people who lose coverage or move).

Frequently Asked Questions

What if I miss the December 7th deadline?

You will stay in your current plan for the rest of the year. You cannot switch Medicare Advantage plans again until October 15th of the following year, unless you have a may have access to life event like moving, losing coverage, or becoming newly may be able to access for Medicaid. If your situation changes dramatically — your doctor leaves the network or your medication becomes uncovered — contact your plan to ask whether an exception is possible.

Can I go back to Original Medicare during open enrollment?

Yes. If you decide Medicare Advantage is not working for you, you can switch to Original Medicare (Part A and Part B) during the October 15 through December 7 window. Your coverage starts January 1st. If you switch to Original Medicare, you may want to enroll in a Medigap or Part D plan at the same time, because Original Medicare does not cover prescription drugs.

Do I have to pay a penalty if I switch plans?

No. Switching Medicare Advantage plans during open enrollment has no penalty. You can switch as many times as you want during the enrollment window without extra cost. The only time a penalty applies is if you go without creditable drug coverage for 63 days or more, which is a separate rule.

What if my plan is being discontinued?

Medicare notifies members if their plan is ending. If your plan is discontinued, you will be automatically moved to another plan offered by the same company, or you can choose a different plan during open enrollment. You will receive a notice by September 30th if your plan is ending, so you will have time to review your options.

How do I know if a plan's network is good for my needs?

Check the provider directory for the specific doctors and hospitals you use. Do not rely on the plan's marketing materials or general reputation — networks are local and specific. If your main doctor is in-network and your hospital is in-network, that is usually enough. If you see many specialists, check each one individually.