7 Key Things You Should Consider Before Signing Up for a Medicare Advantage Plan During This Year’s Open Enrollment Period

Key Takeaways

• Medicare Advantage plans may offer additional benefits beyond Original Medicare, but you need to carefully evaluate coverage, costs, and provider networks before enrolling.

• Open Enrollment runs from October 15 to December 7, 2025, giving you the chance to switch, drop, or enroll in a Medicare Advantage plan that best fits your healthcare needs.

Understand What Medicare Advantage Really Offers

Medicare Advantage, also called Medicare Part C, combines Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan, often with additional benefits like vision, hearing, and dental coverage. Some plans may also include prescription drug coverage. However, the trade-offs vary, so it’s essential to understand what you’re signing up for.

Unlike Original Medicare, these plans operate through private insurance companies approved by Medicare. Each plan has different benefits, provider networks, and costs. You need to weigh the pros and cons based on your health needs, preferred doctors, and budget.

Be Aware of Enrollment Deadlines

Open Enrollment for 2025 runs from October 15 to December 7. This is the only time most Medicare beneficiaries can enroll in, switch, or drop a Medicare Advantage plan. Changes take effect on January 1, 2026.

Outside of Open Enrollment, you can only make changes if you qualify for a Special Enrollment Period (SEP) due to specific life events like moving out of your plan’s service area, losing employer coverage, or qualifying for Medicaid.

Compare Monthly Premiums and Annual Out-of-Pocket Costs

While some Medicare Advantage plans have low monthly premiums, they may have higher copayments, coinsurance, or deductibles compared to Original Medicare. Before choosing a plan, check:

• Monthly premium (if any)

• Annual deductible (how much you must pay before coverage kicks in)

• Copayments and coinsurance (your share of costs for medical visits and services)

• Maximum out-of-pocket limit (the most you’ll pay for covered services in a year)

For 2025, Medicare caps the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans at $9,350 for in-network care and $14,000 for combined in- and out-of-network care. Once you reach this limit, your plan covers 100% of covered services for the rest of the year.

Check if Your Preferred Doctors and Hospitals Are In-Network

Medicare Advantage plans use provider networks, meaning you may need to use specific doctors, hospitals, and specialists to receive full benefits. Networks can include:

• Health Maintenance Organization (HMO) plans: Require you to use in-network providers except in emergencies. You usually need a referral to see a specialist.

• Preferred Provider Organization (PPO) plans: Allow you to see out-of-network providers, but at a higher cost.

• Private Fee-for-Service (PFFS) plans: Let you see any Medicare-approved provider that agrees to the plan’s terms.

If you have specific doctors or hospitals you want to continue using, confirm they accept the Medicare Advantage plan you’re considering. Otherwise, you could face unexpected out-of-pocket expenses.

Evaluate Prescription Drug Coverage and Costs

Not all Medicare Advantage plans include Medicare Part D prescription drug coverage. If yours does, review:

• The formulary (list of covered drugs) to ensure your medications are included.

• Drug tier levels—higher tiers often mean higher copayments.

• Preferred pharmacies—some plans have lower costs at certain pharmacies.

• Mail-order options—may offer savings for long-term medications.

If your plan doesn’t include drug coverage, you’ll need a standalone Medicare Part D plan, but you cannot have both a Medicare Advantage plan and a separate Part D plan at the same time.

Consider Extra Benefits and Their Limitations

Medicare Advantage plans often include extra benefits like:

• Dental, vision, and hearing coverage

• Fitness memberships

• Transportation to medical appointments

• Over-the-counter (OTC) allowances

However, these benefits may come with limitations, such as caps on coverage, restricted networks, or annual limits on how much the plan will cover. Always read the details to ensure the extras are truly valuable to you.

Review Plan Star Ratings and Past Performance

The Medicare Star Ratings system evaluates Medicare Advantage plans based on factors like customer satisfaction, provider responsiveness, and preventive care services. Ratings range from 1 to 5 stars, with 5 stars indicating excellent quality.

Higher-rated plans typically provide better care and fewer issues with claims, but availability may vary by location. If a plan has consistently low ratings, it may indicate problems with coverage, provider networks, or customer service.

How to Make the Right Choice During Open Enrollment

To ensure you pick the right plan for 2025, follow these steps:

1. Review your current coverage. If you already have a Medicare Advantage plan, compare the Annual Notice of Change (ANOC) to see what’s changing next year.

2. Compare costs. Look beyond monthly premiums—consider out-of-pocket limits, drug costs, and copayments.

3. Check provider networks. If keeping your doctor is important, verify that they’re in-network.

4. Confirm prescription drug coverage. Make sure your medications are covered at a cost you can afford.

5. Look at additional benefits. Determine whether dental, vision, or other perks are useful to you.

6. Consider Medicare Star Ratings. Higher-rated plans may provide better service and coverage.

7. Get expert advice. Speak with a licensed agent listed on this website to ensure you understand all your options before making a final decision.