by Kevin Rigg, CFP®, CPA®
Medicare open enrollment is in full swing (from October 15th to December 7th), so whether you have a Medicare Advantage plan or Original Medicare, now is the time to review your current coverage and determine if any changes are needed. Medicare Advantage plans have grown in popularity since their introduction in 1997 (originally known as Medicare Part C). They are now used by over half of Medicare beneficiaries, according to the KFF analysis below.
This steady growth highlights the increasing popularity of Medicare Advantage plans compared to Original Medicare. However, it remains unclear whether this trend will continue, given the evolving health insurance landscape and proposed legislative changes set to take effect in 2026.
Here are a few ideas to consider when considering your coverage needs:
Check your Annual Notice of Change: This will show if premiums, deductibles, or copayments are increasing—or if your preferred doctors and prescriptions will still be covered.
Evaluate Prescription Drug Coverage: Drug formularies (the list of covered medications) can shift annually. Confirm that your medications are still included, and compare plans to find the lowest out-of-pocket costs at your preferred pharmacy.
Assess Changes in Health Needs: If you’ve had new diagnoses or other health changes, your current plan may no longer fit as well as it once did. Open Enrollment is your opportunity to realign your coverage with your current situation.
What’s the Big Deal?
If you’re considering switching between Medicare Advantage and Original Medicare, it’s important to understand the distinct benefits and trade-offs between the two types of plans:
Coverage Structure: Medicare Advantage (Part C) is offered by private insurers approved by Medicare, typically through HMOs or PPOs (which often have network restrictions and can change each year). Original Medicare (Parts A and B) is administered directly by the federal government, allowing beneficiaries to see any provider that accepts Medicare nationwide.
Costs and Out-of-Pocket Limits: Medicare Advantage plans are required to have annual out-of-pocket caps, offering some financial protection but with varying cost-sharing structures. Original Medicare generally has no annual out-of-pocket maximum, though Medigap coverage is available for purchase to fill cost gaps.
Additional Benefits: Medicare Advantage plans often include vision, dental, hearing, fitness programs, and prescription drug coverage (Part D). Original Medicare covers only medically necessary services, with extras requiring supplemental plans.
You can learn more about 2026 Medicare plan options and changes on the Medicare website (www.medicare.gov) or in the Medicare & You handbook (http://bit.ly/3L5znKf).
We’re Here to Help!
Your advisor is available to help, too, so please reach out if you have a general question or would like a comprehensive review of your plan — we'd be happy to provide insights and guide you in the right direction.
