What you need to know about switching plans

Consumers with Medicare Advantage health insurance are in the midst of a brief annual period during which they can reevaluate their coverage options. Experts say it would be wise to reevaluate this year, as both the Centers for Medicare and Medicaid Services and private insurers consider changes.

In late January, CMS announced new proposed policies for Medicare Advantage and Part D aimed at ensuring the accuracy of payments to insurance companies, the agency said. It also proposed that the new Medicare Advantage payment rate would be roughly flat, rising just 0.9% from 2026 to 2027, amounting to $700 million in payments to plans.

Government payment rates determine the amount that insurance companies can charge policyholders for premiums and plan benefits.

Shares of major healthcare companies fell following the announcement. Analysts are predicting a 4% to 6% increase, and insurers say the proposed rate could prompt benefit cuts or plan cancellations.

More than half (54%) of Medicare beneficiaries were enrolled in Medicare Advantage in 2025, according to KFF, a nonpartisan health policy, research, polling, and news organization. According to KFF, approximately 34.1 million beneficiaries are enrolled in Medicare Advantage, compared to 62.8 million enrolled in Medicare Parts A and B.

united healthcare CEO Tim Noel said on a Jan. 27 earnings call that the company could lose an estimated 1.3 million to 1.4 million Medicare Advantage members in 2026, as competition in the market causes more members to snap up the membership.

“For the people who have been working on this plan, it’s going to have some real-world impact someday,” says Philip Moller, author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.

In 2024, United Healthcare or humana According to KFF’s 2025 study, it represents the largest Medicare Advantage insurer in more than half of the counties.

Despite the changes on the horizon, the Medicare Advantage market in 2026 will be “pretty solid,” said Tricia Newman, executive director of KFF’s Medicare policy program.

“The average beneficiary can choose from more than 30 Medicare Advantage plans, and virtually all of them offer additional benefits such as vision, hearing, and dental,” Newman said in an email.

Medicare Advantage plans, also known as Part C, are offered by private insurance companies and typically cover the same areas as the original government-run Medicare Parts A and B plans, and sometimes Part D prescription coverage.

Medicare Advantage Open Enrollment is available to enrollees until March 31st.

During this period, current Medicare Advantage enrollees can switch to another Medicare Advantage plan or drop their Medicare Advantage coverage and return to Original Medicare. This typically includes Medicare Parts A and B hospital and medical insurance, and selective Part D prescription drug coverage.

“I would encourage people to take the time to research whether they have Medicare Advantage,” Mueller said.

Medicare Advantage plans may include features that help attract enrollees. Some plans will have zero premiums, Moller said. Some plans offer supplemental benefits not typically included in government-sponsored Medicare plans, such as dental, hearing and vision, he said.

“Medicare Advantage makes sense for people who don’t have very high medical needs,” Moller said.

If you have a serious medical condition, your Medicare Advantage plan may cost more.

“When you’re healthy, you love Medicare Advantage because it’s cheaper,” says Carolyn McClanahan, a physician and certified financial planner with Life Planning Partners in Jacksonville, Florida.

“But as soon as you get seriously ill, you have to go through all this pre-approval and get denied and challenge it,” she says.

McClanahan, who is also a member of CNBC’s Council of Financial Advisors, said Medicare Advantage plans often require patients to stay in-network rather than see their preferred doctor.

The current open enrollment period allows Medicare Advantage enrollees to switch to Medicare Original.

But experts say original Medicare enrollees should be aware that Medigap private insurance plans can have high out-of-pocket costs, which are often required to cover additional costs such as copays, coinsurance and deductibles.

“People need to do their homework and make sure they have a good landing spot,” Moller said. “Personally, I wouldn’t have been on Original Medicare without the (supplemental) plan. There’s just too much exposure.”

Most states require Medicare Advantage enrollees who want to switch to Original Medicare to go through the underwriting process to qualify for Medigap.

“If you’re already sick, you’re not going to pass underwriting,” McClanahan said.

McClanahan said there are only four states where individuals can switch to a Medigap plan without underwriting: Connecticut, Maine, Massachusetts and New York.