New York Elder Law Attorney
Did you choose a Medicare Advantage (MA) plan during the open enrollment period and are disappointed with the coverage? The good news is the law is on your side. You have until March 31 to enroll in a different MA plan or return to traditional Medicare (TM).
The healthcare and insurance landscape has changed considerably. Healthcare costs are escalating, insurance companies are denying authorizations for necessary treatments, and prescription co-pays are increasing. MA plans change coverage every year or drop coverage in your area. The stakes are high. If you are disappointed with the coverage, you can make a change in the next few days. Here’s what you need to know
The law permits those who choose MA plans to switch to a new MA plan or drop their MA plan entirely and return to traditional Medicare during the Advantage Open Enrollment Period, which runs annually from January 1 through March 31. Once that change is made, it’s locked in for the rest of the year.
If you’ve encountered unexpected costs or access issues in the first few months of 2026, now is the time to make the change. Waiting could saddle you with a year’s worth of unplanned medical expenses or limited care options.
Switching to TM offers broader provider access and access to specialists and treatments without prior authorization. However, there are several issues you should consider. Traditional Medicare doesn’t cap out-of-pocket spending, but a Medigap supplemental plan helps contain costs. While many states require underwriting and limit coverage for pre-existing conditions, New York allows enrollment in or switching Medigap policies without underwriting or higher premiums, regardless of age or pre-existing conditions. If you go to Traditional Medicare, you’ll need a standalone Part D to cover prescriptions.
Here’s the thing: most people pay the closest attention to monthly premium payments, but they’re really only part of the picture. What are the plan deductibles, copays, and maximum out-of-pocket costs?
For example, a plan with $0 premium sounds great, but if you require specialty medications or frequent care, you may find it costs you more than a plan with a $350 monthly bill. TM may provide better protection against larger medical bills. There are Medigap policies that eliminate copays.
Most MA plans have a defined provider network. If your doctor is out-of-network, you could face higher costs or have to change doctors. So before making any changes, make sure your preferred providers and healthcare networks are included in the plan. For those who live with chronic conditions, like heart disease or cancer, this is especially important. With TM, you can use any doctor who accepts Medicare.
Timing matters too. When you make a change, it doesn’t take effect until the first day of the following month. Waiting until the last minute could limit your ability to resolve issues, gather plan details, or have a smooth transition between coverage options.
The deadline is less than a week away, so if you want to make any changes, review the costs, provider access, and prescription coverage to be sure your plan aligns with your healthcare needs for the coming year.