Medicare Open Enrollment: Tips To Choose the Right Medicare Plan

Medicare provides insurance for most seniors 65 and older, and you have a choice of Medicare plans. The decision you make can affect the size of your premiums as well as the coverage available to you.

You can switch Medicare plans only during a specific time of the year, called open enrollment season. Open enrollment starts October 15 and ends December 7 each year. If you don't act during this time, you'll generally have to wait a full year before you can switch your coverage again.

Whether this is your first open enrollment period or you simply haven't shopped around for a Medicare plan for a while, here are a few key things you need to know about the decisions you'll need to make to find the best and most affordable coverage to meet your needs.

Original Medicare vs. Medicare Advantage

Original Medicare refers to Medicare Parts A and B. It's administered by the federal government, with Part A providing coverage for hospitals and skilled nursing facilities and Part B providing coverage for your routine outpatient care. If you opt for original Medicare, your premiums, deductibles, coinsurance costs, copays, and all other terms of your insurance policy are set by the government. Plus, you don't have to shop around for a policy because there's only one original Medicare plan.

Medicare Advantage, on the other hand, is offered by private insurers. Also called Medicare Part C, Medicare Advantage plans are an alternative to traditional Medicare, but they still entitle you to all the coverage that original Medicare provides.

Coverage

The big difference is that Medicare Advantage plans can also provide extra coverage, such as for dental care, which original Medicare doesn't cover. Many Advantage plans also offer prescription drug coverage, which you'd otherwise need to get by shopping around for yet another optional part of Medicare called Medicare Part D.

Costs and restrictions

Medicare Advantage plans can have different out-of-pocket costs and impose different rules for when you can get medical services. For example, an Advantage plan might require you to get referrals to see a specialist. There are also multiple Medicare Advantage plans provided by different private insurers. This means you have a lot of options, but it can also complicate your shopping. You'll want to thoroughly compare providers if you go the route of a Medicare Advantage plan.

There's no one correct answer for everybody when it comes to choosing between Medicare and Medicare Advantage plans, which is why it's important to think carefully about your decision.

4 decisions to make during Medicare open enrollment

1. How much can you spend?

When you buy original Medicare, your premiums are set by the government and are the same no matter where you live. In 2025, for example, everyone with Medicare Part B paid $185 per month unless they earned above $106,000 as a single tax filer or $212,000 as a joint filer, in which case premiums increased based on income.

Medicare Advantage Plans, on the other hand, can vary in cost from one plan to another. Where you live, as well as which plan you choose, can affect your premiums. Many Medicare Advantage plans come at a higher monthly cost than Medicare Part B, but that doesn't automatically make them less affordable. You need to look at both the premium and the out-of-pocket spending you'd potentially face.

If you can afford to pay a slightly higher premium for more coverage, you may be better off with an Advantage Plan. This is especially the case if you tend to use a lot of services Part B doesn't cover, such as dental care.

Alternatively, if you stick with original Medicare, you may need to buy a Part D plan to cover prescription drugs as well as a Medigap plan to limit your out-of-pocket costs. Once you add everything up, it may turn out that Part B isn't as inexpensive as it seems.

2. What providers do you want access to?

If you opt for original Medicare, you'll be able to see any doctor who accepts Medicare, anywhere in the U.S. If you opt for Medicare Advantage, you may be restricted to doctors who participate in that plan's network. You may also be required to fulfill certain additional requirements, such as getting a referral before seeing a specialist.

Make sure any Medicare Advantage plan you're considering participates with specific providers you're interested in seeing, if you have any.

3. Do you plan to travel in the future?

As mentioned above, original Medicare provides you with coverage to see any doctor throughout the entire U.S. as long as the provider accepts Medicare.

Medicare Advantage plans may have narrower networks, and you may be limited to seeing providers within a specific geographic area. In other words, if you travel to a different state, your Advantage plan may not cover you once you get there.

Not all Medicare Advantage plans restrict your ability to get coverage when traveling, though. In fact, there are some plans that offer coverage for care even if you're traveling overseas. Traditional Medicare, on the other hand, generally pays only for medical care received in this country. So if you travel abroad with only original Medicare coverage, you'd be out of luck. In this case, you could buy a supplementary travel insurance plan from another insurance provider to cover yourself.

You'll need to think about traveling you intend to do to decide whether Medicare Advantage or original Medicare would be more cost-effective for you.

4. Is your current Medicare plan the right plan for you?

If you're happy with your current Medicare plan, you don't have to make a change. But it's possible your provider might make some changes during open enrollment, including altering your premium costs or coverage.

Even if you like your current plan, we strongly recommend reviewing your plan paperwork carefully in case your coverage has changed.

How to choose the right Medicare plan

Again, open enrollment runs from October 15 through December 7 every year. If you miss the window to shop around for coverage, you have to wait a full year to get another chance.

To choose the best Medicare plan for you, there are a few key steps you'll need to take, including:

• Evaluate your care needs. If you require more medical services, you may find it's more cost-effective to pay higher premiums for a comprehensive Medicare Advantage plan.
• Review your current coverage. If you're happy with your plan, you may want to keep it. But make sure you understand any changes to coverage or your premiums that may have occurred.
• Shop for Medicare Advantage plans. You should carefully review premiums and coverage to determine if a plan is a good fit. Pay attention to a plan's network, out-of-pocket expenses, and coverage during domestic and foreign travel. 

Bottom line

When Medicare open enrollment season comes around, make sure you get the insurance coverage you need so you don't end up with unpaid medical bills you can't afford. Missing out on open enrollment could be a costly retirement mistake if it means you end up stuck with the wrong plan for an entire year, so take steps to avoid this.