Millions of Americans enrolled in Medicare Advantage are currently in a brief annual window to review and change their coverage — and experts say this year is especially important. With proposed policy shifts from federal regulators and potential benefit changes from insurers, taking time to reassess plans could make a real difference in costs and care.
Policy Changes Could Reshape Medicare Advantage Plans
In late January, the Centers for Medicare and Medicaid Services (CMS) unveiled proposed updates to Medicare Advantage and Part D policies. According to the agency, the goal is to ensure payments to insurers more accurately reflect patient care costs. CMS also proposed payment rates that would remain largely flat, increasing by just 0.9% from 2026 to 2027 — roughly $700 million in additional funding.
These payment rates play a critical role, as they influence how much insurers charge for premiums and what benefits they can afford to offer. The announcement rattled Wall Street, sending major health insurer stocks lower. Analysts had anticipated a much larger increase of 4% to 6%, and insurers have warned that slimmer margins could lead to benefit reductions or even plan withdrawals in some areas.
Enrollment Remains Strong, but Competition Is Intensifying
Despite the uncertainty, Medicare Advantage remains hugely popular. In 2025, about 54% of all Medicare beneficiaries — roughly 34.1 million people — were enrolled in Medicare Advantage plans, according to KFF, a nonpartisan health policy research organization.
Still, competition is fierce. UnitedHealthcare CEO Tim Noel said during a January earnings call that the company could lose between 1.3 million and 1.4 million Medicare Advantage members in 2026 as more beneficiaries shop around for better options.
“That’s going to have a real-world impact,” said Philip Moeller, author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, noting that many enrollees may soon feel the effects of tighter plan economics.
In 2024, UnitedHealthcare and Humana dominated more than half of U.S. counties, according to KFF research. Even so, experts say consumers still have plenty of choice heading into 2026.
“The average beneficiary can choose from more than 30 Medicare Advantage plans,” said Tricia Neuman, executive director of KFF’s Medicare policy program. “And nearly all of them offer extra benefits like vision, dental, and hearing coverage.”
Understanding Medicare Advantage Open Enrollment
Medicare Advantage — also known as Part C — is offered by private insurers and typically combines hospital (Part A), medical (Part B), and often prescription drug (Part D) coverage into a single plan.
The Medicare Advantage open enrollment period runs through March 31. During this time, current enrollees can:
Switch to a different Medicare Advantage plan, or
Drop Medicare Advantage and return to original Medicare (Parts A and B), with the option to add Part D drug coverage.
“I urge people to really spend time researching their options,” Moeller said. “This is the moment to make changes if something isn’t working.”
Why Medicare Advantage Appeals to Many Enrollees
Medicare Advantage plans often attract beneficiaries with low or even zero premiums and added perks not typically covered by original Medicare, such as dental, vision, and hearing benefits.
“For people with modest medical needs, Medicare Advantage can make good sense,” Moeller said, especially for those looking to keep monthly costs predictable.
When Original Medicare May Be a Better Fit
The trade-off comes when health needs become more complex. Medicare Advantage plans can involve prior authorizations, coverage denials, and network restrictions that limit which doctors patients can see.
“People love Medicare Advantage when they’re healthy because it’s cheaper,” said Carolyn McClanahan, a physician and certified financial planner. “But when serious illness hits, the hurdles can become overwhelming.”
Switching back to original Medicare is allowed during open enrollment, but experts caution that doing so may come with hidden costs. Many beneficiaries need a Medigap supplemental plan to cover deductibles, copays, and coinsurance — and those plans can be expensive.
“I personally wouldn’t have original Medicare without a supplemental plan,” Moeller said. “There’s just too much financial exposure otherwise.”
Medigap Rules Can Be a Major Barrier
In most states, switching from Medicare Advantage to original Medicare requires passing medical underwriting to qualify for a Medigap plan. That can be a major obstacle for people with existing health conditions.
“If you’re already sick, you’re not going to pass underwriting,” McClanahan said.
Only four states — Connecticut, Maine, Massachusetts, and New York — allow beneficiaries to enroll in Medigap plans without medical underwriting.
Bottom Line
With regulatory changes, insurer adjustments, and rising competition all converging, this open enrollment season is not one to ignore. Whether staying put, switching plans, or returning to original Medicare, experts agree on one thing: doing your homework now can help prevent costly surprises later.
