Medicare Advantage: What You Need to Know As Open Enrollment Approaches

Why Bigger Isn’t Always Better

Medicare Advantage (MA) plans are a popular alternative to Original Medicare. But recent reports show that in most U.S. counties, one or two private insurers dominate the market — raising concerns about consumer choice, care quality, and long-term risk. Medicare Advantage plans will often change their benefits including co-pays, co-insurances, deductibles, provider networks, pharmacy networks, drug formularies and other elements that alter the value to the member. Open enrollment is the time to re-evaluate whether your current plan meets your needs.

This guide walks you through:

• How Medicare Advantage works

• Dates of Open Enrollment

• The risks of market consolidation

• What questions to ask when comparing plans

• How to protect your care options

🏥 What Is Medicare Advantage?

Medicare Advantage (Part C) combines Parts A (hospital) and B (medical) — and often Part D (prescription) — into a single plan offered by a private insurance company.

Instead of the government paying your medical bills directly, it pays a private insurer to manage your care.

📌 Open Enrollment

• Medicare Open Enrollment starts on October 15 and runs through December 7, 2025

• Open Enrollment is for the following calendar year of 2026

• Open Enrollment is NOT just for those looking to enroll for the first time

🚫 The Risk of Too Few Choices

A recent analysis found:

• 91% of Medicare Advantage markets are controlled by just one or two insurers

• In nearly half the country, one company has 75%+ market share

Why That Matters:

• Fewer doctors: Limited provider networks can restrict access to specialists and hospitals - make sure your plan will include your doctors in the coming plan year

• More red tape: Prior authorizations and referrals may delay care

• Less competition: Fewer plan options = less pressure to improve quality or service, or further narrowing of benefits - this is especially true with Medicare Part D as many insurers have left that market. Medicare Advantage enrollees typically do not have Part D, but traditional Medicare enrollees often do

🔍 Questions to Ask When Choosing a Plan

Before selecting a Medicare Advantage plan, consider:

• Are your doctors in-network?

• How easy is it to get prior authorizations?

• What happens if you need care while traveling?

• What are the maximum out-of-pocket costs?

• How do prescription benefits compare? Are your current medications still in the formulary for the upcoming plan year?

✅ How to Protect Your Options

• Review your plan every year during Open Enrollment (Oct 15 – Dec 7)

• Get help comparing MA plans vs. Original Medicare + Medigap

• Look beyond brand names: Bigger plans are not always better

• Plan ahead: Don’t wait for a hospitalization to find out what’s covered

🤝 We Can Help

At Apex Health Advocates, we provide independent Medicare guidance to help you:

• Avoid coverage surprises

• Stay in control of your care

• Choose the right plan for your health, budget, and values

Need help reviewing your Medicare options

Schedule a Medicare Planning Session: 📞 (619) 316-6869
📧 apexhealthadvocates@gmail.com
🌐 https://apexhealthadvocates.com