Key Takeaways

• In 2025, Medicare plan switching is at an all-time high, but many beneficiaries are making decisions based on incomplete comparisons.

• To make an informed choice, you need to assess more than just premiums—consider total costs, provider access, and how plans coordinate with your specific healthcare needs.

Why Plan Switching Is More Common in 2025

A growing number of Medicare beneficiaries are re-evaluating their plans in 2025, and for good reason. The healthcare landscape is shifting rapidly. From changing provider networks to new rules around prescription drug costs, the stakes are higher than ever when it comes to your coverage.

Several trends are fueling this surge:

• Expanded supplemental benefits under Medicare Advantage plans have drawn interest.

• The elimination of the Part D “donut hole” has changed drug coverage dynamics.

• More robust digital tools make plan switching easier, even if not always more informed.

While switching is becoming easier technically, the quality of plan comparisons has not kept up. Many still rely on surface-level features, risking higher long-term costs or reduced access to care.

The Trouble With How People Compare Plans

It’s common to focus on just one or two factors when comparing Medicare plans—typically premiums and copays. But that approach is too narrow. A plan that looks appealing on one measure might fall short on others that matter just as much.

Here are some overlooked elements you should factor in:

• Out-of-pocket maximums: Especially critical if you have chronic conditions or expect major care.

• Provider and pharmacy networks: A lower premium means little if your doctor or hospital isn’t in-network.

• Referrals and authorizations: These affect how easily you can see specialists or get treatments.

• Drug formulary tiers: Just because your medication is covered doesn’t mean it’s affordable under the plan.

Plan Switching Without Reviewing Annual Changes

Each year, Medicare plans must notify you about updates through the Annual Notice of Change (ANOC). Yet many people don’t read it thoroughly, or skip it altogether.

In 2025, those notices can include:

• Increases in coinsurance for outpatient care

• Removal of doctors or specialists from networks

• Shifts in drug tiers or formulary exclusions

• New prior authorization rules

If you switch based only on monthly premium or advertising claims, you might miss these changes and end up with unexpected costs or coverage gaps.

Costs to Consider Beyond the Monthly Premium

In 2025, average Medicare Part B premiums are $185/month, and Part D deductibles can be up to $590. Many Medicare Advantage plans advertise low premiums, but that doesn’t mean low overall costs.

Here are the major cost components to watch:

• Deductibles: These reset each year and apply to Part A, B, and D.

• Copayments and coinsurance: Often hidden until you need care. These can be higher for specialists, hospital stays, and certain medications.

• Emergency and out-of-network care: Some plans have steep cost-sharing if you receive care outside their service area.

• Prescription costs: Despite the $2,000 annual out-of-pocket cap in 2025, you still need to reach that threshold. Until then, tiered pricing can add up quickly.

If you take multiple prescriptions or require ongoing care, the cumulative cost may be higher than you expect under a plan that appears inexpensive at first glance.

How Provider Networks Influence Your Experience

Medicare Advantage plans use provider networks, and these change frequently. In 2025, some plans are narrowing networks to control costs. This can impact:

• Access to specialists

• Hospital options

• Continuity of care, especially during treatment

Before switching plans, verify that your primary care physician, specialists, and preferred hospitals are in-network. Also confirm:

• Whether referrals are required for specialist visits

• If your current providers accept new patients under the plan

• Whether telehealth services are covered by your chosen providers

Staying in-network is key to avoiding surprise bills and unnecessary delays in treatment.

Prescription Coverage Can Still Catch You Off Guard

Medicare Part D has undergone major changes for 2025. The elimination of the coverage gap means that once you reach $2,000 in out-of-pocket costs, your plan covers 100% of additional drug costs. But before that, pricing is still tiered and varies by plan.

When comparing plans:

• Look at your current medication list

• Check each drug’s tier and cost-sharing amount

• Confirm if your pharmacy is in-network and preferred

Also, beware of plans that cover your drugs but at a much higher cost tier than others. Generic drugs may still carry significant costs in certain plans.

Timing Your Switch: Annual Enrollment Period vs. Special Enrollment

There are only specific times when you can switch plans:

• Annual Enrollment Period (AEP): October 15 to December 7. Changes take effect January 1.

• Medicare Advantage Open Enrollment: January 1 to March 31. Allows one switch if you’re already in a Medicare Advantage plan.

• Special Enrollment Periods (SEPs): Triggered by events like moving or losing other coverage.

Many people wait until the last days of enrollment to decide, which limits their ability to research thoroughly. Planning ahead gives you time to compare carefully.

Digital Tools Help—But They’re Not Foolproof

Online plan comparison tools have improved significantly by 2025. But they often:

• Focus too heavily on premiums

• Provide estimates that may not match actual costs

• Miss details about provider availability

Use these tools as a starting point. Then verify specifics:

• Call the plan’s customer service

• Confirm provider participation

• Review the full Summary of Benefits and Evidence of Coverage

Always look beyond what the tool highlights.

Coordination With Other Coverage Matters

Do you have other coverage in addition to Medicare—like retiree benefits, Medicaid, or VA coverage? Coordination rules affect which plan pays first and what your out-of-pocket liability will be.

When switching:

• Ask how the new plan coordinates with existing coverage

• Check if drug coverage overlaps or conflicts

• Ensure you’re not duplicating benefits or losing valuable protections

Failure to coordinate can result in gaps or penalties down the line.

Health Status and Risk Tolerance Should Influence Your Choice

Choosing a Medicare plan isn’t just about cost. It’s also about matching coverage to your health needs and financial risk tolerance.

If you have chronic health issues, consider:

• Lower out-of-pocket maximums

• Broader networks

• Predictable cost-sharing for frequent services

If you’re in good health but want peace of mind, balance premium costs with the potential financial risk of future illness or injury. Medicare is insurance, after all—not just a budgeting tool.

Many Are Switching—But Without a Full Picture

In 2025, switching Medicare plans has become easier. But convenience doesn’t always equal understanding. Too many people are still making decisions based on limited information, eye-catching perks, or misleading assumptions.

Before you join the wave of switchers this year, make sure you take the time to:

• Review your ANOC carefully

• Evaluate your full healthcare needs and costs

• Research each plan’s provider network, drug coverage, and rules

• Consider how it works with any other coverage you have

Your healthcare is too important to leave to chance—or to headlines.

Choosing Smart in 2025 Means Asking the Right Questions

Plan switching is surging in 2025 for good reason, but rushing the decision or focusing on the wrong criteria can lead to costly surprises. If you’re considering a change this year, do more than just skim the basics.

Ask yourself:

• Will I still be able to see my preferred doctors?

• What will I really pay for the medications I take?

• Are my future health needs covered adequately?

• What happens if I travel or move?

If you’re unsure how to evaluate these questions, it’s time to speak with a licensed agent listed on this website. The right help can make a major difference in both your experience and your expenses.