Ah Autumn... the leaves are turning, the air is feeling crisp, and everywhere you turn, there are reminders that it's almost Medicare open enrollment season. Whether it's the agent sitting at the table just inside your grocery store, or posters on every community bulletin board, or the ads that seem to run during every timeout of your favorite team's game, it's hard to escape the pitch each October 15 through December 7.
There's a reason for the volume. Medicare Advantage plans are run by private insurers, and the Medicare Payment Advisory Commission (MedPAC) estimates that Medicare spends about 14% more on Advantage enrollees than it would in traditional Medicare, roughly $76 billion in 2026. Insurers dispute the math, but enrolling you is clearly valuable business. So how do you know what's right for you?
What is Medicare open enrollment actually about?
For most people already in Medicare Advantage, open enrollment isn't typically about the choice between traditional Medicare or Medicare Advantage (sometimes called Part C). It's about picking next year's plan. Advantage plans reset every January, and premiums, copays, drug lists, out-of-pocket maximums, and provider networks can, and often do, change. Your plan's Annual Notice of Change, sent by the end of September, spells out what's different.
Confirm your doctors and hospitals are still in network, that your prescriptions are still covered, and your out-of-pocket maximum hasn't crept up. Mayo Clinic, for example, went out of network for most individual UnitedHealthcare and Humana Advantage plans at its Midwest locations in 2026, and members who counted on that access had to change plans or give it up.
It's also a good moment to ask whether Medicare Advantage is the right structure for you at all.
How is Medicare Advantage different from traditional Medicare?
If you had health insurance through an employer, you likely already understand how Medicare Advantage plans work. Much like those plans, you have a network of providers, often need referrals to see specialists or prior authorization for certain procedures, and each plan has list of covered drugs (called their formulary). Premiums are often low, and in-network out-of-pocket costs are capped each year, at up to $9,250 in 2026.
Traditional Medicare is far simpler, and for many people that's a revelation. There's no network. You can see any doctor or hospital in the country that accepts Medicare, and you generally don't need a referral to see a specialist. Most people pair it with a separate Part D drug plan, which is something you can change each year during open enrollment as well.
Do you have to buy a Medigap policy with traditional Medicare?
No. Medigap supplements are optional, and some people skip them. Going without one, though, carries financial risk:
You pay 20% of Part B costs after the deductible, with no annual cap. For cancer treatment or a major surgery, that 20% can be very large.
The Part A hospital deductible, $1,736 in 2026, applies to each benefit period, so it can hit more than once a year if you are in and out for different issues.
Longer hospital stays and skilled nursing care add daily coinsurance.
For households with significant assets, self-insuring those costs can be a deliberate choice. For most people, the predictability of a Medigap policy eases the potential of an endless stream of healthcare bills.
What happens if you get sick out of state with Medicare Advantage?
Advantage plans must cover emergency and urgently needed care anywhere in the US, at in-network cost-sharing. The trouble starts after the emergency. Follow-up visits, rehab, and other non-urgent care away from home are generally out of network. An HMO may not cover them at all. A PPO will, at higher cost-sharing, with a combined cap of up to $13,900 in 2026. Picture a fall on vacation: the ER visit is covered, but weeks of physical therapy before you can travel home may not be.
What should snowbirds consider?
Splitting the year between two homes raises questions that people rooted in one place never face.
Which home is your service area? An Advantage plan is tied to where you live. Be away more than six months and the plan must disenroll you, or 12 months if it offers a visitor or traveler program.
Where are your doctors? Routine care and specialists in your second home may be out of network.
Is there a travel benefit? Some PPOs offer national networks or travel programs, but the details vary by plan, and only cover domestic services in the US. Get them in writing.
Traditional Medicare sidesteps all of this. It works the same in Florida as it does in Kentucky.
Who does Medicare Advantage work for, and who gets burned?
It might sound like traditional Medicare is the preferred option here, and in many cases, you would be correct. But Medicare Advantage can be the better choice for people who:
Live in one place year-round with a strong health system in-network.
Are generally healthy and value low premiums plus a hard out-of-pocket cap.
Have a subsidized employer group retiree plan, which can have broader networks.
Want dental, vision, and hearing benefits bundled in.
The people who get burned are usually those whose lives change after they enroll: a diagnosis that calls for an out-of-network specialist or academic medical center, a move or second home, or a plan that drops their doctors.
Can you switch back to traditional Medicare later?
Yes, during any open enrollment. The catch is Medigap. Outside your initial six-month window at 65, and a one-year trial right for first-time Advantage enrollees, insurers in most states can review your health and charge more or decline you. Connecticut, Massachusetts, and New York are notable exceptions. If you're considering a switch, get approved for Medigap before you leave your Advantage plan.
Approaching 65? Save this post. That first six-month window is the only time most people can buy any Medigap policy without answering health questions.
If you're weighing this decision this fall or ahead of your 65th birthday, reach out to us. We can help you see how it fits the rest of your financial plan.