Medicare Advantage OEP Checklist (Jan 1–Mar 31): What to Review Before You Switch

If you’re currently enrolled in a Medicare Advantage plan and something doesn’t feel right—your costs went up, your doctor isn’t in-network, your prescriptions changed, or your benefits aren’t what you expected—there is a specific window where you may be able to make a change.

That window is the Medicare Advantage Open Enrollment Period (OEP), which runs each year from January 1 through March 31.

This post is designed to be practical. Below is a straightforward checklist you can use to evaluate your plan and decide whether switching makes sense—without guessing.

First: Who Can Use Medicare Advantage OEP?

You can use the Medicare Advantage Open Enrollment Period if:

• You are currently enrolled in a Medicare Advantage (Part C) plan on January 1.

• You want to change your Medicare Advantage plan or return to Original Medicare.

If you have Original Medicare only (without a Medicare Advantage plan), OEP generally does not apply to you.

What You Can Do During OEP

During OEP, eligible members can typically:

• Switch from one Medicare Advantage plan to another Medicare Advantage plan

• Drop Medicare Advantage and return to Original Medicare (and add a standalone Part D plan)

In most cases, you can make one change during this period, so it’s smart to be intentional and make sure the plan you’re switching to is truly a better fit.

The 10-Minute Medicare Advantage OEP Switch Checklist

1) Confirm Your Doctors and Specialists

This is one of the most common reasons people switch.

• Is your primary doctor in-network?

• Are your specialists in-network?

• Are the hospitals and facilities you use in-network?

• Do you need referrals for specialists under the plan type?

Important note: being “accepted” by an office isn’t always the same as being “in-network.” You want the plan’s network confirmation.

2) Confirm Your Prescriptions and Pharmacy

Prescription coverage can change year-to-year.

• Are all of your medications on the plan’s formulary?

• Are there restrictions such as prior authorization, quantity limits, or step therapy?

• Are your medications in a preferred tier?

• Can you use your preferred pharmacy at the best cost?

Tip: Make a quick list of your medications, dosage, and frequency. A correct comparison depends on accurate information.

3) Compare the Four Costs That Actually Matter

Many plans look good at first glance. The real difference is how the plan works when you use it. Compare:

• Monthly premium (what you pay just to have the plan)

• Deductibles (medical and/or prescription, if applicable)

• Copays/coinsurance (doctor visits, specialists, urgent care, ER, outpatient, imaging, etc.)

• Maximum out-of-pocket (MOOP) (your annual cap on many medical costs)

A plan with a $0 premium can still be expensive if copays and MOOP are high for how you use care.

4) Review Prior Authorization and How the Plan Approves Care

Some plans require approvals more frequently than others.

• Does the plan require prior authorization for common services you might need?

• Are there tighter rules for imaging, outpatient procedures, skilled nursing, or home health?

• Does the plan require referrals for specialists?

If you had delays or denials last year, this should be part of your decision.

5) Evaluate Dental, Vision, Hearing, OTC, and Other “Extra” Benefits

Extra benefits can be valuable, but details matter.

Ask:

• Dental: What is the actual annual allowance? What is covered (cleanings vs. crowns/dentures)? Any waiting periods or network limits?

• Vision: Allowance amount? Is it for exams only or eyewear too?

• Hearing: Coverage amount? Specific providers?

• OTC: Monthly or quarterly amount? Where can you use it?

• Transportation, meals, gym programs: Are they available in your area, and what are the limits?

If you plan to use these benefits, you want clarity—not assumptions.

6) Check How Your Plan Handles Travel

If you spend time outside your home area:

• Does your plan cover urgent care and emergencies nationwide?

• Do you have in-network access when traveling?

• Are there limits on non-emergency care out of area?

7) Look at Your 2025/2026 Health Outlook (Not Just Last Year)

A plan that worked last year may not work this year.

Consider:

• Are you anticipating procedures, imaging, or therapy?

• Do you have ongoing specialist care?

• Are you managing chronic conditions?

• Did you start new prescriptions?

Matching a plan to your expected needs can save significant money and frustration.

8) Confirm Eligibility and Plan Availability in Your County

Medicare Advantage plans vary by county. Your options depend on where you live, so plan comparisons should be based on your actual service area.

9) Decide Whether Returning to Original Medicare Makes More Sense

For some people, returning to Original Medicare can reduce headaches related to networks and approvals—especially if you want broader provider access.

If you return to Original Medicare during OEP:

• You’ll typically want to add a standalone Part D plan (prescription coverage)

• You may also consider a Medicare Supplement (Medigap), depending on your situation

This is a key decision point, and it’s worth reviewing carefully.

10) Gather What You Need for an Accurate Review

To run a real comparison, have:

• Your Medicare card (or plan ID card)

• List of doctors and preferred hospitals

• Medication list (name, dosage, frequency)

• Preferred pharmacy

• Any upcoming procedures or ongoing care you anticipate

Common Mistakes to Avoid During OEP

• Switching based only on premium or TV ads without confirming doctors and prescriptions

• Assuming a doctor “takes” the plan without verifying in-network status

• Ignoring MOOP and copays (these often drive the real annual cost)

• Switching too quickly without comparing how you use care

• Waiting too late and rushing the decision

What to Do Next

If you’re unhappy with your Medicare Advantage plan, the right move is not to guess—it’s to compare your options side-by-side using your doctors, medications, and expected needs.

At Jackson Insurance Group, we help local members review Medicare Advantage options in plain English. We’ll walk through your checklist items, explain tradeoffs, and help you feel confident about the plan you choose.

If you want a quick review, reach out and we can help you evaluate whether switching during OEP is worth it.