Tejal Somvanshi
Medicare Advantage plans are advertising lower premiums this fall. What the ads do not show is the out-of-pocket cost structure that caused nearly half of surveyed beneficiaries to skip or delay care in the past year.
Medicare open enrollment runs from 15 October to 7 December 2026. An eHealth survey of more than 1,000 Medicare beneficiaries, fielded in September 2026 and released on 8 October 2026, found that 48% skipped or delayed medical care in the past year because of confusion about their coverage. A separate 54% skipped or delayed care or prescriptions because of out-of-pocket costs. The survey margin of error is plus or minus 3%. eHealth is a private insurance marketplace that sells Medicare plans.
After 7 December, you generally cannot switch plans until the next open enrollment. Medicare Advantage enrollees also have a separate Open Enrollment Period from 1 January to 31 March each year to switch Advantage plans or return to Original Medicare. Qualifying life events—such as moving, losing other coverage, or qualifying for Medicaid—can trigger a Special Enrollment Period at other times.
The Premium Paradox
Medicare Advantage plans consistently advertise zero or low monthly premiums, and many deliver on that headline figure. The cost structure that generates those low premiums shifts spending from the monthly premium to point-of-care expenses: higher copays for specialist visits, tiered drug formularies with varying coinsurance rates depending on the plan and drug tier, and prior authorization requirements that can delay or deny access to services your doctor has ordered.
The 54% who skipped care over out-of-pocket costs faced a gap between what their plan technically covered and what they could afford to pay at the point of service. That gap is not a coverage exclusion in the legal sense; the plan covers the service. But the cost-share structure made the covered service financially out of reach for those individuals.
Before 7 December, log in to Medicare.gov and run a plan comparison with your actual prescription list and your current doctors. Read your Annual Notice of Change, which your current plan sent in September. It summarizes cost and coverage changes taking effect in 2027. Check your drug’s tier in each plan you are comparing—a drug moving from one tier to a higher tier can raise your annual out-of-pocket cost substantially.
The eHealth survey also found that 58% of beneficiaries suspect they have been targeted by Medicare-related scams. If you receive an unexpected call claiming to be about your Medicare coverage and asking for personal information, hang up and call Medicare directly at 1-800-MEDICARE to verify. Medicare Advantage plans and authorized agents may contact enrolled members for specific plan-related purposes, but unsolicited calls requesting personal information are a common fraud tactic.
Is it better to have Medicare Advantage or Original Medicare?
The right choice depends on your prescription list, your doctors, and your expected care needs. Original Medicare has no annual out-of-pocket cap in Part A and Part B combined; Advantage plans cap your out-of-pocket exposure but restrict your provider network. Run the comparison on your own situation, not on average-case assumptions.
What is the Annual Notice of Change, and what should I look for?
It is the letter your current Medicare Advantage or Part D plan sends each September. Check for premium changes, deductible changes, drug tier changes, and any doctors or pharmacies leaving the plan’s network.
What happens if I miss the enrollment deadline?
Outside of specific qualifying events and the Medicare Advantage Open Enrollment Period, you cannot switch Medicare plans until the next open enrollment in October 2027. Coverage decisions made during this window take effect 1 January 2027.
Log in to Medicare.gov now. Compare plans with your real prescription list before 7 December 2026.
Related Karmactive coverage: Medicare eligibility guidance Medicare Advantage plan changes.
