Medicare Advantage

Medicare Advantage Open Enrollment: What Hilo Can Change by March 31

HILO, Hawaii — If you signed up for a Medicare Advantage plan for 2026 and something about it isn't sitting right — the pharmacy network, a doctor who isn't in-network, a drug that costs more than you expected — you still have a window to fix it. The Medicare Advantage Open Enrollment Period runs January 1 through March 31, and it gives Hilo residents one more chance to make a change before their coverage is locked in for the year.

Here's what this period actually allows, what it doesn't, and the mistakes that trip people up most.

What the Medicare Advantage Open Enrollment Period is

This period, often called MA-OEP, is different from the Fall Annual Enrollment Period (October 15 – December 7). AEP is when almost anyone with Medicare can make almost any change. MA-OEP is narrower — it's a second look, meant for people who are already in a Medicare Advantage plan and want to adjust.

If you're happy with the plan you chose for 2026, you don't need to do anything. Your coverage simply continues.

What you can change between January 1 and March 31

During MA-OEP, if you're already enrolled in a Medicare Advantage plan, you can:

• Switch to a different Medicare Advantage plan (with or without drug coverage).
• Drop your Medicare Advantage plan and go back to Original Medicare (Parts A and B).
• Add a stand-alone Part D prescription drug plan if you return to Original Medicare.

You only get to make one change during this window. Whatever you choose takes effect the first of the following month.

What you cannot do during MA-OEP

This is where people get tangled up. During MA-OEP you cannot:

• Switch from Original Medicare to a Medicare Advantage plan (that had to happen during AEP or another special period).
• Join a stand-alone Part D drug plan if you're staying on Original Medicare and weren't already in one.
• Switch from one stand-alone Part D plan to another if you're on Original Medicare.

If you're on Original Medicare right now and wish you had signed up for something different in the fall, MA-OEP generally will not help. Your next broad opportunity is the following AEP, unless you qualify for a Special Enrollment Period (for example, if you move or lose other coverage).

Why 2026 is a year to double-check your drug coverage

Even if your plan looks the same as last year, the rules around prescription drugs have shifted in ways worth knowing:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615.
• The old coverage gap ("donut hole") is gone — as of 2025, Part D has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to sign up for through your plan.

If your medications changed, or if your plan's formulary or preferred pharmacies changed for 2026, MA-OEP is the moment to reconsider.

Plan availability in Hilo

Hilo is in Hawaii County, and Medicare Advantage availability is set at the county level. There are multiple Medicare Advantage plans and carriers offered in Hawaii County for 2026. To see the current list and compare them side by side, use the Plan Finder at medicare.gov and enter your ZIP code. The tool will show you plans available where you live, their networks, and how your specific prescriptions would be covered.

Avoiding the most common MA-OEP mistakes

• Don't assume switching is automatic. If you enroll in a new Medicare Advantage plan, you'll be disenrolled from your old one — but if you're leaving MA to return to Original Medicare, you may need to actively enroll in a stand-alone Part D plan to keep drug coverage.
• Check the network before you switch. On the Big Island, provider networks vary. Confirm your doctors, specialists, and preferred Hilo-area pharmacies are in-network for any plan you're considering.
• Watch the IRMAA threshold. Higher-income beneficiaries pay a surcharge on Part B and Part D premiums. IRMAA begins above $109,000 in income for a single filer in 2026 (higher for joint filers). This is based on your tax return from two years ago.
• Only one change allowed. Choose carefully. Once you use your MA-OEP change, that's it until the next AEP.