Medicare Advantage

Augusta Medicare Advantage members: the one do-over between New Year's and spring

AUGUSTA, Maine — If the Medicare Advantage plan you woke up with on January 1 is not the fit you thought it would be, you have a second look built into the calendar. From January 1 through March 31, people already enrolled in a Medicare Advantage plan get one chance to change course. It is a narrower window than the fall Annual Enrollment Period, with its own rules — and knowing what it does and does not allow can save you a frustrating phone call.

What this window is — and who it's for

The Medicare Advantage Open Enrollment Period (often shortened to MA OEP) is not a repeat of the fall Annual Enrollment Period. It exists for one reason: to give people who are already in a Medicare Advantage plan a chance to correct a choice that isn't working.

If you enrolled in an Advantage plan during the fall and then discovered your doctor is out of network, your prescriptions cost more than you expected, or the plan simply doesn't feel right, this is your reset button. You have from January 1 through March 31 to act, and any change takes effect the first day of the month after your new plan gets your request.

What you can do between January 1 and March 31

During this window, you get one change. That change can be:

• Switch to a different Medicare Advantage plan. With or without drug coverage.
• Drop your Medicare Advantage plan and go back to Original Medicare. If you do this, you can also join a stand-alone Part D drug plan.

That's it — one move, and it's used up. If you switch plans on January 20 and then decide two weeks later you'd rather have picked a different one, you generally cannot switch again until the fall.

What you cannot do

This is where a lot of confusion happens. During the January–March window, you cannot:

• Join a Medicare Advantage plan if you're currently in Original Medicare.
• Join a stand-alone Part D drug plan if you're staying in Original Medicare (unless another special situation applies).
• Switch from one stand-alone Part D plan to another.

If you're in Original Medicare and want to pick up drug coverage now, you'll typically need to wait for a Special Enrollment Period (if you qualify) or the fall Annual Enrollment Period, which runs October 15 through December 7.

Augusta and Kennebec County: how availability works

Augusta is in Kennebec County, and Medicare plan availability is set at the county level. That means the menu of Advantage plans and stand-alone Part D plans you can choose from is the same for anyone with a Kennebec County ZIP code, whether you live in Augusta, Waterville or a smaller town nearby.

If you want to see the current list for your address, the plan finder at medicare.gov shows every option available to you, along with which prescriptions each plan covers.

Common mistakes to avoid

A few missteps come up every year in this window:

• Waiting until March 31. Requests take effect the first of the following month, and paperwork or phone hold times can eat up days. If you want an April 1 start, don't leave it to the last minute.
• Assuming your doctors are in-network. Networks can change from year to year, even on a plan you've had for a while. Confirm directly with the practice, not just the plan's online directory.
• Overlooking drug coverage. If your plan includes prescription coverage and you leave it for Original Medicare without picking up a Part D plan, you may face a late enrollment penalty later.
• Forgetting about Medigap rules. If you drop an Advantage plan and go back to Original Medicare, buying a Medigap policy may involve medical underwriting depending on your situation. Ask questions before you switch.

A few numbers worth knowing for 2026 and 2027

Even if you're only comparing Advantage plans, the drug side of the program matters, because most Advantage plans in Kennebec County include Part D. A couple of figures to keep in mind:

• Part D out-of-pocket costs are capped at $2,100 for the year.
• The Part D deductible cannot be higher than $615.
• The old coverage gap (the "donut hole") is gone as of 2025 — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan is available if you'd like to spread drug costs across the year in monthly bills instead of paying at the pharmacy counter.
• IRMAA surcharges (higher premiums for higher incomes) start above $109,000 in income for a single filer.