Medicare Advantage

Medicare Advantage Open Enrollment: Your Jan. 1–Mar. 31 Reset

MANSFIELD, Ohio — The window that gives Medicare Advantage members a second chance to fine-tune their coverage opens January 1 and runs through March 31. If you looked at your plan documents over the holidays and realized something doesn't fit — a doctor left the network, a prescription now costs more than you expected, or the plan simply isn't what you thought — this is the period built for you.

It's called the Medicare Advantage Open Enrollment Period (MA OEP), and it's separate from the fall Annual Enrollment Period that just ended December 7. It has its own rules and its own limits. Here's what Mansfield-area readers can — and cannot — do between now and the spring deadline.

Who this period is for

The MA OEP is only for people who are already enrolled in a Medicare Advantage plan on January 1. If you stayed with Original Medicare (Parts A and B) and a stand-alone Part D drug plan, this window doesn't apply to you — you'd generally need to wait for the next Annual Enrollment Period (October 15 – December 7) or qualify for a Special Enrollment Period.

If you are in a Medicare Advantage plan, you get one change during this three-month window. Not unlimited swaps — one.

What you can change between January 1 and March 31

According to CMS, during the MA OEP you may:

• Switch to a different Medicare Advantage plan. That can be with the same carrier or a different one.
• Drop your Medicare Advantage plan and return to Original Medicare. If you do this, you can also join a stand-alone Part D prescription drug plan.

That's the menu. It's narrower than fall enrollment, but for many people it's exactly enough to fix a mismatch.

What you cannot do in this window

The MA OEP is not a do-over for every kind of coverage decision. During this period, you cannot:

• Switch from Original Medicare into a Medicare Advantage plan for the first time.
• Join a stand-alone Part D drug plan if you're staying on Medicare Advantage.
• Change from one stand-alone Part D plan to another while on Original Medicare.

Those moves generally have to wait for the next Annual Enrollment Period or a qualifying Special Enrollment Period (for example, if you move out of your plan's service area).

Why 2026 might prompt a second look

A few program-level changes are worth knowing as you evaluate your current plan:

• Part D out-of-pocket cap of $2,100. In 2026, once your out-of-pocket spending on covered prescriptions reaches $2,100, you pay $0 for covered drugs for the rest of the year. This cap applies whether your drug coverage is inside a Medicare Advantage plan or a stand-alone Part D plan.
• Part D deductible maximum of $615. No Part D plan can charge more than that as a drug deductible in 2026.
• The coverage gap is gone. The old "donut hole" was eliminated in 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• Medicare Prescription Payment Plan. You can ask your drug plan to spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter. It doesn't lower the total — it smooths it.
• IRMAA thresholds. Higher-income enrollees pay an income-related surcharge on Part B and Part D. For 2026, that surcharge begins above $109,000 in modified adjusted gross income for a single filer (based on the 2024 tax return).

Plan availability in Richland County

Mansfield is in Richland County, where Medicare Advantage availability is set at the county level by CMS. Ohio has a robust Medicare Advantage market, and most Ohio counties offer a wide range of plans and participating carriers. To see the specific plans available at your ZIP code — with current premiums, drug formularies, and provider networks — the official comparison tool is the Plan Finder at medicare.gov.

How to make a smart change (not a rushed one)

Before you switch, it helps to gather a short list:

1. Your prescriptions, with dosages. Formularies differ from plan to plan. 2. Your doctors and hospitals, so you can check networks. Ohio State-Mansfield-area providers, OhioHealth, Avita, and independent clinics don't all contract with the same plans. 3. Any planned procedures or specialist referrals for 2026. 4. Your Medicare number and current plan ID card.

Then run the Plan Finder, call 1-800-MEDICARE (24/7), or sit down with a trained counselor from Ohio's SHIP — the Ohio Senior Health Insurance Information Program — which offers free, unbiased help. In Ohio, SHIP is administered through the Ohio Department of Insurance and has counselors serving Richland County.