Medicare Advantage

Why Philadelphia Medicare Advantage Enrollees Get a Do-Over

People in Philadelphia can choose from 98 Medicare Advantage plans for 2027, against 97 this year. Twelve of this year’s plans are gone, 13 are new to Philadelphia County, and 39 that continue have changed their premium, deductible, plan type or name, 9 of them under a new name.

PHILADELPHIA — If you signed up for a Medicare Advantage plan last fall and are already having second thoughts, you have a second chance. From January 1 through March 31, the Medicare Advantage Open Enrollment Period gives current Advantage members a limited window to change course — a chance to fix a mismatch before you're locked in for the rest of the year.

This window is smaller and more specific than the fall Annual Enrollment Period, and it comes with its own rules. Here's what Philadelphia-area readers should know before the March 31 deadline.

Who can use this window

The Medicare Advantage Open Enrollment Period (often called MA-OEP) is not open to everyone. According to CMS, it is only for people who are already enrolled in a Medicare Advantage plan as of January 1.

If you are still on Original Medicare (Part A and Part B) and want to join an Advantage plan for the first time this spring, this is not your window. You would generally need to wait for the fall Annual Enrollment Period (October 15 – December 7) or qualify for a Special Enrollment Period.

What changes you can actually make

During January 1 – March 31, you have three options:

• Switch from your current Medicare Advantage plan to a different Medicare Advantage plan.
• Drop your Medicare Advantage plan and return to Original Medicare.
• If you go back to Original Medicare, join a stand-alone Part D prescription drug plan.

You get one change during this period. Once you use it, the window closes for you. The new coverage begins the first day of the month after the plan gets your request.

One important limit: you cannot use MA-OEP to join a stand-alone Part D drug plan if you are staying on a Medicare Advantage plan that already includes drug coverage. And you cannot use it to switch from one stand-alone Part D plan to another if you are on Original Medicare.

Why people use this window

The fall enrollment season moves fast, and plans change from year to year. It is common for members to realize in January or February that:

• A doctor or hospital they use is no longer in the network.
• A prescription is not covered the way they expected.
• The plan type (HMO vs. PPO) is not a good fit for how they actually use care.
• They would rather have the flexibility of Original Medicare plus a stand-alone drug plan.

MA-OEP exists precisely for these situations. It is a course-correction, not a do-over of every choice on the table.

What's new to keep in mind for 2027

Some program-level numbers are worth knowing as you weigh a switch:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your out-of-pocket spending on covered drugs reaches that amount, you pay nothing for the rest of the year on covered prescriptions.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional way to spread your drug costs into predictable monthly payments across the year instead of paying big amounts at the pharmacy counter.
• IRMAA: higher-income enrollees pay Part B and Part D surcharges; the 2026 thresholds begin above $109,000 for a single filer.

These rules apply nationwide, whether you stay on Medicare Advantage or move back to Original Medicare.

A quick word on the Philadelphia market

Philadelphia is in Philadelphia County, where Medicare Advantage plan availability is set at the county level by CMS. The number of plans and carriers offered in the county can shift each plan year, which is one reason members sometimes find their coverage looks different in January than it did the year before. When you compare options on Medicare.gov's Plan Finder, the results are based on your ZIP code and county, not the city name alone.

How to decide before March 31

A few practical steps:

1. Look at your first month of claims. Are your doctors in-network? Are your prescriptions covered at a cost you expected? 2. Read the "Evidence of Coverage" document your plan sent. It spells out how the plan actually works this year. 3. Compare on Medicare.gov using your list of drugs, pharmacies, and providers. The Plan Finder shows every plan available in your county. 4. Get free, unbiased help. Pennsylvania's State Health Insurance Assistance Program (SHIP) — called APPRISE — offers one-on-one counseling at no cost. You can also call 1-800-MEDICARE (1-800-633-4227), available 24/7.