Medicare Advantage OEP 2026: What Beneficiaries Need to Know
As in previos years, the Medicare Advantage OEP 2026 runs from January 1 to March 31, giving Medicare beneficiaries a valuable second chance to fine-tune their health coverage. While the Annual Enrollment Period (AEP) in the fall gets the most attention, OEP is just as important; especially with the growing number of changes expected in Medicare Advantage benefits, Star Ratings, utilization management, and supplemental offerings in 2026.
Here’s an overview of what OEP is, how it works, and why 2026 may be an especially important year to review plan choices.
What Is the Medicare Advantage OEP
The Medicare Advantage OEP is a once-per-year enrollment window designed specifically for people already enrolled in a Medicare Advantage plan. It allows beneficiaries to:
- Switch to a different Medicare Advantage plan (with or without drug coverage)
- Drop Medicare Advantage and return to Original Medicare
- Enroll in a stand-alone Part D prescription drug plan if switching back to Original Medicare
However, OEP does not allow someone on Original Medicare to join a Medicare Advantage plan. It is strictly for current MA members who want to make a change.
Why OEP Matters in 2026
Medicare Advantage plans are expected to see continued adjustments in 2026, including:
More Care Management Controls
Many carriers are tightening prior authorization, utilization management, and cost-sharing rules. Some beneficiaries may find their 2026 MA plan more restrictive than expected once the new year begins.
Shifts in Supplemental Benefits
Non-medical extras like dental, vision, hearing, transportation, and OTC allowances are being closely reviewed by CMS. Some plans reduced benefits for 2026 to balance rising medical costs.
Watch a quick video on the differences between Medicare Advantage vs Medicare Supplements
Star Rating Modifications
With CMS proposing changes to the Star Ratings program, some plans entered 2026 with lower ratings than previous years. Lower ratings can mean reduced rebates, resulting in trimmed benefits or higher out-of-pocket costs for members.
Provider Network Adjustments
Every year brings hospital and physician network changes. Beneficiaries often don’t notice these changes until January, making OEP their opportunity to switch to a plan with more compatible providers.
With these shifts, OEP 2026 will be especially important for those who discover their new coverage doesn’t meet their expectations.
Who Should Consider Making a Change
A Medicare Advantage member may want to explore options during OEP if:
- Their plan dropped key doctors or specialists for 2026
- Prescription costs or formularies changed
- Supplemental benefits were reduced or removed
- Prior authorization requirements increased
- Their total out-of-pocket costs are higher than anticipated
- They enrolled in a new plan during AEP but are experiencing “buyer’s remorse”
Even a small change; like a different tier placement for a medication can significantly impact annual healthcare expenses.
How to Review Medicare Advantage Options During OEP
During OEP, beneficiaries should:
- Review their 2026 Evidence of Coverage (EOC) to understand changes.
- Compare local plan alternatives, focusing on doctors, drug coverage, and copays.
- Check Star Ratings, but also evaluate real-world factors like provider access.
- Consider switching back to Original Medicare if they prefer provider flexibility; though Medigap underwriting rules may apply depending on the state.
Working with a licensed Medicare agent is the quickest way to compare plans side-by-side and avoid unexpected coverage gaps.
Agents; join the team at Crowe – click here for online contracting
The Medicare Advantage Open Enrollment Period is a valuable opportunity for beneficiaries to correct course after the new plan year begins. With ongoing regulatory changes and shifting benefits in 2026, OEP gives Medicare members the flexibility to ensure their plan still aligns with their healthcare needs, budget, and preferred providers.
Whether it’s a minor adjustment or a full switch, the OEP helps ensure beneficiaries start the rest of 2026 with confidence in their coverage.
Recent Comments