Read This Before Open Enrollment 2025

Critical Information for Every Medicare Beneficiary

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Why Listen to Me?

Until this open enrollment, I was an insurance agent specializing in Medicare and senior health benefits. I have 40 years of experience dealing with health insurance products (including Medicare) and was the 2011–2012 president of the National Association of Insurance and Benefit Professionals (formerly National Association of Health Underwriters).

As we approached this year’s open enrollment, I decided to retire from my career. I ended my career primarily because my wife has terminal cancer and recently entered hospice. That, combined with the many changes to Medicare Advantage Plans, made providing the level of service that I felt my clients deserved impossible.

Understand the Changes

The annual Medicare Open Enrollment period begins on October 15, 2025, and ends on December 7, 2025. But this year will be very different from past enrollments. There are several changes to plans this year that you should be aware of.

First, virtually all major national companies are eliminating plans. Although this occurred during the last open enrollment period, the volume of plan cancellations this year is expected to surpass last year’s.

Regardless of how good you think your agent is, if you did not receive a letter from the insurance company or hear from your agent, call the insurance company and double-check. Remember that your agent probably has several hundred (or more) clients, and people may fall through the cracks.

In addition to plan cancellations, many plans will change benefit levels. For example, last year, many of my clients saw reductions in their dental and vision benefits. Do not assume that benefit levels will remain the same.

Reviewing network providers is always essential during open enrollment, but it is critical this year. This applies to both your medical doctors and the dental providers.

Keep Insurance Agents Honest

There is one change that will have a significant impact on your agent. Many insurance companies that offer Medicare Advantage are eliminating commissions on a substantial number of their Preferred Provider Organization (PPO) plans. This means that many agents will only show you the plans that pay them commission. Often, that means an HMO (Health Maintenance Organization). THIS IS IMPORTANT!!

I rarely enrolled anyone in an HMO plan. In the absence of a compelling reason to use an HMO, the PPO plan was my first choice. I reasoned that an HMO eliminated many treatment choices that might have been better in each situation. The PPO allowed you to use any medical provider, anywhere in the country, if they were willing to work with the plan. The challenge for agents this year will be how to earn a living if the PPO plans do not pay commission. Unfortunately, the solution will likely be to enroll more people in HMO plans.

This is why it is so important to use the tools available at Medicare.gov and understand all your options before speaking with an agent. Even if you love your agent, be aware of what is available.

As a FYI, it is incredibly easy to make an HMO sound like the best option. The HMO typically has significantly lower out-of-pocket costs compared to a PPO plan. Their dental and vision benefits will often be higher.

Lower out-of-pocket costs and higher ancillary benefits come at a price. You will have restrictive networks and less freedom of choice. And the more restrictive, the lower the out-of-pocket costs.

A Better Alternative

Last year, because of Aetna cancelling our Advantage Plan, I moved both my wife and me to the High-Deductible F Medicare Supplement. The plan cancellation allowed us to enroll in a Medicare Supplement regardless of health. Even with my wife’s cancer, our out-of-pocket costs were less than they would have been on our former PPO plan.

You might be wondering why I did not enroll us in a different Advantage Plan. The reason is simple. There is a risk that no agent talks about when it comes to Advantage Plans. That risk is that while your provider might be in network at the beginning of the year, there is no guarantee that he/she will still be in network in six months.

In 2023, one of my clients in Nevada was dealing with metastatic melanoma. Five months into the plan and in the middle of his treatment, his oncologist left the plan network. Worse, the oncologist refused to accept the plan as an out-of-network provider. That left my client needing to find a new oncologist.

Because I knew that my wife’s cancer was likely to return, I did not want to take the risk that when she needed her oncology team, they would not be in the network. By switching to the supplement, I eliminated that risk.

NOTE: The contracts that providers have with Advantage Plans may be up for renewal in months other than January.

My recommendation to everyone is to choose the High-Deductible G plan and get a separate Plan D prescription drug plan. If you care about your ability to see anyone, anywhere, if they accept Original Medicare, this is the only option.

NOTE: I love the High-Deductible G, but was required to enroll in the “F” due to age.

At age 72, my monthly premium is a low $53. Even though I will have to pay for my own dental and vision benefits, that is a low price to pay for the freedom of choice I now have.

Summary

There are numerous changes to Advantage Plans this year. If you are speaking with an agent who only shows you HMO plans, ask about the PPO plans and why they are not being shown. If you are talking to any agent who does not discuss the High-Deductible G Medicare supplement, ask why.

It is imperative to recognize that agents are human. Despite giving lip service to the idea of “I only do what is in my client’s best interest”, they still must eat and pay rent.

It was easy only to do what was best for the client when every available plan paid the same commission. But that world is changing in ways that are not in the best interest of you, the consumer.

Never has the saying “buyer beware” been more appropriate. And never has it been more important for you, the consumer, to use the tools at medicare.gov before talking to any agent.