Key Takeaways

• Before jumping into plan comparisons, you need to assess whether your client’s circumstances actually demand a switch—or just a reassessment of their current Medicare plan.

• The smarter question isn’t “Which plan is better?” but rather “What’s changed in your health, budget, or lifestyle this year that could affect your needs?”

---

The Trap of the Plan-First Mindset

Too many Medicare conversations start with a question about which plan might offer better coverage. It sounds logical on the surface, but it’s rarely the best place to begin. When clients tell you they’re thinking about switching plans, pause. Don’t go straight into comparing deductibles or premiums.

Instead, shift the conversation toward their lived experience with their current coverage.

• Did they face any unexpected bills last year?

• Are their doctors still in-network?

• Have their prescriptions changed?

• Are they planning to travel or relocate?

When you ground the conversation in their life—not just plan specs—you uncover deeper needs, frustrations, or misunderstandings.

Why Switching Isn’t Always the Right Move

Switching Medicare plans can be a smart decision—but only when it aligns with a real change in health, lifestyle, or finances. Many beneficiaries assume that switching is automatically an upgrade. It’s not.

Here’s why a change can sometimes backfire:

• Provider Access Disruption: Changing plans may mean losing access to long-trusted physicians or specialists.

• Prescription Coverage Gaps: Formularies vary. A new plan might cover fewer of their medications.

• Hidden Costs: A new plan might lower some costs and raise others—like out-of-pocket limits or coinsurance.

• Reenrollment Restrictions: Some Medigap policies have underwriting restrictions if clients try to return later. It’s not always a revolving door.

Your job isn’t just to help clients change plans. It’s to help them make changes for the right reasons.

Three Areas to Review Before Considering a Switch

Before even mentioning another plan, review three personal factors with your client. These areas are often where the need for a switch either becomes obvious—or unnecessary.

1. Health Changes in the Past 12 Months

Ask open-ended questions like:

• Have you had any new diagnoses?

• Are you seeing new specialists?

• Are you now taking new medications regularly?

Clients with new chronic conditions, upcoming surgeries, or increased reliance on specialists may require different benefits than they did a year ago. That’s when it makes sense to explore plans with more comprehensive specialist coverage, broader networks, or lower prescription copays.

But if health needs are stable—and their current plan met last year’s needs—switching might not be the smartest choice.

2. Financial Adjustments or IRMAA Brackets

You should review the current year’s out-of-pocket exposure, but also talk through any expected changes in income. In 2025, the IRMAA brackets determine how much your clients pay in Part B and D premiums. Even a one-dollar increase in income could nudge them into a higher bracket.

Also, many Medicare Advantage enrollees are surprised to learn that certain cost-sharing elements shift annually:

• Deductibles can go up

• Coinsurance percentages can rise

• Out-of-pocket maximums can increase

Discussing their tolerance for unpredictability can help determine whether their current plan still aligns with their budget or whether a new structure would serve them better.

3. Lifestyle, Travel, or Relocation

Clients often don’t realize how geography shapes Medicare access. If they’re moving to a different ZIP code—even if it’s in the same state—their plan options may change entirely.

And for clients who plan to travel frequently, work remotely, or live seasonally in two places, a plan that was once ideal may now come with gaps. Discuss how coverage works across multiple states or with out-of-network providers.

It’s not just about what fits now. It’s about what fits next.

The Enrollment Period Math: Why Timing Matters

A switch at the wrong time can cost your client not just money, but access. You must be crystal clear on the timeline options:

Medicare Advantage Open Enrollment Period (MA OEP)

• Runs January 1 to March 31 each year.

• Only applies to those already enrolled in a Medicare Advantage plan.

• Clients can switch to another Medicare Advantage plan or return to Original Medicare.

Annual Enrollment Period (AEP)

• Runs October 15 to December 7 each year.

• Clients can make changes to their Medicare Advantage or Part D plans.

• Changes go into effect January 1 of the following year.

Special Enrollment Periods (SEPs)

• Triggered by specific life events: moving, loss of employer coverage, Medicaid eligibility changes.

• SEP timing depends on the qualifying event, usually lasting 2–3 months.

When clients ask you about switching, one of your first responses should be: What enrollment window are we in? If you’re not within a valid period, it’s time to shift the conversation to future planning.

The Smarter First Question to Ask

If the client initiates the conversation with “Should I switch plans?”, you should respond with something like:

“Before we talk about switching, let’s go over what’s changed for you this year.”

This resets the framing. It moves you out of the mindset of sales and into the mindset of strategy.

Try using one of these opening lines instead:

• “Let’s talk about what worked or didn’t work with your current plan last year.”

• “Are your doctors, medications, and budget still lining up the way they did when you chose this plan?”

• “Has anything changed in your routine or health that we should factor in before making a change?”

The result? You’ll uncover more meaningful data, position yourself as a trusted advisor, and reduce the likelihood of a regretful switch.

What to Do When a Switch Does Make Sense

Once you’ve identified a legitimate reason for change—be it medical, financial, or geographic—here’s how to proceed:

• Clarify timing: Confirm the client is in an enrollment window.

• Evaluate future-proofing: Will the new plan support their likely needs over the next 12 months?

• Prepare for the switch: Review potential disruption in services, pharmacy networks, or referrals.

• Set expectations: Changes take effect based on enrollment timing. Outline the start date and any gaps.

It’s also a good idea to create a quick comparison sheet for them—not just of benefits, but of trade-offs. No plan is perfect. A thoughtful switch always involves compromise.

Make Annual Reviews More Meaningful

Don’t limit plan review to AEP season. Build a rhythm of client outreach that includes:

• Mid-year check-ins (June–July): Ask if any health or financial shifts have occurred.

• Late summer pre-review (August–September): Get a read on potential upcoming changes.

• Enrollment planning (October–December): Finalize any decisions based on confirmed plan updates.

This cadence lets you stay ahead of problems, spot misalignments early, and present switching as a proactive decision—not a panicked one.

Focus on Alignment, Not Change

The smartest Medicare switch happens when it reflects real change—not curiosity, frustration, or aggressive marketing from competitors.

As an independent agent, you’re uniquely positioned to ask the hard questions and help your clients think clearly. Don’t rush to answer “Should I switch?” Instead, help them understand what they actually need.

---

Rethink Your Role as an Advisor, Not a Switch Facilitator

What sets successful agents apart in 2025 is their ability to challenge the question—not just answer it. Instead of offering a menu of options every time a client mentions switching, get comfortable pressing pause.

Focus on the relationship. Focus on context. And focus on helping the client make fewer—but better—decisions.

If you want more ways to deliver this kind of value to your clients, we’d love to help.

At BedrockMD, we offer independent agents like you the tools, training, and lead support to help you focus on real strategy, not just plan sales. Join us, and bring your advisory practice to the level clients actually remember.