If you are an adult child, there is a good chance you have wondered whether your parent is on the right Medicare plan. Maybe Mom mentions a doctor visit cost more than she expected. Maybe Dad got a surprise bill from a specialist. Maybe their drug costs are creeping up every year. Maybe they just shrug when you ask about their plan and say, “It is what it is.”
I am a Medicare broker in Mesa, and a lot of the families I work with come to me because something stopped feeling right. The good news is that picking the wrong plan is fixable. Most years, your parent has at least one window during which they can switch. The bad news is that nobody flags the problem for them. The plan keeps charging the premium and processing claims, and it is up to your parent or someone watching out for them to notice the warning signs.
Here are the seven I see most often.
Sign 1: Their Doctor Is Not in Network
This is the most common and most fixable problem. Your parent enrolled in a Medicare Advantage plan and did not realize, or did not remember, that the plan has a network. Now they are seeing their primary care doctor or a specialist and getting hit with out-of-network bills, or worse, the doctor stopped seeing them entirely because the plan does not cover them.
The signs are subtle. A higher-than-expected bill after a routine visit. A note from the doctor’s billing office about a charge insurance did not cover. Your mom mentioning she has to see a different doctor now because hers “stopped taking the insurance.”
The fix is to switch plans during the next eligible window. We make a list of the doctors she actually wants to keep, and I find a plan that includes all of them in network. Sometimes that means a different Medicare Advantage plan from a different carrier. Sometimes it means moving to Original Medicare with a supplement, which has no network at all.
Sign 2: They Are Paying a Premium for a Plan They Could Get for Less
Your parent is on a Medicare Advantage plan that charges, say, $80 a month. They believe that is just what Medicare costs. In reality, there are $0 premium plans in Maricopa County that offer comparable benefits. They are paying $960 a year for nothing.
This usually happens when someone enrolled years ago and never reviewed the plan since. The market shifts every year, plans change, and a plan that was the best deal in 2018 may not be a competitive deal in 2026.
The fix is an annual review. Plans change every year, and a comparison run during AEP will show whether their current plan is still the right choice or whether they should move to something else.
Sign 3: Their Drug Costs Have Climbed Year Over Year
This is one of the easiest signs for an adult child to spot. Your dad takes the same medications he has been taking for five years, but the cost at the pharmacy keeps going up. Maybe the medication moved to a higher tier. Maybe the carrier changed the formulary. Maybe the deductible is now higher.
Your parent might assume the cost is just rising naturally. Sometimes that is true. But if a drug used to be in tier 2 and is now in tier 4, that is a plan-level change that you can fix by switching to a different plan whose formulary places it more favorably.
The fix is to enter their current medications into the medicare.gov Plan Finder, or have a broker do it, and see what each available plan would cost for those drugs over a year. The right plan often saves hundreds.
Sign 4: They Are Avoiding Care Because of Costs
This one is heartbreaking and more common than people realize. Your mom needs a hearing aid but the plan covers nothing. Your dad needs physical therapy after his hip surgery but the copays are too high. Your parent skips a follow-up appointment because they cannot afford the specialist visit.
If you notice your parent declining care or rationing visits, the plan is probably misaligned with their needs. Some plans cover hearing aids well. Some have low specialist copays. Some have rich physical therapy coverage. The right plan, picked specifically for what they actually need, can change this picture.
The fix is to look at what care they need and find a plan that covers it well. For some families this means moving from a $0 premium MA plan to a richer MA plan with a small premium and better coverage. For others, it means moving to Original Medicare with a Plan G supplement, where almost everything is covered.
Sign 5: They Got a Surprise Bill After a Hospital Stay or Procedure
Your parent went into the hospital for something serious, recovered, and a few weeks later started getting bills. The bills add up to thousands. Your parent assumed the plan would cover everything.
Medicare Advantage plans have out-of-pocket maximums, but those maximums in Maricopa County range from around $4,000 to over $7,500 for in-network care. Out-of-network care has a separate, higher maximum on PPO plans, and HMO plans generally do not cover out-of-network care at all. A serious hospital stay can hit the out-of-pocket maximum, especially if any of the services were out of network or required a referral that was not obtained.
The fix in some cases is helping your parent appeal denied claims. The fix going forward is to choose a plan with a lower out-of-pocket maximum or move to Original Medicare with a supplement, where there is essentially no out-of-pocket exposure for Medicare-covered services.
Sign 6: They Travel and the Plan Does Not Travel With Them
Your parents winter in Arizona and summer in Wisconsin. Or they live in Mesa year-round but visit grandkids in Texas for months at a time. Or they have a cabin in Colorado.
Most Medicare Advantage plans have local networks. Out-of-area care is covered for emergencies and urgent care, but not for routine visits, follow-ups, or specialist appointments. If your parent has been delaying care while they are away, or scheduling everything for the few months they are home, the plan is fighting against their actual life.
The fix for travelers is usually Original Medicare with a Medigap supplement. Original Medicare works with any provider in the country who takes Medicare, and a supplement covers the gaps. The plan literally travels with them. We have a separate article specifically on Medicare for snowbirds in Arizona that goes into the details.
Sign 7: They Cannot Explain What Plan They Have
This sounds funny but it is one of the strongest signals that something is off. When you ask your parent what Medicare plan they are on, do they know? Do they have any idea what the premium is, what the copays are, or what is covered? Or do they shrug and say, “I think it is United something. The lady who came to my house signed me up.”
If they cannot explain it, they probably did not get walked through it carefully when they enrolled, and they probably are not on the right plan for them. Either an aggressive sales agent rushed them through the enrollment, or someone signed them up for whatever the agent was being pushed to sell that month.
The fix is a fresh comparison done with your parent and ideally with you in the room. We take their actual doctors, actual medications, actual lifestyle, and find the plan that fits. Then we make sure they understand what they signed up for so the next time someone asks, they can answer the question.
When You Can Actually Switch
Recognizing a problem is only useful if you can act on it. Here are the windows your parent has to switch plans.
The Annual Enrollment Period runs from October 15 through December 7 every year. During this window, anyone on Medicare can switch Medicare Advantage plans, switch drug plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. During this window, anyone enrolled in a Medicare Advantage plan can switch to a different Advantage plan or move back to Original Medicare with a Part D plan.
Special Enrollment Periods are triggered by specific events, including moving out of a plan’s service area, losing employer coverage, qualifying for Extra Help, or other life events. These windows let your parent change plans outside of the regular enrollment periods.
The 5-Star Special Enrollment Period lets anyone switch to a 5-star plan once a year between December 8 and November 30. This rule only matters if there is a 5-star plan available in your county, which is rare but does happen.
Need Help Reviewing Your Parent’s Plan?
If you are noticing any of these signs and want a second opinion on your parent’s Medicare plan, I am happy to help. I work with families across Mesa, Gilbert, Chandler, Tempe, Scottsdale, and the East Valley. We can run a no-cost comparison using their actual doctors and medications and see if there is a better plan available for 2026 or 2027.
Call me at 480-296-5804 or request a free consultation. No pressure, no obligation, and no cost to you. If the current plan turns out to be the right one, I will tell you. If there is a better option, we will look at it together with your parent in the conversation.