What You Can Review and Change During Medicare Open Enrollment

Every year, Medicare beneficiaries have a limited window of time — known as Open Enrollment — to review, compare, and make changes to their coverage. Understanding what you can adjust during this period can save you money, ensure you keep your doctors and prescriptions, and help you access the benefits you truly need.

This guide walks you through what to review, what to change, and how to prepare for this important season — all in a friendly, professional, and educational tone.

When Is Medicare Open Enrollment and Why It Matters

Medicare Open Enrollment — also called the Annual Election Period (AEP) — runs every year from October 15 through December 7.
During this time, you can:

• Join, switch, or drop a Medicare Advantage (Part C) plan.

• Add, change, or drop a Medicare drug plan (Part D).

• Move between Original Medicare and Medicare Advantage.

Any changes you make take effect on January 1 of the following year.

Even if you don’t plan to switch, this is the right time to review your plan because premiums, covered medications, provider networks, and benefits often change annually. A quick review can help ensure you’re not paying more than you should.

What to Review During Medicare Open Enrollment

1. Your Plan Premiums

Your monthly premium may increase, decrease, or stay the same. Check the new rates for next year — sometimes new plans offer better benefits at similar or lower costs.

2. Your Drug Coverage (Formulary)

Drug formularies — the lists of covered medications — change often.
Review:

• Whether your prescriptions are still covered.

• Any changes in drug tiers or copay amounts.

• Prior authorization or step therapy requirements.
  A medication that’s affordable this year could become costly next year if it moves to a higher tier.

3. Provider Networks

If you’re in a Medicare Advantage plan, make sure:

• Your primary care doctor and specialists remain in-network.

• Your preferred hospitals are still covered.

• You check network changes if you’ve moved or plan to relocate.

4. Extra Benefits and Supplemental Coverage

Many Advantage plans include vision, dental, hearing, transportation, and wellness benefits.
Confirm whether these perks still exist — or if a competing plan offers better value.

5. Deductibles, Copays, and Out-of-Pocket Maximums

Review your plan’s cost structure:

• Deductible amounts before coverage kicks in.

• Copays for doctor visits, hospitals, or urgent care.

• Annual out-of-pocket limits (especially important in Advantage plans).

6. Switching Between Original Medicare and Medicare Advantage

During Open Enrollment, you can:

• Move from Original Medicare (Parts A & B) to a Medicare Advantage plan.

• Switch from one Advantage plan to another.

• Drop Medicare Advantage and return to Original Medicare (with or without Part D drug coverage).

• Add or change your standalone drug plan (Part D).

7. Eligibility for Cost Assistance Programs

Check if you qualify for:

• Extra Help for prescription costs.

• Medicare Savings Programs to help pay premiums and deductibles.
  Changes in income or household size can affect eligibility.

What You Can Change During Medicare Open Enrollment

• Change Advantage Plan

• Return to Original Medicare

• Modify or Add a Drug Plan

• Adjust Within Your Plan

These changes let you tailor your healthcare coverage to your evolving medical and financial needs each year.

How to Prepare for Open Enrollment

Step 1: Gather Your Medical and Prescription Information

• Current medication list (name, dosage, frequency)

• List of doctors and specialists

• Pharmacy preferences

• Recent healthcare visits and needs

Step 2: Review Your Annual Notice of Change (ANOC)

Each fall, your plan sends you a Notice of Change.
This document lists any modifications in:

• Premiums

• Copays

• Coverage

• Drug formulary
  Don’t skip it — it’s your roadmap for knowing what will change next year.

Step 3: Use Medicare’s Plan Finder Tool

Visit Medicare.gov and use the Plan Finder to compare:

• Total yearly costs (not just premiums)

• Covered drugs and pharmacies

• Star ratings and quality scores

Step 4: Compare Total Annual Costs

Consider your total estimated expenses — including deductibles, copays, and medications — not just the monthly premium.

Step 5: Talk with a Licensed Medicare Advisor or SHIP Counselor

SHIP (State Health Insurance Assistance Programs) offer free, unbiased help comparing plans.
You can also consult with a certified Medicare advisor who can help you understand complex details and choose confidently.

Step 6: Make Your Decision Early

Avoid last-minute stress. Submit your enrollment changes before December 7 to ensure they take effect smoothly on January 1.

Recent Medicare Trends to Be Aware Of (2025–2026)

• Fewer Part D options: Many areas are seeing a reduction in drug plan choices, so compare carefully.

• Benefit adjustments: Some Advantage plans are scaling back supplemental perks (like dental or fitness programs) to manage rising costs.

• Lower out-of-pocket limits: New federal rules are capping maximum drug spending, helping reduce total costs for some beneficiaries.

All these shifts make it more important than ever to review your coverage each fall.

Medicare Open Enrollment is more than just paperwork — it’s your annual opportunity to take control of your healthcare coverage. Reviewing your plan, drug list, and provider network ensures you have the right benefits at the best cost for your situation.

Not sure where to start?
Speak with a certified Medicare advisor or schedule a free consultation to compare your options and make confident decisions for the year ahead.