Why Open Enrollment Matters Every Year
Medicare's open enrollment period runs from October 15 to December 7 every year. During those weeks you can switch between Original Medicare and a Medicare Advantage plan, change from one Medicare Advantage plan to another, and join, switch, or drop a Part D drug plan. Changes take effect on January 1.
Many people assume that a plan that worked this year will work the same next year. Plans change their premiums, deductibles, drug lists, pharmacy networks, and doctor networks every year. A medicine that was cheap in 2026 can move to a higher cost tier or require prior authorization in 2027. A few hours of review in November can prevent a year of surprises.
Step 1: Read Your Annual Notice of Change
Every Medicare Advantage and Part D plan sends members an Annual Notice of Change, usually by the end of September. It lists what is changing for next year: premiums, copays, the drug list, and network changes. If you did not receive one or cannot find it, call the plan. This single document answers most of the questions below.
Step 2: Check Every Medicine You Take
Make a complete list of your prescriptions, including the dose and how often you take each one. Then check each drug against next year's plan:
- Is it still covered? Plans add and remove drugs every year.
- What tier is it on? Tier changes can multiply your copay.
- Are there new restrictions? Prior authorization, step therapy, or quantity limits add hassle.
- Which pharmacies are preferred? Using a preferred pharmacy often lowers costs.
This matters most for people managing conditions such as diabetes or heart disease with brand-name drugs, such as insulin glargine or the blood thinner apixaban. Since 2025, Part D has had an annual cap on out-of-pocket drug spending, and the Medicare Prescription Payment Plan lets you spread those costs across the year in monthly payments. Ask your plan how both apply to you.
The Medicare Plan Finder lets you enter your exact drug list and compare estimated annual costs across every plan in your area.
Step 3: Confirm Your Doctors and Hospitals
For Medicare Advantage
Medicare Advantage plans usually rely on networks. Before choosing or keeping a plan, confirm that your primary care doctor, your specialists, and the hospitals you would want to use are in network for next year. Networks change, and a doctor in network this year may not be next year. Call each office directly, since online directories are not always current.
If you are considering a change and want to keep seeing us, call our office to confirm whether we participate with the plan you are considering before you enroll.
For Original Medicare
Original Medicare lets you see any doctor who accepts Medicare, but you will want a Part D plan for prescriptions and, for many people, a Medigap supplement for the costs Original Medicare does not cover. Our article on Medicare Advantage vs. Original Medicare walks through the trade-offs.
Step 4: Compare Total Costs, Not Just Premiums
A zero-premium plan is not always the cheapest. Add up:
- Monthly premiums for the plan and any Part B premium you pay
- Deductibles for medical care and drugs
- Copays and coinsurance for the visits, tests, and drugs you actually use
- The out-of-pocket maximum in a Medicare Advantage plan, the most you would pay in a bad year
- Extra benefits such as dental, vision, and hearing, which vary widely in what they really cover
Think about a typical year and a difficult year. A plan that looks cheap when you are healthy can cost far more if you need surgery or a hospital stay.
Step 5: Know the Rules That Trip People Up
Switching back to Original Medicare
You can leave Medicare Advantage for Original Medicare during open enrollment, but in most situations a Medigap supplement company can review your health history and charge more or decline you outside your guaranteed-issue periods. If you might want Original Medicare plus Medigap later, understand the rules before you switch.
The Medicare Advantage open enrollment period
From January 1 to March 31, people already in a Medicare Advantage plan get one more chance to switch to another Medicare Advantage plan or return to Original Medicare. It is a safety valve, not a substitute for careful review now.
Help paying for drugs
People with limited income and savings may qualify for Extra Help, a federal program that lowers drug costs. Applications go through Social Security, and it is worth checking even if you were denied in the past.
Free, Unbiased Help in Florida
Florida's SHINE program, Serving Health Insurance Needs of Elders, offers free one-on-one Medicare counseling from trained volunteers who do not sell insurance. You can reach them through the Florida SHINE website. The MedlinePlus Medicare page links to official resources as well. Be cautious with unsolicited calls and mailers that pressure you to switch plans quickly.
Bring Your Health Into the Decision
Your health needs should drive the choice. If you expect a surgery, a new specialist, or a new medicine next year, factor that in. Your Medicare Annual Wellness Visit is a good time to review your medicines and care plans, and our guide to navigating Medicare coverage explains what different parts of Medicare pay for.
When to Call Us
- You are considering a new plan and want to know whether we participate with it
- You need an up-to-date medication list to compare plans
- A plan change means a medicine may need prior authorization or a substitute
- Your new plan requires referrals for specialists you already see
- You have questions about which preventive services are covered in a visit
Reviewing your Medicare options this fall? Contact Zimmer Medical Group for an updated medication list and to confirm plan participation before December 7.
