Medicare Open Enrollment: 5 Things to Know Before You Choose
The annual Medicare Open Enrollment Period gives beneficiaries the opportunity to review and change their Medicare coverage for the upcoming year. Understanding your options during this window can significantly impact your healthcare costs and coverage.
Every fall, millions of Medicare beneficiaries face an important decision: whether to keep their current coverage or make changes for the year ahead. The Medicare Open Enrollment Period, which runs from October 15 through December 7 each year, represents the primary opportunity for most beneficiaries to adjust their coverage.
During this period, Medicare beneficiaries can switch from Original Medicare to Medicare Advantage (or vice versa), change Medicare Advantage plans, join, switch, or drop a Medicare Part D prescription drug plan, and make other coverage adjustments that take effect on January 1 of the following year.
With the complexity of Medicare options and the potential financial implications of coverage decisions, taking time to understand the enrollment process is worthwhile. Here are five key considerations for the 2026 Medicare Open Enrollment Period.
1. Understand What You Can Change During Open Enrollment
The Medicare Open Enrollment Period offers specific options for beneficiaries looking to modify their coverage. Understanding exactly what changes are permitted during this window helps ensure you make the most of this annual opportunity.
Changes Permitted During Open Enrollment
- Switch from Original Medicare to Medicare Advantage: Beneficiaries currently enrolled in Original Medicare (Parts A and B) can choose to enroll in a Medicare Advantage plan.
- Switch from Medicare Advantage to Original Medicare: Those with Medicare Advantage coverage can return to Original Medicare.
- Change Medicare Advantage Plans: Beneficiaries can switch from one Medicare Advantage plan to another.
- Join a Part D Plan: Those with Original Medicare can enroll in a standalone prescription drug plan.
- Switch Part D Plans: Beneficiaries can change from one Part D plan to another.
- Drop Part D Coverage: Those with Part D can choose to disenroll, though this may result in late enrollment penalties if coverage is needed later.
What You Cannot Change
Medicare Open Enrollment does not provide an opportunity to enroll in Medicare for the first time or to make changes to Medicare Supplement Insurance (Medigap) policies. Initial Medicare enrollment occurs during your Initial Enrollment Period, which is typically tied to your 65th birthday. Medigap policies have their own enrollment rules and timing.
2. Review Your Current Plan’s Annual Notice of Change
Each fall, Medicare plans are required to send beneficiaries an Annual Notice of Change (ANOC) document. This notice, typically mailed in September, outlines any changes to your plan’s coverage, costs, or provider networks that will take effect in the upcoming year.
Key Elements to Review
- Premium Changes: Monthly premium amounts may increase, decrease, or remain the same.
- Deductible Adjustments: Annual deductibles for medical services and prescription drugs may change.
- Copay and Coinsurance Modifications: Your share of costs for doctor visits, hospital stays, and medications may be different.
- Formulary Changes: The list of covered prescription drugs and their tier placement may have been modified.
- Provider Network Updates: Doctors, hospitals, and pharmacies in your plan’s network may have changed.
- Coverage Changes: Benefits covered by your plan may have been added, removed, or modified.
Even if you’ve been satisfied with your current coverage, reviewing the ANOC is important because plans can make substantial changes from year to year. A medication you currently take might move to a higher cost tier, or a doctor you see regularly might leave the plan’s network.
3. Compare Original Medicare vs. Medicare Advantage
One of the most significant decisions Medicare beneficiaries face is choosing between Original Medicare and Medicare Advantage. Each approach has distinct characteristics that may make it more suitable for different individuals’ needs and circumstances.
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Coverage Structure | Part A (hospital) + Part B (medical) | Combines Part A + Part B, often includes Part D and extra benefits |
| Provider Choice | Any provider that accepts Medicare | Typically limited to plan network |
| Prescription Drug Coverage | Requires separate Part D plan | Often included in plan |
| Out-of-Pocket Maximum | No annual limit (unless you have supplemental coverage) | Required annual limit on out-of-pocket costs |
| Additional Benefits | Not included; may add Medigap for coverage gaps | May include vision, dental, hearing, fitness benefits |
| Referrals | Not required for specialists | May be required depending on plan type |
Geographic Considerations
Medicare Advantage plan availability and quality vary significantly by location. Urban areas typically have more plan options than rural areas. Some beneficiaries in rural areas may find that Original Medicare with a Medigap policy provides better access to care, while those in areas with robust Medicare Advantage competition may find plans with attractive benefits and lower costs.
4. Evaluate Your Prescription Drug Coverage Carefully
Prescription drug coverage represents one of the most important and complex aspects of Medicare planning. Whether you have a standalone Part D plan or drug coverage through Medicare Advantage, annual review is essential.
Using the Medicare Plan Finder
The Centers for Medicare & Medicaid Services (CMS) provides an online Medicare Plan Finder tool at Medicare.gov that allows beneficiaries to compare plans based on their specific prescription drugs. This tool can estimate total annual costs including premiums, deductibles, and out-of-pocket costs for medications.
Formulary Considerations
Each Part D plan and Medicare Advantage plan with drug coverage maintains a formulary—a list of covered medications organized into cost tiers. When comparing plans, consider:
- Whether your current medications are on the plan’s formulary
- What tier each medication is placed in (higher tiers generally mean higher costs)
- Whether any medications require prior authorization or step therapy
- Quantity limits that may apply to your prescriptions
- Which pharmacies are in the plan’s preferred network
Coverage Gap and Catastrophic Coverage
Part D plans include a coverage gap (sometimes called the “donut hole”) where beneficiaries historically paid a larger share of drug costs. Legislative changes have gradually reduced this gap. Additionally, plans provide catastrophic coverage after out-of-pocket spending reaches a certain threshold, at which point cost-sharing is significantly reduced.
5. Know Where to Find Help and Resources
Medicare decisions can be complex, and beneficiaries have access to several resources for assistance. Taking advantage of these resources can help ensure informed decision-making.
State Health Insurance Assistance Programs (SHIP)
Every state has a State Health Insurance Assistance Program that provides free, unbiased Medicare counseling. SHIP counselors can help beneficiaries understand their options, compare plans, and navigate enrollment. These services are funded by the federal government and state sources, and counselors do not sell insurance products.
Medicare.gov Resources
The official Medicare website offers several tools for beneficiaries:
- Medicare Plan Finder: Compare Medicare Advantage, Part D, and Medigap plans available in your area
- Medicare & You Handbook: Comprehensive guide to Medicare coverage mailed annually to beneficiaries
- Out-of-Pocket Cost Estimator: Tool to estimate costs based on your expected healthcare utilization
1-800-MEDICARE
Medicare’s official helpline (1-800-633-4227) is available 24 hours a day, seven days a week. Representatives can answer questions about Medicare coverage, help with enrollment, and provide information about plans in your area. TTY users can call 1-877-486-2048.