Every year, Medicare has a window in which beneficiaries can review and change certain parts of their coverage. According to the official site, the Open Enrollment Period (sometimes called the Annual Election Period) runs October 15 – December 7, 2025. Changes made during this period take effect January 1 of the following year.
During this period, depending on the type of Medicare coverage you currently have, you can:
- Join, switch or drop a Medicare Advantage (“Part C”) plan.
- Join, drop or switch a Medicare Part D prescription drug plan (if you have Original Medicare or in some cases Advantage).
- Switch between Original Medicare (Parts A + B) and Medicare Advantage (with or without drug coverage).
- If you switch from Medicare Advantage back to Original Medicare, you’ll likely also need to consider a stand-alone Part D drug plan and optionally a Medigap (supplemental) policy.
If you like your current plan and it still meets your needs (and is still offered), you don’t have to do anything — your coverage will just continue (with whatever changes the plan is making).
Why it’s important to review your plan every year
Even if you’re happy with your plan, there are a number of good reasons to compare again each year:
- Plan benefits, provider networks, pharmacies and drug formularies can change from one year to the next.
- Your health needs may have changed (new medications, new doctor’s relationships, changes in routine) which might make a different plan more cost-effective or better suited.
- Some plans leave certain geographic areas, or their premiums, deductibles, or cost-sharing change.
- If you don’t review and your current plan shifts in a way that doesn’t suit you (for example, your medications are no longer covered, or your doctor is no longer in-network) you may end up paying more or losing access.
Yet, studies show many beneficiaries skip the review: for example, nearly 7 in 10 Medicare beneficiaries did not compare their plan with other options during one past open enrollment period.
What’s new or different this year
- The average premium for Medicare Advantage plans (after rebates) is projected to go down for 2026: e.g., in one piece it says it will decrease from ~$16.40/month to ~$14.00/month. A word of caution, though: even though average premiums for some plans may decline or remain relatively stable, deductibles, cost-sharing, and out-of-pocket exposure may still increase or shift in structure.
- The number of stand-alone Part D prescription drug plans is dropping — fewer options than in past years in many areas.
- One of the most significant changes: for many parts of Medicare (both Advantage and Part D drug plans), there is now an annual cap on out-of-pocket costs for covered prescription drugs. For example, starting in 2025 there is a $2,000 cap on what you pay out-of-pocket for covered drugs, however, the cap does not apply to drugs not covered under your plan.
- In addition, there’s a new “payment plan” option for drug costs: meaning you may be able to spread your out-of-pocket prescription cost payments over the course of the year rather than paying everything at the time of fill.
- Provider networks for Medicare Advantage plans may shrink in some areas; major carriers are reducing or exiting certain counties.
- The tools to compare plans (via Medicare.gov) have been enhanced: for example, you can now check whether your preferred doctors are in-network across different plans, see the effect of your specific medications, etc.
How to Approach Your Review This Year: A Checklist
Here’s a suggested step-by-step plan to review your Medicare coverage this open enrollment season:
- Gather your information:
- Find your current plan’s “Annual Notice of Change” (ANOC) or “Evidence of Coverage” (EOC) — this outlines changes your plan will make next year.
- Make a list of all prescription drugs you currently take (dosage, frequency, pharmacy).
- Make a list of your preferred doctors / specialists and check if you’re comfortable with the network under your plan.
- Consider any changes in your health or lifestyle (new diagnosis, new medication, moving, etc.).
- Use the official tools:
- Visit Centers for Medicare & Medicaid Services (CMS) or the official Medicare website (Medicare.gov) and use the “Plan Finder” or equivalent comparison tools.
- Consider reaching out to your State Health Insurance Assistance Program (SHIP) for free counseling.
- Compare your current plan to alternatives:
- Are there other plans in your area that cover your medications at lower cost?
- Are your preferred providers in-network under your current and competing plans?
- What are the premium, deductible, copay/coinsurance, out-of-pocket limits (especially for drugs) for each plan?
- Are there additional benefits (e.g., dental, vision, hearing) offered under Advantage plans you might value?
- Has your current plan increased costs or shrunk the network in a way that matters to you?
- Decide: stay or switch:
- If you’re satisfied with your current plan and it still meets your needs, and its changes for next year are acceptable, you might choose to stay.
- If you find a better fit (for your medications, doctors, cost structure), then switching may save money or improve coverage.
- Remember: If you change, the deadline to submit your request is December 7 (for changes to take effect Jan 1).
- Submit required enrollment changes:
- If you’re switching, enroll online via Medicare.gov, by phone (1-800-MEDICARE), or via your chosen plan/agent. Keep a record (date, plan, representative).
- Make sure you meet the deadline and follow up to confirm the change was processed.
- After January 1st: Review your coverage
- Once your new plan begins (or your current plan rolls over), monitor your claims, medication coverage, provider network usage, etc., especially in the first months of the year.
- Be aware: If you’re in a Medicare Advantage plan, there is a separate “Medicare Advantage Open Enrollment Period” (Jan 1 – March 31) during which you can switch Medicare Advantage plans or revert to Original Medicare.
Open Enrollment for Medicare is a key annual opportunity to make sure your health coverage aligns with your needs — both medical and financial. With the notable changes coming to prescription drug coverage (for example, the new out-of-pocket cap), evolving plan options, and possible shifts in provider networks and plan offerings, this year’s review is particularly important.
Even if switching seems like a hassle, the potential to save money, reduce unexpected costs, and ensure access to your doctors and drugs can make it well worth the effort.
The Elder Law attorneys at Mandelbaum Barrett PC are here to answer any questions you may have.