Medicare Open Enrollment is an important time to review your health and drug coverage for the coming year.
Even if you are happy with your current Medicare plan, it is still worth checking your options. Plans can change their premiums, deductibles, copays, prescription drug coverage, pharmacy networks, doctor networks, prior authorization rules, and extra benefits from one year to the next.
A plan that worked well this year may still be a good choice next year. But it might not be. The only way to know is to review the details before the deadline.
This checklist can help you compare your current coverage with your options and avoid common surprises.
What Is Medicare Open Enrollment?
Medicare Open Enrollment is the yearly period when people with Medicare can review and change certain types of coverage.
During this period, you may be able to:
- Switch from one Medicare Advantage plan to another
- Switch from Original Medicare to a Medicare Advantage plan
- Switch from a Medicare Advantage plan back to Original Medicare
- Join, switch, or drop a Medicare Part D prescription drug plan
- Review whether your current plan still fits your needs
Changes made during Medicare Open Enrollment generally take effect on January 1 of the following year.
This period is different from your first Medicare enrollment period. It is also different from special enrollment periods that may apply if you move, lose coverage, qualify for certain assistance programs, or experience another qualifying life event.
Because the rules can be confusing, it is a good idea to use official Medicare resources or speak with a trusted Medicare counselor before making a final decision.
Why You Should Review Your Medicare Plan Every Year
It is easy to assume that if your plan worked this year, it will work the same way next year. Unfortunately, that is not always true.
Medicare Advantage and Part D plans can change from year to year. These changes may affect:
- Monthly premiums
- Deductibles
- Copays
- Coinsurance
- Maximum out-of-pocket limits
- Prescription drug formularies
- Medication tiers
- Pharmacy networks
- Provider networks
- Referral rules
- Prior authorization requirements
- Dental, vision, hearing, and other extra benefits
Even a small plan change can matter if you take regular medications, see specialists, use a preferred hospital, or expect surgery, imaging, therapy, or other care in the coming year.
The goal is not always to find the cheapest plan. The goal is to find coverage that fits your doctors, prescriptions, health needs, budget, and comfort level with plan rules.
Medicare Open Enrollment Checklist
Use this checklist before keeping your current plan or switching to a new one.
1. Review Your Annual Notice of Change
If you are already enrolled in a Medicare Advantage plan or Part D prescription drug plan, your plan should send you an Annual Notice of Change before the new plan year.
This document explains what is changing next year.
Look for changes to:
- Monthly premium
- Deductible
- Copays
- Coinsurance
- Prescription drug coverage
- Provider network
- Pharmacy network
- Prior authorization rules
- Extra benefits
- Maximum out-of-pocket limit
Do not ignore this notice. It may contain the first warning that your plan will cost more, cover less, or work differently next year.
If you do not understand something in the notice, call the plan and ask for a plain-English explanation.
2. Check Your Monthly Premium
The monthly premium is the amount you pay each month to have the plan.
Some Medicare Advantage plans have low or even $0 plan premiums. Some Part D plans may also have relatively low premiums. But the premium is only one part of the total cost.
A low-premium plan may still have:
- Higher copays
- Higher drug costs
- A deductible
- A limited pharmacy network
- A smaller doctor network
- More prior authorization requirements
- Higher costs for out-of-network care
When comparing plans, do not choose based on premium alone. Look at what you would likely pay if you actually use the coverage.
3. Compare Deductibles, Copays, and Coinsurance
A deductible is the amount you pay before certain coverage begins. A copay is a set dollar amount you pay for a service. Coinsurance is usually a percentage of the cost.
Review costs for services you are likely to use, such as:
- Primary care visits
- Specialist visits
- Urgent care
- Emergency room care
- Hospital stays
- Outpatient surgery
- Lab work
- X-rays, CT scans, or MRIs
- Physical therapy
- Durable medical equipment
- Ambulance services
If you have a chronic condition, see multiple doctors, or expect a procedure next year, these costs may matter more than the monthly premium.
A plan that looks inexpensive at first may become more expensive if the services you need have higher copays or coinsurance.
4. Review Your Prescription Drug Coverage
Prescription coverage is one of the most important parts of Medicare plan review.
Make a complete list of your medications, including:
- Drug name
- Dose
- How often you take it
- Whether it is brand-name or generic
- Your preferred pharmacy
- Whether you use mail order
- Any medications you expect to start or stop soon
Then check each plan to see:
- Whether the medication is covered
- What tier the medication is on
- What you will pay at your pharmacy
- Whether prior authorization is required
- Whether step therapy is required
- Whether quantity limits apply
- Whether a different pharmacy would cost less
Medication costs can vary widely from one plan to another. A plan that works well for one person may be a poor fit for another person taking different prescriptions.
If you take several medications, review drug coverage carefully before switching plans.
5. Make Sure Your Doctors Are Still In Network
If you are considering a Medicare Advantage plan, provider networks are very important.
Check whether your current doctors are in network, including:
- Primary care doctor
- Specialists
- Cardiologist
- Endocrinologist
- Orthopedic doctor
- Eye doctor
- Mental health provider
- Physical therapist
- Any other provider you see regularly
Do not rely only on memory or assumptions. A doctor who accepted your plan this year may not necessarily be in the same network next year.
It is wise to check both:
- The plan’s provider directory
- The doctor’s office directly
Ask the office whether the doctor will be in network for that specific plan next year. Be specific, because insurance companies may offer several similar-sounding plans.
6. Check Your Preferred Hospitals and Pharmacies
Doctors are only part of the network. Hospitals, outpatient centers, labs, imaging centers, and pharmacies may also matter.
Before choosing a plan, check whether it includes:
- Your preferred hospital
- Nearby urgent care centers
- Common lab locations
- Imaging centers
- Surgery centers
- Rehabilitation facilities
- Skilled nursing facilities
- Your preferred local pharmacy
- Mail-order pharmacy options
This can be especially important if you live near multiple health systems or if your doctors operate out of specific hospitals.
A plan may include your doctor but not your preferred hospital, or it may include a pharmacy but charge less at a different “preferred” pharmacy.
7. Look at Prior Authorization Rules
Prior authorization means the plan must approve certain services, medications, tests, or procedures before it will cover them.
Medicare Advantage and Part D plans may require prior authorization for some types of care.
Prior authorization may apply to:
- Advanced imaging
- Surgeries
- Hospital stays
- Skilled nursing care
- Physical therapy
- Certain medications
- Durable medical equipment
- Home health services
- Some specialist care
Prior authorization is not automatically a reason to reject a plan, but you should know the rules before you enroll.
This is especially important if you expect a procedure, take expensive medications, use medical equipment, or have a condition that requires ongoing specialist care.
Ask the plan:
- Which services require prior authorization?
- How long does approval usually take?
- What happens if approval is denied?
- How does the appeal process work?
- Will existing treatments need to be approved again next year?
8. Compare Dental, Vision, Hearing, and Extra Benefits
Many Medicare Advantage plans advertise extra benefits, such as:
- Dental coverage
- Vision coverage
- Hearing benefits
- Fitness memberships
- Over-the-counter allowances
- Transportation benefits
- Meal benefits after hospital stays
- Telehealth options
These benefits can be useful, but they can also be limited.
Before choosing a plan because of extra benefits, ask:
- What exactly is covered?
- Is there an annual dollar limit?
- Are only certain providers covered?
- Are implants, dentures, crowns, or major dental work included?
- Are hearing aids fully covered or only discounted?
- Can I use the vision benefit at my preferred eye doctor?
- Is the over-the-counter allowance monthly, quarterly, or yearly?
- Does unused allowance roll over?
Extra benefits should be considered, but they should not outweigh the basics: your doctors, prescriptions, hospitals, out-of-pocket costs, and access to care.
9. Consider Travel and Snowbird Needs
Your travel habits can affect which Medicare option works best for you.
Ask yourself:
- Do I travel often?
- Do I spend part of the year in another state?
- Do I visit family for long periods?
- Do I need routine care away from home?
- Would I be comfortable using only emergency or urgent care while traveling?
Original Medicare is accepted by many Medicare-participating providers across the United States. Medicare Advantage plans, however, often use local or regional networks.
Emergency and urgent care may be covered when traveling, but routine care outside the plan’s service area may be limited or more expensive.
If you split time between two states or travel frequently, ask the plan exactly how out-of-area care works before enrolling.
10. Compare the Maximum Out-of-Pocket Limit
Medicare Advantage plans have an annual maximum out-of-pocket limit for covered medical services. Once you reach that limit, the plan pays covered medical costs for the rest of the calendar year.
This limit can vary by plan.
When comparing plans, check:
- The in-network out-of-pocket maximum
- The out-of-network maximum, if applicable
- Whether prescription drug costs count toward that limit
- Which services are included or excluded
- How likely you are to approach the limit in a bad health year
A lower out-of-pocket maximum may be valuable if you expect significant medical care.
Original Medicare by itself generally does not have the same type of built-in yearly out-of-pocket maximum for Part A and Part B services. Many people who choose Original Medicare consider supplemental coverage, such as Medigap, to help manage costs.
11. Review Star Ratings, but Do Not Rely on Them Alone
Medicare uses star ratings to help people compare plan quality and performance. A higher rating may be a positive sign, but it should not be the only factor in your decision.
A highly rated plan may still be a poor fit if:
- Your doctor is not in network
- Your medications are expensive
- Your preferred hospital is not included
- The pharmacy network does not work for you
- The plan has prior authorization rules that affect your care
- The out-of-pocket costs are too high for your situation
Use star ratings as one piece of information, not the whole decision.
Your personal needs matter more than a general rating.
12. Decide Whether to Stay, Switch, or Get Help
After reviewing your options, you may decide to stay with your current plan. That can be a good choice if the plan still fits your needs.
You may also decide to switch if another plan offers:
- Better drug coverage
- Lower total expected costs
- Better doctor access
- Better pharmacy options
- A lower out-of-pocket maximum
- More useful extra benefits
- Fewer access problems
If you are unsure, get help before making a change.
Good places to ask for help include:
- Medicare
- Your State Health Insurance Assistance Program
- A trusted licensed insurance agent
- A caregiver or family member who can help compare details
- Your doctor’s office, for network questions
- Your pharmacy, for prescription cost questions
Do not feel pressured to make a quick decision from a TV ad, phone call, postcard, or mailer. Take time to compare the actual plan details.
Quick Worksheet: Information to Gather Before Comparing Plans
Before using Medicare’s plan comparison tools or speaking with someone about your options, gather this information:
| Information to Gather | Notes |
|---|---|
| Medicare number | Needed if enrolling or using your Medicare account |
| Current plan name | Include Medicare Advantage, Part D, or supplement details |
| Current premium | Note monthly cost |
| Current doctors | Include primary care and specialists |
| Preferred hospitals | Include health systems you want to keep |
| Pharmacy | Include local and mail-order preferences |
| Prescription list | Include name, dose, frequency, and brand/generic status |
| Expected procedures | Include surgeries, imaging, therapy, or specialist care |
| Travel plans | Note if you spend time in another state |
| Budget concerns | Consider monthly cost and worst-case costs |
| Extra benefits you use | Dental, vision, hearing, fitness, transportation, OTC allowance |
Keeping this information in one place makes it easier to compare plans accurately.
Common Mistakes to Avoid During Open Enrollment
Choosing a Plan Based Only on a TV Commercial
Advertisements often highlight low premiums and extra benefits. They may not explain whether your doctors, medications, hospitals, and pharmacies are covered.
Use ads as a starting point, not as your decision-making tool.
Forgetting to Check Prescription Costs
Medication coverage can change each year. A plan that covered your medication well this year may place it on a different tier next year or add restrictions.
Always check your actual prescription list.
Assuming Your Doctor Is Covered
Provider networks can change. Do not assume your doctor is in network just because you saw that doctor under your current plan this year.
Confirm before enrolling.
Ignoring the Annual Notice of Change
The Annual Notice of Change is easy to set aside, but it may explain important changes to your coverage.
Read it carefully each year.
Looking Only at Monthly Premiums
A low monthly premium does not always mean a low-cost plan. Copays, deductibles, coinsurance, drug costs, and out-of-pocket limits can make a big difference.
Compare total expected costs.
Overvaluing Extra Benefits
Dental, vision, hearing, fitness, and over-the-counter benefits can be helpful. But they should not be the main reason you choose a plan if the medical or drug coverage does not fit your needs.
Waiting Until the Last Minute
Open Enrollment has a deadline. Waiting until the final days can make the process stressful, especially if you need help comparing plans.
Start early enough to ask questions and review your options carefully.
Final Thoughts
Medicare Open Enrollment is not just a paperwork deadline. It is a yearly chance to make sure your coverage still fits your life.
Your doctors, medications, pharmacies, health needs, travel habits, and budget can all change. Plans can change too.
Before keeping or switching coverage, review your Annual Notice of Change, compare prescription costs, confirm your doctors and hospitals, check prior authorization rules, and look at your total possible costs.
The best Medicare plan is not always the one with the lowest premium or the most advertised extras. It is the one that gives you the best fit for your actual health care needs.
Disclaimer
This article is for general educational purposes only and is not medical, legal, financial, or insurance advice. Medicare rules, plan benefits, costs, provider networks, prescription coverage, enrollment periods, and out-of-pocket limits can change. Always review official Medicare materials, compare plans carefully, and consider speaking with Medicare, a licensed insurance professional, or your State Health Insurance Assistance Program before making coverage decisions.