What to Review During Medicare Open Enrollment Season

Every fall, millions of retirees face the same question: Should I change my Medicare plan? Medicare’s Annual Enrollment Period (AEP), also known as Open Enrollment, runs from October 15 through December 7, and offers a brief but powerful opportunity to reassess your coverage for the year ahead. For many retirees, Medicare isn’t a “set it and forget it” program. Plans change. Premiums shift. Medications get added. Even your favorite doctor can quietly drop out of a network. Taking time to review your coverage each year ensures your health plan continues to align with both your medical needs and your financial strategy.

Medicare, administered by the Centers for Medicare & Medicaid Services (CMS), is one of the largest expenses many retirees face, and its costs can creep up quietly if you aren’t paying attention. Even small changes in your prescription coverage, network, or cost structure can lead to hundreds or thousands of dollars in unexpected out-of-pocket spending. That’s why your goal during Open Enrollment isn’t just to find the lowest-cost option, but to confirm that your plan still fits your needs and budget. The evaluation is about balancing affordability, access to care, and peace of mind.

How Should You Evaluate Your Current Medicare Plan?

Before you compare alternatives, take a close look at how your current plan has served you over the past year. Review your total out-of-pocket spending, including premiums, deductibles, copays, and any unexpected bills that may have slipped through. Think about your care experiences. Were your preferred doctors, specialists, and hospitals still covered at the in-network rates you expected, or did you face surprise charges? Consider whether any claims were denied and, if so, whether those denials were one-time issues or signs of a broader coverage problem.

It’s also worth revisiting your prescription usage. Have your medications or dosage changed? A shift in your health or prescriptions can affect which plans will offer the best coverage next year.

By September 30 each year, your insurer sends the Annual Notice of Change (ANOC). Be careful not to set it aside with the junk mail since it’s one of the most important pieces of information you’ll receive. The ANOC details next year’s premium changes, deductible adjustments, and updates to coverage or benefits. Reviewing it carefully now can help you catch small changes that could lead to big expenses later.

What Are Your Medicare Coverage Options?

It’s helpful to understand what coverage options are available when evaluating your plan during open enrollment. Medicare coverage falls into two primary options: Original Medicare and Medicare Advantage.

• Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). You can add Part D for prescription drug coverage and a Medigap supplemental policy to help pay out-of-pocket costs such as coinsurance and deductibles.
• Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare. These “bundled” plans are offered by private insurers and include Part A, Part B, and usually Part D. Many also provide extra benefits that Original Medicare does not, such as dental, vision, or fitness coverage.

Should You Choose Medicare Advantage or Original Medicare?

If you’re enrolled in Original Medicare (Parts A and B), you might consider switching to a Medicare Advantage (Part C) plan that bundles medical, hospital, and often prescription coverage into one policy. Conversely, those in a Medicare Advantage plan can switch back to Original Medicare and add a Part D prescription plan or a Medigap (supplemental) policy from a private provider.

The right choice depends on how you prefer to manage your healthcare. Medicare Advantage plans tend to offer convenience, lower upfront premiums, and extras like dental or vision coverage. The tradeoff is usually a more limited provider network and potential pre-authorization requirements. Original Medicare with Medigap offers flexibility and broad access to doctors nationwide, but comes with higher premiums and separate drug coverage.

If you split your time between states or plan to travel more in retirement, confirm that your plan covers you in those areas. Some Medicare Advantage plans have very localized networks, while Original Medicare offers national coverage. Don’t assume your favorite doctors or specialists will still be in-network next year; always verify before renewing.

How Should You Review Your Prescription Drug Coverage?

Drug plans change every year, which is where many people see the biggest surprises. Even if your plan’s name hasn’t changed, the formulary (the list of covered medications) may look very different from last year. Costs can also shift as insurers reclassify drugs into new pricing tiers or adjust preferred pharmacy networks.

Take time to confirm that your prescriptions are still covered, that the dosage or copay amounts haven’t increased, and that your go-to pharmacy remains in-network. A quick check now can prevent unpleasant surprises later. The Medicare Plan Finder at Medicare.gov makes it easy to compare your current plan against other Part D or Medicare Advantage options side-by-side.

What Costs Should You Compare When Reviewing Medicare Plans?

When comparing plans, don’t only focus on the monthly premium, as it’s only part of the story. Take a closer look at how the deductibles, copays, and out-of-pocket maximums stack up for the coming year. A plan that looks cheaper on paper can end up costing more overall if you expect frequent doctor visits, ongoing treatments, or new prescriptions.

Your income also plays a role in what you’ll pay for coverage. If your earnings have changed, it could affect your Income-Related Monthly Adjustment Amount (IRMAA), which is the surcharge applied to Medicare Parts B and D for higher-income retirees. These surcharges can add up quickly, so reviewing your income levels and coordinating with your financial or tax advisor can help you manage costs and avoid surprises when premiums adjust next year.

Many Medicare Advantage plans have added perks like dental, vision, hearing, transportation, or fitness benefits. These can be valuable, but coverage limits vary. Check whether the benefits you actually use are still included and whether any coverage caps have changed.

How to Avoid Medicare Scams During Open Enrollment

Unfortunately, Open Enrollment also attracts scammers and aggressive marketing. Remember:

• Medicare and CMS will never call you to sell a plan.
• Be cautious with anyone asking for personal or banking information.
• Confirm all plan changes directly through Medicare.gov or a licensed professional you trust

Get Expert Guidance Before You Make Changes

Medicare choices play a key role in your overall financial plan, influencing your taxes, income, and long-term healthcare expenses. Before making any changes, talk with your advisor, McLean’s Medicare specialist, and your CPA to confirm your coverage supports your broader retirement goals and financial plan.

Download the Medicare Open Enrollment Flowchart

This visual guide covers considerations that can influence your decisions during Medicare open enrollment, such as changes in health care needs, premium and deductible costs, and the effective dates of any changes.