Medicare’s Annual Enrollment Period runs from October 15 to December 7. Whatever you have in place on December 7 is what you live with starting January 1. Most people either change plans in a hurry because of a mailer, or do nothing because they are happy with this year. Both can cost money.
You do not need to switch plans every year. Plenty of my clients keep the plan they have, and that is often the right answer. The point is to check before you decide. Here are the steps I walk every client through when AEP opens.
Step 1: Read your Annual Notice of Change
Every Medicare Advantage and Part D plan must mail you an Annual Notice of Change by September 30. It lists what is changing for next year: premium, deductible, copays, drug coverage, and sometimes the provider network.
Look for four things:
- Did the monthly premium go up?
- Did the drug deductible or drug tiers change?
- Did your copays for doctors, specialists, or hospital stays change?
- Did the maximum out-of-pocket limit go up?
If you cannot find the letter, call the number on the back of your member card and ask for it, or look it up on the plan’s website.
Step 2: Find out if your plan is still around next year
Some plans are not renewing for 2027, and some carriers are pulling out of whole counties. If your plan is ending, you get a separate non-renewal letter. Do not ignore it. If you do nothing, you may end up on Original Medicare with no drug coverage.
A plan ending also gives you special rights, including a window to pick a new plan and, in many cases, a chance to buy certain Medicare Supplement plans without health questions. Our guide on what to do if your plan is ending walks through the options.
Step 3: Run your drugs against next year’s plans
This is where most of the money is. Drug lists and tiers change every year, and a medicine that was a low copay this year can move to a higher tier next year.
- Make a list of every prescription, with the dose and how often you take it.
- Note the pharmacy you use. Preferred pharmacies can cut your costs a lot.
- Compare your total yearly cost, not just the premium. A low premium with high drug costs is not a deal.
For 2027, the Part D deductible is $700 and the yearly cap on what you pay for covered drugs is $2,400. Covered insulin stays at $35 a month or less. Once you reach the cap, you pay nothing more for covered drugs the rest of the year.
Step 4: Confirm your doctors and hospitals
If you have a Medicare Advantage plan, your doctors and hospitals have to be in the plan’s network for next year, not just this year. Networks change, and contracts between hospital systems and carriers sometimes end in the fall.
Check each doctor and hospital you use. Call the office and ask, “Will you be in network with this plan in January?” A provider directory is a good start, but the office is the final word. If a doctor you rely on is leaving, see what to do when your doctor leaves the network.
Step 5: Look at total cost, not just the premium
A $0 premium plan is not a $0 plan. Add up what you would really pay in a normal year and in a bad year:
- Monthly premium times 12
- Your drug costs for the year
- Copays for the doctor visits you usually have
- The maximum out-of-pocket limit, which is what a bad year could cost you
Remember that you still pay your Part B premium of $202.90 a month, unless a program like Medicaid pays it for you or your plan has a Part B giveback.
Step 6: Think hard before leaving a Medicare Supplement
If you have a Medicare Supplement plan today and you are tempted by an Advantage plan’s extras, slow down. In most states, if you drop your Supplement and want it back later, the company can ask health questions and turn you down. A move that saves a little now can lock you out of the coverage you had.
The reverse move, from Advantage back to Original Medicare with a Supplement, also usually means passing health questions. Read the real difference between a Supplement and Medicare Advantage before you switch either way.
What to watch out for during AEP
- Unsolicited calls. Medicare and Social Security will not call you to sell a plan. If someone calls out of the blue asking for your Medicare number, hang up. See our guide to Medicare scam calls.
- TV ads with big promises. The benefits in those ads are not available everywhere, and the caller on the other end works for a call center, not for you.
- Switching for one extra. A larger grocery card or dental allowance is not worth losing your doctor or paying more for your drugs.
If you miss something
Changes you make by December 7 start January 1. If you have a Medicare Advantage plan and realize in January that you picked wrong, you get one more chance. The Medicare Advantage Open Enrollment Period runs from January 1 to March 31, and you can make one plan change during that time. See AEP vs. OEP for how the two windows differ.
People with Original Medicare and a Supplement plan do not get that second window, so get it right during AEP.
Let us do the comparing
Running drugs and doctors against every plan in your county takes time. That is our job, and it costs you nothing. Start with the Medicare Clarity Score, which takes about three minutes and flags penalties, coverage gaps, and overpayment risks. Or call Scott at 512-844-3983. If your current plan is still the best fit, we will tell you to keep it.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not affiliated with or endorsed by the federal government or the federal Medicare program.