Between October 15 and December 7, you get one clean shot to change your Medicare coverage for next year. Miss it, and for most people, the plan you have now is the plan you keep for the next twelve months. Good or bad.
Here is what I see every year. Most folks do not look at their plan in the fall. They look at it in March, standing at a pharmacy counter, when a drug that used to cost a little suddenly costs a lot. By then the easy window has closed.
The Medicare Rights Center’s Medicare Rights Watch put out a reminder that Fall Open Enrollment is now underway. It is a good, plain summary of the choices you have during this window. I want to go a step further and talk about what those choices mean for you, and where people tend to get tripped up.
If you are on Medicare today, this matters to you even if you love your plan. Plans change every year. Drug lists change. Doctor networks change. Sometimes a plan leaves your area completely. The fall window is your built-in chance to catch those changes before they catch you.
What can I actually change between October 15 and December 7?
You can change how you get your Medicare coverage for next year, and you can change your drug plan. That is the short answer. Here is what that looks like in real life:
- Leave Original Medicare and join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and bundle your hospital and medical coverage together. Many also include drug coverage.
- Leave a Medicare Advantage plan and return to Original Medicare. You can do this, but read the section below about Medigap first. There is a catch.
- Trade one Medicare Advantage plan for another. Maybe your doctor left the network, or your costs went up.
- Join, switch, or drop a standalone Part D drug plan. This is the one I see people skip the most, and it is often where the money is.
Whatever you pick, your new coverage starts January 1. If you make more than one change during the window, the last one you make before December 7 is the one that counts.
For a full rundown of the other windows during the year, our page on Medicare enrollment periods lays them out side by side.
Why should I look if my plan seems fine?
Because “fine this year” does not mean “fine next year.” Your plan is allowed to change its costs, its drug list, and its network every year. You were supposed to get a letter about those changes, called the Annual Notice of Change, by the end of September.
Be honest. Did you read it? Most people do not. It is long, it is dry, and it looks like junk mail. But that letter is where the surprises hide. Things like:
- A drug you take moving to a higher cost tier
- A drug being dropped from the list altogether
- A doctor or hospital leaving the network
- Higher copays for specialists or hospital stays
- The plan not being offered in your county next year
Plan exits are the big one. When a plan pulls out of an area, people on that plan have to find something new. You will usually get a separate notice and a special window to choose, but it is still much easier to deal with during the fall window, when every option is laid out in front of you.
Star ratings are worth a glance too. Each plan gets a rating from one to five stars based on things like member experience and how well the plan handles care. Stars are not the whole story, but a big drop is a reason to ask questions.
What is changing with drug costs for next year?
The yearly cap on what you pay out of pocket for covered drugs keeps doing its job. For 2027, the Part D out-of-pocket cap is $2,400. Once you reach that amount on covered drugs, you do not pay more for them for the rest of the year.
The Part D deductible for 2027 can be as high as $700. Not every plan charges the full deductible, and some charge none on certain drugs. That is one of the reasons comparing plans matters. And covered insulin stays capped at $35 a month.
Now here is what people miss. The cap protects you from the worst case. It does not mean every plan costs you the same. Two plans can have very different premiums, deductibles, and tiers for the exact drugs you take. One plan might get you to the cap in February. Another might keep your costs low enough that you never get near it.
The only way to know is to run your actual drug list against the plans in your area. If you take several brand-name drugs, this one step can matter more than anything else you do this fall. Our Part D drug plan help page walks through what to look at.
Can I go back to Original Medicare and buy a Medigap plan?
You can always return to Original Medicare during this window. Getting a Medigap plan to go with it is a different question, and the honest answer is: maybe not.
This is the part that could cost me business if I left it out, so I am going to say it plainly.
Medigap, also called a Medicare Supplement, helps pay the costs Original Medicare leaves behind. Things like the Part A hospital deductible, which is $1,736 for 2026, and the 20% you would otherwise owe on many Part B services.
But Medigap does not follow the same rules as the fall window. In most states, once your first chance to buy Medigap has passed, the insurance company can ask health questions. Based on your answers, they can charge you more or turn you down. There are some exceptions and some special rights in certain situations, and a few states have their own rules. But for a lot of people, leaving a Medicare Advantage plan for Original Medicare means living without a supplement.
That does not mean Medicare Advantage is a bad choice. For many people it works well, especially if they are healthy, like their network, and want lower monthly costs. It just means you should go in with your eyes open. The switch that is easy to make in October may be hard to undo later.
If you are weighing this, our Medicare Supplement help page explains how Medigap works and when you have the strongest rights to buy it.
What if I miss December 7?
You are not completely stuck, but your options shrink. If you are already in a Medicare Advantage plan, there is a second window from January 1 to March 31. During that time you can make one change: pick a different Medicare Advantage plan, or return to Original Medicare and pick up a Part D plan.
If you are on Original Medicare with a standalone drug plan, that January window does not help you. Outside of the fall window, you generally need a special situation, like moving or losing other coverage, to make a change.
That is why I keep pushing the fall window. It is the one time of year when nearly everyone with Medicare gets a fair, open chance to compare and switch.
What are the tradeoffs nobody likes to talk about?
I am an independent advisor, not a call center. So let me be straight with you about a few things.
- A $0 premium plan is not the same as no cost. You still pay your Part B premium, which is $202.90 a month in 2026. And you still pay copays, coinsurance, and deductibles when you use care.
- Lower monthly costs usually mean more cost when you get sick. That is true across almost every plan type. Think about the year you might have, not just the year you hope for.
- Extra benefits are nice, but they are not the main thing. Dental, vision, or hearing perks can be useful. They should not outweigh your doctors, your drugs, and your hospital.
- Switching is not always the answer. Sometimes the right move is to stay put. A good review should be willing to tell you that.
What should I do next?
You do not need to become a Medicare expert by December 7. You just need to know whether your current plan has a problem worth fixing.
That is why we built a short quiz. Find out in 3 minutes if your plan has hidden risks. It looks at the spots where people most often get surprised, things like drug coverage, network gaps, and what happens if your health changes. You will come away knowing if you should take a closer look this fall or if you can relax.
If you would rather talk it through with a real person, you can call me at 512-844-3983. We work with clients in multiple states, and we will give you a straight answer, even if that answer is “keep what you have.”
Talk soon,
Scott Bowling
Trusted SR Solutions
Trusted SR Solutions is not affiliated with or endorsed by the federal government or the Medicare program. 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.