Critical Information and How to Prepare

What is Medicare Open Enrollment?

Medicare is the federal health insurance program largely for seniors 65 and older. Medicare open enrollment, also known as the Annual Election Period (AEP), is the time of year in which program beneficiaries like yourself can assess and change their health and prescription drug coverage. 

Medicare open enrollment occurs every year from Oct. 15 to Dec. 7, with plan changes going into effect on the first day of the following year. So, in other words, if you switch Medicare plans on Nov. 13, 2025, your new coverage starts on Jan. 1, 2026. Are you ready to make the most of this short window? Here’s what to know. 

What Can You Do During Open Enrollment?

Medicare can be quite complex, with different “Parts” offering different types of coverage. Medicare open enrollment allows for changes across these coverage types, meaning this is your chance to:

• Switch from Original Medicare (Parts A and B) to a Medicare Advantage (MA) Plan.
• Switch from Medicare Advantage to Original Medicare.
• Switch from one MA plan to another, including one at a different insurance company.
• Join, drop, or switch a Medicare Part D prescription drug plan.

6 Steps You Can Take to Prepare

Ensure you’re ready to make any necessary changes to your Medicare coverage during this open enrollment season by taking the following steps.

1. Review Your Current Plan

By now, you’ve likely received your Medicare Annual Notice of Change (ANOC), a letter that details any plan updates—from new monthly premiums to network cutbacks—that’ll affect your coverage next year. 

Reading and understanding your ANOC is a crucial first step in determining whether you should—or need to—change coverage during open enrollment. 

MA beneficiaries, in particular, should verify whether their current plan will still be available next year. Several large health insurers, including UnitedHealth Group and Aetna CVS Health, announced cutbacks to their 2026 MA plan offerings in recent months. 

2. Compare Costs & Features 

If you’re thinking about a switch, research new plan options on Medicare.gov, the federal website run by the Centers for Medicare & Medicaid Services (CMS). They offer a free online search tool that lists all the plans available in your ZIP code for 2026.

As you do your research, key costs and features to consider in light of this year’s Medicare changes include:

• Premiums, particularly among Medicare Part B and Medicare Part D plans, which are expected to rise by 11.6% and 6% respectively, in 2026.
• Deductibles, copays, and out-of-pocket maximums limits, which can all significantly impact a plan’s value from year to year. Look beyond a plan’s premium and try to estimate how much you’ll pay throughout the year, including these additional costs. 
• Supplemental benefits: New rules prohibit MA plans from offering certain Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2026, and other MA benefits, such as over-the-counter medication and nutrition coverage, have become increasingly less common in recent years.  
• Prior authorization requirements: Formerly only common among MA plans, six states are testing new pre-authorization requirements for Original Medicare. 

3. Check Drug Formularies & Networks

Be sure that any medications you’re currently taking are on a plan’s prescription drug list and eligible for low copays. Similarly, check to see if your preferred primary care and specialty care physicians are in-network or at least eligible to be seen for out-of-network coverage for a higher out-of-pocket cost

4. See if You’re Eligible for Extra Assistance

That includes a new Medicare Prescription Payment Plan (MPPP), which lets Part D participants spread out-of-pocket drug costs across the calendar year instead of paying upfront for pharmacy prescriptions. There are also Medicare Savings Programs that provide assistance for Part A premiums and Part B out-of-pocket expenses.  

These programs can make certain Medicare Parts more attractive than others, but also have special enrollment requirements you’ll want to note, such as you’ll automatically be renewed annually unless you opt out. 

5. Consult SHIP

State Health Insurance Programs (SHIP) specialize in helping Medicare beneficiaries, families, and caregivers understand enrollment periods and find the best coverage. You can find a local counselor on the SHIP website. 

6. Decide Whether to Use a Broker

Medicare insurance brokers can help you assess your options and actively enroll you in a new plan. Unlike agents representing one company, brokers sell plans from multiple insurers, so you can compare. Ensure you’re working with a reputable one by confirming their credentials on your State Department of Insurance website, getting referrals from friends or physicians, or consulting the National Council on Aging’s Medicare Standards of Excellence list.

What Happens If You Miss Open Enrollment?

Generally speaking, if you miss Medicare open enrollment, you’ll get automatically re-enrolled in your current health care plan. If you’re in an MA plan and it’s no longer available, you’ll get automatically enrolled in Original Medicare. That means you’ll no longer have a private insurance plan to help cover the Original Medicare out-of-pocket costs.  

If you have an MA plan by year-end that you want to change, you’ll have another chance to update your coverage. A second annual enrollment period for these beneficiaries occurs between January 1 and March 31 each year, with new elections taking effect on the first of the month that follows them.

Beyond that, you might qualify for a special enrollment period that allows you to change your Medicare Advantage or prescription drug coverage. These special enrollment periods are typically triggered by life events, like changes in residence, loss of coverage, or significant network adjustments after you join.

Still, the most convenient time to make plan changes is during Medicare open enrollment. Move now to establish your 2026 coverage.