Every fall, Medicare beneficiaries can review and adjust their selections for the coming year to ensure their plan still fits their health care needs.
That’s because Medicare Part D prescription drug plans and Medicare Advantage plans can change their pricing and benefits from year to year, explains Meagan Dow, a senior strategist within the client needs research team at Edward Jones, a financial services firm headquartered in St. Louis, Missouri.
“The fall open enrollment period is the chance for enrollees to make sure their coverage still works for them and to comparison-shop to see if there’s a better option,” she adds.
But heading into 2026, it’s more important than ever to carefully review your plan because of recent changes to the Medicare market, says Whitney Stidom, vice president of consumer enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
“This fall’s Medicare enrollment period will feature significant changes that beneficiaries should be aware of, so this is not the year to go on autopilot and default to last year’s coverage. Personal health needs and financial circumstances often change from year to year, as do nearly all Medicare Advantage and Part D plans,” she says.
Comparing Medicare options and picking the right plan based on your personal needs and preferences each year is crucial, and it can translate into big savings and improved access to care, Stidom adds.
[READ: How Do I Know When I’m Eligible for Medicare?]
What to Know About Medicare Open Enrollment
Finding the right Medicare plan to fit your needs can be confusing and cause anxiety. But the following FAQs can help you understand what to focus on during the Medicare fall open enrollment period.
When Is the Medicare Fall Open Enrollment Period?
The Medicare annual enrollment period, which is the window for Medicare recipients to review, tailor or change their plans, runs from October 15 through December 7.
[Read: When Can You Sign Up for Medicare?]
What Happens During the Medicare Fall Open Enrollment Period?
During the Medicare fall open enrollment period, beneficiaries are able to:
— Change from a Medicare Advantage plan to original Medicare, known as Part A and Part B
— Change from one Medicare Advantage plan to another
— Enroll in a Part D prescription drug plan, change from one Medicare prescription drug plan to another or completely opt out of Medicare prescription drug coverage. (Late penalties might apply if you didn’t sign up for Medicare Part D and don’t have other “creditable” prescription drug coverage when you first became eligible.)
In most states, you aren’t guaranteed the option to switch or join a new Medigap plan during this time. Changes made during this period go into effect on January 1 of the following year.
Medicare beneficiaries are encouraged to review their Medicare coverage every year during fall open enrollment. At the same time, you can also scrutinize other plan options to ensure you’ve selected the most appropriate plan for your needs.
“If someone is unhappy with their choice of original Medicare, they’ll have the option to switch to a Medicare Advantage plan,” Dow explains.
However, she notes that it can be difficult to switch back to original Medicare with a supplemental Medigap plan once someone has opted for Medicare Advantage.
“They should understand all the differences — and not just the benefits touted on commercials and ads — before switching,” she says.
Key Dates for the Medicare Annual Enrollment Period
Key dates to be aware of during the annual enrollment period include:
— October 1: Plan details become available; start comparing options. While the open enrollment period hasn’t opened yet, plan specifics will become available on this date. Vijay Kotte, CEO at GoHealth, a health insurance marketplace and Medicare-focused digital health company based in Chicago, says you can start “window shopping” in early October to compare your options.
— October 15: Open enrollment begins. The annual enrollment period opens on this date, which means it’s the first day you can submit a new application. You can revise this application as many times as you want up until December 7.
— December 7: Open enrollment ends. The annual enrollment period closes on this date and whichever plan you’ve selected will be your plan for 2026.
— January 1: Your new plan begins. Your new plan goes into effect on this date.
Are there other deadlines I need to know about?
There is a second open enrollment period from January 1 to March 31 for people already enrolled in Medicare Advantage plans to either change their Medicare Advantage plan or switch to original Medicare.
Dow says she only recommends making the switch back to original Medicare if you’ve qualified for a supplemental Medigap plan.
[Read: How to Avoid Paying a Medicare Late Enrollment Penalty]
What Happens if I Miss the Open Enrollment Period?
In most cases, if you don’t enroll in a Medicare plan during the fall open enrollment window, you won’t be able to sign up until the following year.
But there are some exceptions to this rule. For example, you can still enroll during a special enrollment period if you’ve:
— Lost health coverage
— Moved
— Gotten married
What Do I Need to Watch Out for During Open Enrollment?
Each year, insurance plans can change. Common adjustments include:
— Increases in premiums and deductibles
— Changes to the list of covered prescription medications, also known as a formulary, including removing drugs or moving them to a higher cost tier
— Changes to the list of health care professionals and facilities that are covered or in network
How Can I Find Out What’s Changing in My Plan?
Any planned changes to your coverage will be communicated via an Annual Notice of Change letter. You should receive this letter sometime in September.
“The ANOC isn’t junk mail; it’s your first official warning sign of how higher costs, fewer benefits, plan exits and other changes sweeping across Medicare Advantage options, whether good or bad, may apply to your plan,” Kotte says.
Paula Muschler, president of Insurance Branch, a company that advises Medicare beneficiaries on their coverage options, agrees: “Don’t put it aside — don’t think your plan isn’t changing,” she says. “It might be small changes, but they may be changes you need to pay attention to.”
If you didn’t receive your ANOC or can’t find it, you can call your insurance carrier to get another copy or you can speak with a licensed insurance agent who can tell you what’s changing in your plan and how it compares to other available plans.
How to Read Your ANOC
Stidom recommends taking a multi-step approach when reading this important document.
1. Coverage: See if your plan is changing or shutting down if you have Medicare Advantage.
“Some plans might be shutting down for 2026 entirely, but you may also see changes to the list of covered prescription drugs or to some of the supplemental benefits, such as dental
or vision care, grocery allowance or gym membership discounts, that were previously offered by your Medicare Advantage plan,” Stidom says.
2. Medications: Make sure your prescription drugs are still covered.
According to Stidom, plans may:
— Move medications to different tiers with higher copays
— Require prior authorization for drugs that were previously covered without restrictions
— Remove certain medications entirely
If you take multiple medications, it’s important to carefully review the formulary changes section, as mentioned above, to ensure any current prescriptions will still be covered at a price you can afford.
3. Costs: Look at premiums, copays and the out-of-pocket maximum.
Several cost categories may change in your Medicare plan next year, including monthly premiums, deductibles or copays and coinsurance (which is when you share the cost of care, usually as a percentage) for everything from prescriptions and office visits to emergency care, Stidom explains.
Beyond the most obvious premium changes, you should also check the out-of-pocket maximum limit if you’re enrolling in or have a Medicare Advantage plan.
“These caps on annual spending can vary significantly and may increase from year to year,” Stidom says.
So be sure to review changes to:
— Specialist visit costs
— Diagnostic tests
These items can substantially impact your health care budget.
4. Providers: Check if your doctors and hospitals are still in-network.
Medicare Advantage plans are administered by private insurers that maintain networks of participating doctors and hospitals to offer competitive premiums, Stidom says. These provider networks may be updated annually, so it’s important to verify whether your preferred physicians, clinics and pharmacies will continue to be “in-network” for the upcoming year.
While your primary care provider should be the first doctor you look for, don’t forget to check that any specialists you see are still in your network as well as the hospitals, urgent care centers and pharmacies you’re most likely to use.
“Going out-of-network can result in significantly higher costs or even no coverage at all for nonemergency services,” Stidom says.
If your current providers are being dropped, you can contact them to ask if they’re joining other Medicare Advantage networks that might be available.
If you’ve reviewed your ANOC letter and you’re comfortable with the changes outlined, including any price updates, you can stick with your current plan, Dow says.
However, “it can still be beneficial to compare plans, since there may be a different plan available that’s a better fit,” she notes.
When Can I Start Signing Up for Medicare?
You can first sign up for Medicare during the seven-month window around your birthday. That window, known as the initial enrollment period, opens three months before you turn 65 and ends three months after your birth month.
Because finding the right Medicare plan for your needs can take some time, it’s best to get started as early as you can when researching and comparing options.
“The reason you want to start early is you don’t want any (medical coverage) gap,” Muschler says. “You need to review your options and how you will use your coverage.”
And once you’re on Medicare, Dow recommends blocking off a few hours on your calendar in mid-October each year to sit down and review coverage.
How Can I Best Evaluate Different Medicare Plan Options?
There are many factors to consider when researching your Medicare plan options. When reviewing the various plan options available to you, ask the following questions:
— Does the plan cover your preferred health care providers and facilities?
— What are your health needs, and how much have you spent on health care in previous years?
— Are you planning to relocate? Will your choice of Medicare coverage travel with you if you move?
— Are your medications covered, and how much will you pay out of pocket each time you fill them?
— Are there restrictions on where you can fill your prescriptions, and are the plan’s preferred pharmacies close to where you live?
When comparing Part D plans, Dow recommends using Medicare’s plan comparison tool. There, you can type in the medications you take and your preferred pharmacies to check whether they are all in network.
It’s also important to note that Medicare Advantage plans aren’t standardized.
“Provider networks, drug coverage, premiums, deductibles, copays/coinsurance and out-of-pocket maximums vary from plan to plan,” Dow says. “It’s important to do the work upfront to ensure a new plan meets your needs.”
If you’re considering Medicare Advantage, with or without a Part D plan, you can search and review what’s available in your area with U.S. News’s Best Medicare Advantage ratings.
Should I Sign Up for the Affordable Care Act (ACA) Instead?
The Affordable Care Act changed health insurance options in the United States by providing health insurance plans for people who can’t get coverage through Medicare or an employer.
If you’re enrolled in or eligible for Medicare, the Health Insurance Marketplace under the ACA is not for you. And actually, it is illegal for a licensed insurance agent or a health plan to sell you a Marketplace plan if it is clear that you’re eligible for or are currently covered by Medicare.
If you currently have Marketplace insurance, you should sign up for Medicare as soon as you’re eligible. The only time you can choose a Marketplace plan instead of Medicare is if you are ineligible for premium-free Medicare Part A.
Do Medicare Selections Have Tax Implications?
Most states still do not have a tax penalty for individuals who choose not to sign up for a health insurance plan. Exceptions include Massachusetts, New Jersey, Rhode Island, California and Washington, D.C., which do penalize the uninsured. Vermont residents are required to have health insurance coverage, but there is no penalty if they don’t.
Other states, such as Maryland, have begun asking about insurance status on their state tax returns, but they use this data to try to enroll more people in insurance plans, instead of penalizing them.
Where Can I Get Information About and Help With Signing Up for Medicare?
While wading through your options and choosing the best Medicare plan for your needs can seem complicated and confusing, the good news is that help is available. Contact the following offices for more information and guidance:
— State Health Insurance Assistance Programs. Each state has a SHIP program where you can access free, no-obligation, personalized counseling services. Staffed by highly trained volunteers, these organizations can help you learn more about what’s available locally. Find yours at shiphelp.org.
— Medicare Rights Center. This nonprofit organization supports a national helpline, where you can ask questions and get advice on all Medicare issues. You can reach this center at 1-800-333-4114.
— Local resources. Your local senior center and your local Area Agency on Aging can also point you to additional resources to help you make the best Medicare decision for your needs.
— A licensed broker. There are many licensed Medicare insurance agents and brokers across the country who can help. Dow recommends looking for someone who’s independent and sells both Medigap and Medicare Advantage. It’s also wise to look for someone who doesn’t favor only one company’s products.
Kotte underscores that working with an unbiased broker who represents a number of products is best for helping you wade through all your options: “There are thousands of plans available in the United States, and in any given county, a Medicare consumer may have to choose between 100-plus plan options.”
A recent eHealth survey found the average Medicare beneficiary has more than 40 Medicare Advantage plans to choose from in their local area, “yet 39% of Medicare Advantage beneficiaries incorrectly believe these plans are ‘generally all the same,'” Stidom adds.
But shopping around can help you potentially save an average of over $1,800 annually on your Medicare Advantage plan while helping maintain access to quality care, she notes.
Suffice to say, it can be bewildering, and Kotte urges finding an independent third party who represents multiple health plans and can objectively help you navigate your plan change.
What Else Should I Know About Medicare Open Enrollment?
There have been some significant changes implemented in the wake of the recently passed Inflation Reduction Act, so Dow recommends being extra vigilant in double-checking your options during the open enrollment period.
For example, this law, which went into effect in 2025, capped out-of-pocket maximums at $2,000 for prescription drug coverage. Many plans have changed their pricing and formularies in response.
The IRA also capped insulin copays at $35 and provided $0 copays for vaccines. The new Medicare Prescription Payment Plan was also part of the law, which allows beneficiaries to spread their out-of-pocket costs for prescription drugs throughout the year.
Those changes caused a lot of disruption in the market, Kotte says, and he’s expecting that to continue in 2026, with a focus in three key areas.
— Some plans are going to disappear altogether while others will reduce the size of their network as a means of controlling costs. Some Medicare plans are cutting costs by using providers that charge less. That may mean your current provider is no longer covered, so you should check whether your preferred provider is still in-network when reviewing your plan’s changes for 2026.
— Supplemental benefits, such as vision and dental benefits, grocery cards, transportation benefits and over-the-counter product benefits, are shrinking or going away entirely, Kotte says.
— Prescription drug formularies will continue to shift, with some shrinking and others raising copays for beneficiaries.
The overall trend is expected to be less choice and higher cost, Kotte says. To deal with that, he recommends keeping in mind a simple acronym during annual enrollment season: SMART.
— S = Shop around. Look at all your options, even if you’re happy with your current plan.
— M = Match your needs. Choose a health plan that meets your current health needs.
— A = Assess your options. Think about what matters most: doctors, drugs, costs.
— R = Rely on an expert. Reach out to a trusted, objective advisor to help you decide.
— T = Timing. Start the process early. “Don’t wait till the last minute, because at the last minute, you just don’t get as much time with a broker and you don’t have as much of an informed perspective,” Kotte says.
Stidom also underscores that starting early is key for 2026.
“Given all the changes expected, it’s going to be especially important for Medicare beneficiaries to review their options and enroll in new plans as early as possible during the annual enrollment period,” she says.
If you wait, wait you may experience long wait times when contacting government agencies or licensed insurance agents and not get the help or guidance you need.
Medicare Fall Open Enrollment FAQs
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Medicare Fall Open Enrollment: When It Is and How to Prepare originally appeared on usnews.com
Update 10/01/25: This story was published at an earlier date and has been updated with new information.
