Finding the right Medicare plan to fit your needs can be confusing and cause anxiety, especially when Medicare Part D and Medicare Advantage plans can change from year to year. Picking the right plan, however, can translate into big savings and improved access to care. The following questions can help you understand what to focus on during the Medicare fall open enrollment period.
[Medicare Eligibility for People Under 65 With Disabilities]
What Is the Medicare Fall Open Enrollment Period?
The Medicare fall open enrollment period is “the chance for Medicare enrollees to make sure their coverage still works for them and to comparison-shop to see if there’s a better option,” says Meagan Dow, a senior strategist within the client needs research team at Edward Jones, a financial services firm headquartered in St. Louis, Missouri.
During this period, you can:
— Change from a Medicare Advantage plan to original Medicare (Part A and Part B)
— Change from one Medicare Advantage plan to another
— Enroll in a Part D prescription drug plan, switch Medicare Part D plans 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.)
If you’re interested in a Medicare supplemental insurance plan, or Medigap plan, which can be paired with original Medicare, you usually aren’t guaranteed the option to switch or join one of these plans during this time, in most states. It can also be difficult to change from a Medicare Advantage plan to Medicare plus a Medigap plan, and you may be subject to medical underwriting, namely denial of coverage for preexisting conditions, with a Medigap plan.
Key Dates and Deadlines for 2026 Medicare Coverage
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 the upcoming year.
— January 1: Your new plan begins. Your chosen health insurance goes into effect on this date.
The Medicare Advantage open enrollment period deadline
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 Do You Apply for Medicare?]
How to Review Your Annual Notice of Change (ANOC)
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.
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.
A step-by-step approach to reading your ANOC
Whitney Stidom, vice president of consumer enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Indianapolis, 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
You may see changes to plan benefits, including supplemental perks such as dental or vision care, grocery allowance or gym membership discounts, that your Medicare Advantage plan previously offered. Your plan could also be closing altogether, which means you’ll need to find a different one to suit your healthcare and budget needs.
2. Medications: Make sure your prescription drugs are still covered
Some 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 (the list of covered medications) 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.
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. (In 2026, the limit is $9,250.)
“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 healthcare 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.
When you should keep your current Medicare plan
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.
[Read: How to Choose a Medicare Plan: 5 Essential Steps]
How to Evaluate and Compare 2026 Medicare Plans
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. This law, which went into effect in 2025:
— Caps out-of-pocket maximums for prescription drug coverage ($2,100 in 2026). Many plans have changed their pricing and formularies in response.
— Caps insulin copays at $35
— Provides $0 copays for vaccines
— Creates the Medicare Prescription Payment Plan, which allows beneficiaries to spread their out-of-pocket costs for prescription drugs throughout the year
How the Inflation Reduction Act impacts 2026 plans
Those changes have caused a lot of disruption in the market, Kotte says, particularly 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 are shrinking or going away entirely.
— 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. Medicare Advantage plans, in particular, are not standardized, so provider networks, drug coverage, premiums, deductibles, copays, coinsurance and out-of-pocket maximums vary from plan to plan.
— M = Match your needs. Choose a plan that meets your current health needs. As you review the options, ask yourself: What are my health needs, and how much have I spent on healthcare in previous years? Am I planning to relocate? Will my choice of Medicare coverage travel with me if I move?
— A = Assess your options. Think about what matters most: doctors, drugs, costs. Verify: Does the plan cover my preferred healthcare providers and facilities? Are my prescriptions covered, and are the plan’s preferred pharmacies close to where I live?
— R = Rely on an expert. Reach out to a trusted, objective advisor to help you decide. Additionally, plug your data into unbiased digital resources, such as U.S. News’ Best Medicare Advantage and Part D search tool or the Medicare plan finder.
— 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.
Where to Find Free and Unbiased Medicare Help
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 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 more than $1,600 annually on your Medicare Advantage plan while helping maintain access to quality care.
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Medicare Fall Open Enrollment: When It Is and How to Prepare originally appeared on usnews.com
Update 06/17/26: This story was published at an earlier date and has been updated with new information.
