Key Takeaways

• Medicare Open Enrollment happens every year from October 15 to December 7, giving you the chance to review and change your coverage for the next year. Missing this window could lock you into your current plan.

• Taking time to compare plans and understand the costs, coverage, and benefits ensures you’re not overpaying or missing out on essential services.

Know the Medicare Open Enrollment Window

The Medicare Open Enrollment Period (OEP) is your annual opportunity to evaluate and adjust your Medicare coverage. Every year from October 15 to December 7, you have the chance to make changes that take effect on January 1 of the following year. Whether you’re enrolled in Original Medicare, Medicare Advantage, or Part D prescription drug plans, this is the time to decide if your current plan still fits your needs.

Ignoring this timeline could mean sticking with a plan that doesn’t serve you well for the entire next year. Remember, there are penalties and limitations for changing plans outside of this period unless you qualify for a Special Enrollment Period (SEP), so mark your calendar.

Reassess Your Current Coverage

Your healthcare needs can shift from year to year, so it’s crucial to review how well your current plan is working for you. Start by asking yourself:

• Have your prescription medications changed?

• Are your doctors still in-network?

• Have your healthcare costs increased unexpectedly?

Take a good look at your Annual Notice of Change (ANOC), which your plan sends out before Open Enrollment begins. This document outlines changes in premiums, deductibles, and covered benefits. Compare it against your medical expenses from the past year to see if your current plan is still the right fit.

Compare All Available Plan Options

During Open Enrollment, you can:

• Switch between Original Medicare and Medicare Advantage (Part C).

• Change Medicare Advantage plans.

• Enroll in, drop, or switch Medicare Part D prescription drug plans.

Use the Medicare Plan Finder tool to explore and compare plans in your area. When evaluating your options, pay close attention to:

1. Premiums and Deductibles: Know how much you’ll pay monthly and out-of-pocket before coverage kicks in.

2. Drug Coverage: Ensure your prescriptions are included and compare co-pays or coinsurance.

3. Provider Networks: If you’re considering Medicare Advantage, confirm that your preferred doctors and specialists are in-network.

4. Additional Benefits: Look for perks like dental, vision, and hearing coverage, but remember that these can vary widely between plans.

Even if you’re happy with your current plan, it’s worth reviewing new options. Plans change every year, and a better deal might be available.

Understand the Costs Beyond Premiums

While it’s tempting to focus solely on premiums, you’ll want to dig deeper into the total costs of your Medicare plan. These costs include:

• Deductibles: The amount you pay out-of-pocket before your coverage starts.

• Copayments and Coinsurance: What you’ll owe for doctor visits, hospital stays, and prescription medications.

• Out-of-Pocket Maximums: The most you’ll pay annually for in-network services if you’re in a Medicare Advantage plan.

For 2025, Original Medicare and Medicare Advantage plans each have distinct cost structures. For instance:

• Medicare Part A has a hospital deductible of $1,676 per benefit period.

• Medicare Part B comes with a standard monthly premium of $185 and an annual deductible of $257.

• Part D plans now have an out-of-pocket cap of $2,000, which can help you manage prescription costs more effectively.

Being aware of these expenses helps you choose a plan that fits your budget and avoids surprise medical bills.

Verify Provider and Pharmacy Networks

If you’re considering switching to a Medicare Advantage plan or a new Part D plan, confirming your preferred healthcare providers and pharmacies are in-network is essential. Medicare Advantage plans often operate within specific networks, and going out-of-network can result in significantly higher costs.

Likewise, some Part D plans may only work with certain pharmacies. Double-check that your local pharmacy or mail-order options are included to keep your costs manageable. This step can save you from unexpected out-of-pocket expenses and ensure continuity in your care.

Review Supplemental Benefits Carefully

One of the key advantages of Medicare Advantage plans is the range of supplemental benefits they may offer, including:

• Dental care

• Vision exams and glasses

• Hearing aids

• Fitness memberships

For 2025, however, the availability of certain benefits has declined. For example:

• Over-the-counter benefits are now offered by 73% of plans, down from 85% in 2024.

• Transportation benefits have decreased from 36% to 30%.

Consider whether these benefits align with your needs and if they justify any added costs. If not, staying with Original Medicare and purchasing separate supplemental coverage might be a better choice.

Don’t Overlook the Medicare Part D Changes

In 2025, the Medicare Part D program has introduced significant improvements, including:

• The elimination of the coverage gap (donut hole).

• A new out-of-pocket spending cap of $2,000.

• The option to spread prescription drug costs evenly over the calendar year through the Medicare Prescription Payment Plan.

These changes make managing your prescription costs easier and more predictable. Review your current Part D plan’s formulary—a list of covered drugs—to ensure your medications are included for the upcoming year.

Utilize Free Resources for Help

Navigating Medicare Open Enrollment doesn’t have to be overwhelming. Several resources are available to guide you:

• State Health Insurance Assistance Programs (SHIP): Offers free, personalized counseling.

• Medicare Plan Finder: An online tool to compare plans.

• 1-800-MEDICARE: A hotline for questions and assistance.

Taking advantage of these resources can help you feel confident in your plan choice.

Plan Ahead to Avoid Last-Minute Stress

Waiting until the last few days of Open Enrollment to make changes can lead to rushed decisions or technical issues. Aim to complete your plan evaluation and selection by mid-November. This gives you time to:

• Review all the available plans.

• Confirm provider and drug coverage.

• Contact Medicare or your SHIP counselor if you have questions.

Having extra time ensures you’re not pressured into sticking with a plan that doesn’t suit your needs.

Keep an Eye on Annual Notices and Notifications

Starting in 2025, Medicare Advantage enrollees will receive a Mid-Year Notification of Unused Supplemental Benefits between June 30 and July 31. This personalized notice highlights unused benefits from the first half of the year, encouraging you to maximize what’s available.

While this doesn’t directly impact Open Enrollment, it’s another tool to help you stay informed about your coverage. Pay attention to all notices from Medicare and your insurance provider to stay ahead of changes.

Finalize Your Plan Decisions

Before the December 7 deadline, double-check that you’ve:

1. Enrolled in the plan that best fits your needs.

2. Confirmed coverage details, such as prescription drug formularies and provider networks.

3. Kept a record of your confirmation number or any paperwork.

Once Open Enrollment closes, changes generally can’t be made until the following year’s enrollment period, unless you qualify for a Special Enrollment Period.

Take Control of Your Medicare Coverage Today

Medicare Open Enrollment isn’t just a box to check—it’s a chance to take control of your healthcare for the year ahead. By reviewing your plan’s costs, benefits, and coverage, you can ensure you’re making the best choices for your health and budget. Don’t wait until the last minute. Start exploring your options today and set yourself up for a year of confidence in your Medicare coverage.