Key Takeaways

• Open Enrollment is the only time most Medicare beneficiaries can make changes to their plans for the following year, running from October 15 to December 7 each year.

• Comparing plans carefully ensures you get the best coverage for your needs, helping you avoid unnecessary costs and coverage gaps.

Understanding the Importance of Open Enrollment

If you’re on Medicare, Open Enrollment is your golden opportunity to review your coverage and make necessary changes. This period, which runs from October 15 to December 7, lets you switch plans, join a new one, or make adjustments to fit your evolving healthcare needs.

Many people overlook Open Enrollment, assuming their current plan is still the best option. However, Medicare plans can change each year, affecting your premiums, out-of-pocket costs, provider networks, and covered medications. If you don’t compare plans annually, you might end up paying more than necessary or losing access to services you rely on.

1. Medicare Plans Change Every Year – Know What’s Different

One of the biggest mistakes people make is assuming their plan stays the same. Each year, plans update costs, coverage, and provider networks. Some changes can significantly impact your out-of-pocket expenses, making it crucial to review your Annual Notice of Change (ANOC) document, which is sent each September.

What Should You Look For?

• Premium and deductible changes – Costs may increase, affecting your monthly budget.

• Formulary updates – Your prescription drugs may no longer be covered or may cost more.

• Network modifications – Your preferred doctors or hospitals might not be in-network anymore.

• Copays and coinsurance adjustments – These can increase your overall healthcare expenses.

By carefully reviewing these changes, you can ensure your plan still meets your needs and budget.

2. Original Medicare vs. Medicare Advantage – Understanding the Differences

When comparing plans, it’s important to understand the fundamental differences between Original Medicare (Parts A and B) and Medicare Advantage (Part C). Your choice will impact your coverage, costs, and flexibility.

Original Medicare

• Includes Part A (hospital insurance) and Part B (medical insurance).

• Allows you to see any doctor or hospital that accepts Medicare.

• Requires you to enroll in a separate Part D plan for prescription drug coverage.

Medicare Advantage

• Bundles Parts A, B, and usually Part D into one plan.

• Often includes additional benefits like dental, vision, and hearing coverage.

• Typically has provider networks, meaning you may need to see specific doctors and hospitals.

Understanding these differences helps you make an informed decision based on your medical needs and financial situation.

3. Prescription Drug Coverage – Avoid Unexpected Costs

Medicare Part D plans cover prescription drugs, but each plan has its own formulary (list of covered drugs). These formularies change annually, meaning a medication you rely on could be dropped, moved to a higher cost tier, or require prior authorization.

What Should You Do?

• Review your plan’s drug formulary for 2025 to ensure your medications are covered at a reasonable cost.

• Check if your preferred pharmacy is still in-network, as this affects drug pricing.

• Compare copayments and coinsurance to determine overall affordability.

Switching to a plan that better covers your prescriptions can save you hundreds or even thousands of dollars each year.

4. Out-of-Pocket Costs Can Vary Significantly

While many people focus on monthly premiums, out-of-pocket costs like deductibles, copays, and coinsurance can add up quickly.

Key Costs to Compare:

• Medicare Part A hospital deductible for 2025 is $1,676 per benefit period.

• Medicare Part B deductible is $257 per year.

• Coinsurance for hospital stays starts at $419 per day after 60 days.

• Specialist visits and medical procedures may have different copays or coinsurance percentages.

Comparing these details ensures you don’t just pick the cheapest premium but also factor in the total cost of care.

5. Provider Networks Matter More Than You Think

If you choose a Medicare Advantage plan, checking network coverage is essential. These plans often have limited provider networks, meaning you might not be able to see certain doctors or specialists unless you switch plans.

Questions to Ask:

• Are my current doctors in-network for the plan I’m considering?

• Does the plan require referrals for specialists?

• Will I have out-of-network coverage if I travel frequently?

Switching to a plan that excludes your preferred doctors can lead to higher costs and limited access to care.

6. Timing Is Everything – Don’t Miss Important Deadlines

Medicare Open Enrollment happens once a year, and missing the deadline means you’re stuck with your current plan for another year (unless you qualify for a Special Enrollment Period due to life changes like moving or losing other health coverage).

Important Dates to Remember:

• October 15 – December 7: Open Enrollment period.

• January 1: Your new Medicare plan starts if you made changes.

• January 1 – March 31: Medicare Advantage Open Enrollment Period (if you need to make one last change).

Being aware of these dates helps you avoid being locked into an unsuitable plan for the entire year.

Making the Right Choice for Your Needs

Choosing the best Medicare plan isn’t just about finding the lowest premium—it’s about making sure your plan covers your medical needs at a cost you can manage. Whether you’re sticking with Original Medicare or considering Medicare Advantage, taking time to compare options will help you avoid surprises and unnecessary expenses.

To get expert guidance tailored to your situation, speak with a licensed agent listed on this website. They can walk you through your options and ensure you choose the best plan for your health and budget.