Key Takeaways

• Spotting warning signs in a Medicare plan helps you avoid unexpected costs and coverage gaps during the 2026 Annual Enrollment Period.

• Reviewing every detail before you enroll ensures your coverage actually aligns with your health needs for the coming year.

Understanding Why Careful Review Matters

The Annual Enrollment Period runs from October 15 to December 7, 2025. This is your once-a-year chance to review, update, or change your Medicare coverage for the 2026 plan year. Because plans can update costs, benefits, rules, and provider networks each year, it is important to look for potential red flags before you enroll. When you know what to look for, you reduce the risk of choosing a plan that leads to higher spending or limited access to care in the new year.

This article helps you identify the key warning signs within any Medicare plan so you can make confident decisions about your coverage.

Reviewing Costs With More Attention

When comparing plans during AEP, certain cost-related issues stand out as early warning signs. You want coverage that fits your budget without hidden surprises.

Are Costs Increasing Without Clear Reason?

Some plans adjust deductibles, copayments, and coinsurance each year. Cost increases are normal, but when several costs rise at once without clear explanation, this may indicate a trend that continues into future years.

Look for sudden changes in:

• Annual deductibles

• Copayments for primary and specialist visits

• Coinsurance percentages

• Hospital or outpatient care costs

• Prescription drug cost-sharing across tiers

A plan with these types of increases may lead to unpredictable expenses in the new year.

Are Out-of-Pocket Limits Too High?

Every Medicare Advantage plan includes a yearly limit on what you pay out of pocket. If the limit is significantly higher than similar plans in your area, treat this as a warning sign. A higher limit may expose you to greater financial risk if you experience unexpected medical needs.

Is There A Sudden Change In Drug Coverage?

If a plan increases the cost-sharing for multiple drugs or shifts your prescription to a different tier, you may end up paying more throughout the year. Review the plan formulary carefully to confirm:

• Your medications stay on the same tier

• Your preferred pharmacy remains in-network

• Quantity limits or prior authorizations are not newly added

Evaluating Provider Networks And Access To Care

Access to your preferred doctors and specialists is one of the most important parts of choosing the right Medicare plan. If a plan limits your access, this is a red flag you cannot ignore.

Is Your Doctor Still In-Network?

Provider networks change every year. A doctor or clinic you used in 2025 may not remain in-network for 2026. If your doctor is listed as out-of-network, you could pay much higher costs for care.

Also review:

• Specialists you see regularly

• Clinics associated with your care

• Hospitals or surgical centers in your area

Is The Network Too Small?

Some plans list a very limited group of doctors or hospitals. A small network may make it harder to schedule appointments or access specialized services. If the plan offers fewer options than others in your area, this may be a warning sign.

Are Referrals Or Authorizations Increasing?

Certain plans require you to get referrals before seeing a specialist or receiving certain services. If a plan introduces new referral requirements or expands prior authorization rules for 2026, this may make your care more complicated and lead to delays.

Inspecting Extra Benefits With A Critical Eye

Although extra benefits may appear helpful, it is important to make sure they are meaningful and usable.

Are Extra Benefits Limited Or Hard To Use?

Plans may promote added benefits, but the value depends on how easily you can access them. If benefits require:

• Long wait times

• Only specific vendors

• Strict rules with limited flexibility

then the benefit may not be as useful as it looks.

Do Extra Benefits Replace Core Coverage Improvements?

A plan that highlights many extra benefits but does not improve essential medical coverage may be shifting attention away from areas where it actually falls short. Focus first on medical, hospital, and prescription coverage before considering supplemental benefits.

Reading The Fine Print Carefully

Small details in plan documents often reveal the biggest red flags.

Are There New Restrictions?

Restrictions may appear in different areas of your plan documents, including:

• Prior authorization lists

• Step therapy rules

• Limits on diagnostic tests

• Coverage rules for durable medical equipment

If you notice new or expanded restrictions for 2026, consider whether these changes affect your usual care.

Is There Unclear Language Or Missing Information?

Some plan summaries may use vague descriptions that make it hard to understand what is included. If information is missing or unclear, this may signal that the plan is not fully transparent about costs or coverage.

Look for:

• Missing details about limits

• Lack of clarity about coverage rules

• Unclear pharmacy network descriptions

If it is difficult to find basic facts, this is a warning sign.

Watching For Patterns In Annual Changes

Plans update each year, but patterns can help you understand whether a plan is improving or becoming less stable.

Are Year-Over-Year Changes Showing Decline?

Compare changes from 2024 to 2025 and now from 2025 to 2026. A plan that consistently:

• Raises costs

• Reduces network size

• Adds restrictions

• Offers fewer pharmacy options

may be moving in a direction that affects your long-term stability.

Are Plan Materials Delivered Late?

If documents such as the Annual Notice of Change (ANOC) arrive late or contain multiple corrections, this may reflect poor organization or unclear administration.

Comparing Plans With A Balanced View

When reviewing multiple plans during AEP, look for these warning signs while also considering what matters most to your health needs.

Are You Focusing Only On Bonuses?

Avoid choosing a plan simply because it includes appealing extra features. Instead, compare:

• Total yearly costs

• Access to care

• Drug coverage

• Predictability of expenses

Are You Reviewing Enough Plans?

Some beneficiaries select the first plan that looks good. It is important to compare multiple options to see how they differ in network size, benefits, and costs.

How To Stay In Control During AEP

To protect yourself from red flags, follow a clear process when reviewing your Medicare options.

Are You Reviewing Your Own Health Needs First?

Start with a list of your:

• Current medications

• Preferred doctors

• Chronic conditions

• Expected medical needs for 2026

This makes it easier to compare plans based on your personal situation.

Are You Using The Right Resources?

Reliable resources include:

• Your plan’s official documents

• Medicare’s official comparison tools

• Support from a licensed agent listed on your website

Staying Focused On Your Priorities For 2026

Choosing the right plan requires attention to detail and a clear understanding of what matters most to you. When you recognize early signs of potential problems, you can make informed decisions and avoid plans that may lead to confusion or higher spending.

Moving Forward With Confidence In Your Enrollment Choices

Recognizing red flags before you enroll helps you choose coverage that supports your health needs throughout the 2026 year. Take the time to check costs, networks, restrictions, and changes from previous years. If you ever feel unsure during AEP, get in touch with any of the licensed agents listed on this website for guidance.