Key Takeaways

• Hidden cost changes often appear in areas that are not highlighted in marketing materials, which makes your Annual Enrollment Period review even more important.

• Understanding where these changes typically show up helps you protect your budget and avoid surprises in the year ahead.

Looking Beyond What You See First

When you start reviewing Medicare options during the Annual Enrollment Period, you usually see marketing materials that highlight the most appealing parts of a plan. They might emphasize added services, convenience, or broad overviews of costs. What they do not always highlight are the small but meaningful changes that affect your actual out-of-pocket costs in the upcoming year. These are the details that require a closer look.

The Annual Enrollment Period runs from October 15 to December 7, 2025. During this time, you make choices that take effect on January 1, 2026. Because your decision affects an entire year of healthcare costs, you benefit from going deeper than the surface-level information.

What Details Usually Do Not Appear In Marketing Materials?

Marketing materials give you a general picture but often do not include every cost that matters. You usually need to check plan documents to capture the full story. Hidden cost changes tend to appear in several specific places.

1. Cost Sharing Amounts

Cost sharing includes copayments, coinsurance, and deductibles. These areas can change each year, even when the overall plan structure looks the same. You might see:

• Higher copayments for certain services

• Adjusted coinsurance percentages

• Deductible increases that shift more initial costs to you

Plans often highlight what remains the same, while changes to smaller cost-sharing details may be placed deeper inside the Summary of Benefits or Evidence of Coverage.

2. Prescription Drug Changes

Prescription drug costs can shift from year to year. Even if marketing materials state that the plan continues to offer strong drug coverage, several details may change:

• Tier placements for your medications

• Requirements for step therapy

• Prior authorization rules

• Quantity limits

You need to check your full medication list against plan documents to see whether your annual spending might increase due to movement between tiers or added restrictions.

3. Network Adjustments

Marketing materials often state that a network is “broad” or covers a large area. What they may not highlight is whether:

• Your current providers are still considered in network

• Facilities you use have changed categories

• Service areas were adjusted for the new year

This makes reviewing provider directories important every AEP.

4. Rules Around Using Out-of-Network Providers

Some plans offer limited out-of-network coverage, but the details can shift subtly. You may see:

• Lower reimbursement allowances

• New referral requirements

• Added conditions for coverage approval

Marketing materials usually stay focused on what the plan offers, not the specific limitations that accompany it.

Where Should You Look First?

You benefit from knowing exactly where these hidden changes are most likely to appear. These sections of plan documents give you the clearest picture.

What Does The Summary Of Benefits Show?

The Summary of Benefits outlines the major cost categories. You can review year-to-year comparisons and identify where numbers changed. This includes:

• Primary care and specialist visit costs

• Urgent care and hospital services

• Preventive care coverage details

If you compare the 2025 version with the 2026 version line by line, you can easily identify shifts.

What Does The Evidence Of Coverage Contain?

The Evidence of Coverage gives detailed descriptions of how the plan actually works throughout the year. You can find specifics about:

• Prior authorization rules

• Referral requirements

• Drug coverage exceptions

• Appeals processes

Even small adjustments in this document can influence how your care is approved or handled.

What About The Formulary Document?

The formulary lists every covered prescription. You can check for:

• Tier movements

• New restrictions

• Medications no longer included

Reviewing this document is one of the most effective ways to uncover future drug spending changes.

How Do You Spot Cost Changes Without Getting Overwhelmed?

Plan documents can be long, and reviewing them can feel like a big task. Breaking your process into manageable steps helps you stay focused.

What Should You Compare First?

Focus on comparing the biggest cost areas. You can benefit from evaluating:

• Copayments for the services you use most often

• Prescription tiers for medications you take regularly

• Cost differences between in-network and out-of-network care

Start with services you know you will use, then expand to other sections.

How Can You Track Changes More Clearly?

Create a simple list of your expected healthcare needs for 2026. This may include:

• Number of doctor visits you anticipate

• Any regular therapies

• Planned specialist evaluations

• Prescriptions you expect to continue

Compare this list against the relevant sections of each plan. This increases your accuracy and reduces the chances of missing a key detail.

What Hidden Details Often Lead To Higher Spending?

Some changes may seem small at first but lead to bigger annual costs once the year begins. When comparing plan documents, watch for these areas.

1. Small Copay Increases

A small increase in a copayment may look minor. However, if you use the service often, the cumulative effect across the year can add up.

2. Higher Maximum Out-Of-Pocket Limits

Plans sometimes adjust this limit annually. Even if marketing materials highlight lower costs in one area, a higher maximum out-of-pocket limit could still increase your overall budget risk.

3. Added Prior Authorizations

More prior authorization requirements mean more steps before you are approved for treatment. This can delay care, increase administrative tasks, or lead to denials that create unexpected expenses.

4. Tier Changes For Common Medications

Even a small change in drug tier placement can significantly alter your total costs. Always check the updated formulary, especially if you use multiple medications.

Why Does This Matter Every Year?

Medicare plans can change annually. These updates are normal and expected. When plans adjust their costs or rules, they usually do so for the coming calendar year. Because you use your coverage every month, even small adjustments can influence your financial and healthcare experience.

The AEP review is your annual chance to protect yourself. You only have these few weeks to make changes before the enrollment deadline on December 7. After this period, you generally need to wait until the next AEP unless you qualify for a Special Enrollment Period.

Steps You Can Take To Protect Your Budget

You can make your review more effective by following a structured approach.

1. Gather All Current Plan Documents

Collect your current Summary of Benefits, Evidence of Coverage, and plan notices. This gives you a baseline for comparison.

2. Download The Updated 2026 Versions

Most plans release updated documents at the start of AEP. Once available, you can compare them directly.

3. Read The Annual Notice Of Change

This document highlights what changed from one year to the next. It is one of the most valuable resources during AEP.

4. Focus On Sections That Apply To Your Needs

Review areas that impact your expected care in 2026. Skip sections that do not apply to you to reduce overwhelm.

5. Reach Out For Guidance

Having someone explain specific details can make the process smoother. Assistance from a licensed agent listed on this website can help you understand potential costs and match your needs with available options.

Making Sense Of Everything You Reviewed

By this point, you have compared documents, examined cost changes, and looked for areas that may affect your budget. The next step is making sure you feel confident in your decision.

Ask yourself:

• Does this plan still fit my healthcare needs?

• Do the hidden changes affect medication or provider access?

• Is the new cost structure realistic for my budget?

When you think through these questions, you gain clarity about whether staying with your existing plan or switching to a different option will serve you better in 2026.

Strengthening Your AEP Decision

Taking a close look at hidden costs ensures you enter the new year prepared. This is the advantage of reviewing Medicare plans carefully rather than relying on surface-level summaries.

You can contact any licensed agent listed on this website to talk through your questions, review your medications, or confirm whether certain services are covered the way you expect. Personalized guidance at the right time helps you avoid unnecessary spending and supports a plan choice that works well for your everyday needs.