Key Takeaways

1. Understanding a plan’s changes helps you see whether your doctors, medications, and costs will still fit your needs.

2. Reviewing adjustments early in the Annual Enrollment Period gives you enough time to compare your choices confidently.

Understanding What AEP Changes Mean For You

The Annual Enrollment Period from October 15 to December 7, 2025, allows you to review your Medicare coverage for the 2026 year. During this time, you can study changes in your plan to see whether any adjustments will affect your care, your budget, or your routine. Every plan releases updated information for the new year, and these updates help you make an informed decision before coverage begins on January 1.

When you look at these adjustments, your goal is to identify what applies directly to your situation. Even small changes can influence how you access your doctors or how much you spend. By taking a closer look at each section of your plan materials, you can understand whether your current plan still works for you or whether you should consider new options.

How Do You Read A Plan’s Annual Notice Document?

Your plan sends an Annual Notice of Change, often called an ANOC, before AEP begins. This document explains all updates for the coming year. When reviewing it, focus on the parts that relate to your personal needs.

What Should You Look At First?

Start with the overview section. This part highlights the adjustments that apply across the whole plan. It usually tells you whether there are changes to premiums, deductibles, or copayments. While premiums can vary, you are allowed to focus only on general cost shifts rather than specific private plan pricing.

After the overview, look for updates to your coverage rules. Pay attention to:

• Changes in cost sharing

• Adjustments to deductibles

• Updates to in-network and out-of-network cost differences

• Changes in approval rules for certain services

These areas help you understand how your experience might change.

Why Does The Provider Directory Section Matter?

Every plan includes a list of doctors, hospitals, and specialists. If your preferred providers leave the plan’s network or change their status, you may face higher costs or complicated referral steps.

Check whether:

• Your primary doctor remains in-network

• Specialists you visit stay included

• Hospital options remain the same

• Any new referral rules are added

Your access to care depends heavily on these points, so reviewing them early in AEP gives you enough time to act.

How Do Doctor Network Changes Affect You?

Doctor network adjustments can influence how easily you get care in 2026. Plans may add providers, remove some from the network, or shift certain practitioners to different tiers. Each of these adjustments affects access.

What If Your Doctor Leaves The Network?

If your doctor is no longer in-network, you may face:

• Higher out-of-pocket costs

• Longer travel time to find in-network care

• Referrals to different specialists

If this applies to you, consider reviewing other plans early in AEP to find one that keeps your preferred doctor.

How Can You Check For Network Updates?

Review the plan’s updated provider directory and compare it with last year’s directory. Look carefully because network changes can vary by region. Even if the plan stays the same, your local network might not.

How Do Prescription Adjustments Influence Your Coverage?

Medication coverage plays a large role in your overall healthcare experience. Plans regularly update drug lists, known as formularies, and these updates affect how your medications are covered.

What Should You Check For In The New Formulary?

Look at:

• Whether your medication remains covered

• Changes to the medication tier

• Any new prior authorization steps

• Quantity or dosage rules

These updates determine how much you may spend and whether your pharmacy process stays simple.

How Do Tier Changes Affect You?

If a medication moves to a different tier, your cost may shift. If your medication moves to a higher tier, the cost typically increases. This is important to review early because it helps you understand whether your plan still matches your health needs.

How Can Cost Changes Affect Your Annual Budget?

A plan may adjust its cost sharing from year to year. These updates may influence what you pay for services, tests, or treatment.

What Types Of Costs Should You Review?

Pay attention to:

• The standard Part A cost details

• The standard Part B premium and deductible for 2026

• Cost sharing amounts for specialist visits, lab tests, or imaging

• The plan’s annual out-of-pocket limit

These general medical costs help you understand your likely expenses for the year.

Why Should You Compare Your Spending From Last Year?

Looking at your past medical visits helps you estimate whether the new plan rules or cost structure will affect you more or less in 2026. For example, if you had frequent specialist visits, even a small increase in cost sharing may influence your yearly spending.

How Do Extra Benefits Influence Your Decision?

Some plans include extra benefits. These extras may change from one year to the next.

What Should You Focus On?

Instead of focusing on the added features, look at:

• Whether essential medical coverage stays strong

• Whether your usual care is still affordable

• Whether your prescription coverage remains suitable

Extras can be helpful, but your core medical needs matter most.

How Do You Compare Plan Adjustments During AEP?

AEP lasts for about eight weeks, giving you enough time to compare different coverage options if needed.

When Should You Start Comparing?

Begin reviewing your plan as soon as you receive your updated materials. This usually occurs in late September. This gives you at least two full months to:

• Study your current coverage

• Check changes for 2026

• Review options during AEP

Starting early gives you time to ask questions and avoid rushed decisions.

How Do You Know If A Different Plan Fits You Better?

Ask yourself the following:

• Will my doctor or specialist remain in-network?

• Are my medications still covered in a cost-effective way?

• Do I anticipate more medical visits next year?

• Will my preferred pharmacies still work with the plan?

• Does the plan keep costs predictable for the year?

If many answers point to a potential problem, exploring another plan during AEP may help you stay better protected.

How Do Approval Rules Affect Your Experience?

Plans sometimes change rules around prior authorization or referrals. These requirements influence how quickly you can get care.

What Should You Look For?

Look for changes in:

• Referral steps for specialists

• Approval requirements for treatments or procedures

• New limits on certain services

If you have a condition that requires ongoing care, these approval rules play a major role in your experience.

How To Make Sense Of Your Personal Needs

Every beneficiary has different priorities. Your plan should match your medical patterns.

What Personal Factors Matter Most?

Consider:

• How often you visit your doctor

• Whether you see specialists regularly

• How many medications you take

• Whether you travel often

• Whether you receive ongoing therapy or treatment

Comparing these factors with a plan’s updates helps you see whether your plan fits your lifestyle.

Understanding Your Choices For 2026

You can make one change during AEP, and your new coverage will start on January 1, 2026. Reviewing updates carefully helps you avoid unwanted surprises during the year.

How Do You Finalize Your Decision?

Before selecting a plan, make sure you:

• Understand new benefits

• Know your cost responsibilities

• Confirm your doctor network

• Verify your medication coverage

• Review all changes from the prior year

Taking the time to do this sets you up for a more predictable experience.

Preparing For The Year Ahead

The effort you invest during AEP helps you shape a smoother year ahead. When you know how your plan is changing, you can make choices that feel right for your health and your peace of mind.

Making Well Informed Medicare Choices

Understanding a plan’s adjustments helps you make coverage choices that protect both your health and your budget. If you need extra help reviewing your options, reach out to any of the licensed agents listed on this website for guidance. Their support can help you feel confident as you prepare for 2026 coverage.