Key Takeaways

• Small coverage gaps often start with minor plan changes, and you can spot them early by reviewing your Annual Notice of Change.

• Paying attention to prescription lists, doctor availability, and cost‑sharing updates helps you maintain steady coverage each year.

Understanding Why Small Gaps Can Grow Over Time

When you prepare for the Annual Enrollment Period (AEP), which runs from October 15 to December 7, 2025, you are in a position to evaluate how your current coverage will support you in 2026. Even a very small gap in your benefits can create bigger issues later if you do not notice them in time. By taking a closer look at the areas where your coverage could shift, you can protect yourself from unexpected expenses or disruptions.

AEP gives you just under eight weeks to compare options, check for updates, and make any needed changes. Staying ahead of these timelines helps ensure your coverage for 2026 remains stable.

Key Areas Where Gaps Commonly Begin

What Should You Look For In Plan Documents?

Plan documents can feel long, but they contain critical details that help you spot small changes. Focus on:

• Updates to cost‑sharing, including deductibles, copays, and coinsurance.

• Adjustments to your prescription drug list.

• Changes to the rules for referrals or authorizations.

• Updates to your plan’s rating or performance indicators.

These sections help you identify where your plan may be shifting in a way that affects how you use your benefits next year.

Why Do Small Cost Changes Matter?

A small increase in costs may not seem important at first, but over time it can add up. For example, even a modest change in specialist visit costs or prescription tiers can influence how much you spend across an entire year. Since these changes take effect on January 1, 2026, noticing them now gives you time to make a more informed choice.

How Do Coverage Rules Influence Your Experience?

Some plans adjust rules for certain types of care. This could include:

• New requirements for referrals.

• Different approval steps for imaging or therapies.

• Updated limits related to benefit usage.

Even one change can affect access or timing. Identifying small adjustments now keeps your care consistent.

Spotting Prescription‑Related Gaps

Why Should You Review Your Drug List Every Year?

Prescription formularies change each year, and not always in predictable ways. A medication might:

• Move to a different tier.

• Require authorization.

• Have new quantity limits.

• Be removed from the list entirely.

Checking your list for 2026 during AEP helps you avoid unexpected pharmacy costs.

How Can Tier Changes Affect Your Spending?

Tier movement is one of the most common reasons beneficiaries encounter sudden cost increases. Even if the medication itself has not changed, its position in the plan’s tier structure may have. Tier changes take effect on January 1, 2026, and staying aware helps you adjust your expectations.

What Should You Check For Beyond Tiers?

Look for supporting updates such as:

• Whether your preferred pharmacy is still part of the network.

• Whether new rules apply to refills or generics.

• Whether seasonal medications require different coverage steps.

These details help you catch early warning signs that your coverage may not support your medication needs in the coming year.

Looking Closely At Doctor And Provider Access

Why Is Provider Access A Major Source Of Gaps?

Your access to doctors, specialists, and facilities can shift from year to year. Networks are updated regularly, especially at the beginning of a new coverage year. Even one provider leaving your plan can create a gap.

How Do You Check Network Stability?

During AEP, take time to:

• Confirm your primary care provider remains in the network for 2026.

• Verify that specialists you regularly see are still covered.

• Review updated network directories for any new limits.

Being proactive avoids disruptions around January 1.

What If A Provider You Use Moves Out Of Network?

If you spot this early enough, you can:

• Compare other plans to see if your doctor is covered elsewhere.

• Evaluate your upcoming appointments to determine whether timing matters.

• Ask the doctor’s office if they expect to participate in future years.

This advance planning helps you reduce uncertainty.

Keeping An Eye On Out‑Of‑Pocket Patterns

Why Should You Look At Last Year’s Spending?

Your 2025 usage can predict potential 2026 gaps. Plan changes may influence how much you pay even if the plan seems similar. Look closely at:

• High‑use services.

• Seasonal patterns.

• Prescription spending.

When you match these with your plan’s 2026 changes, you get a clearer picture of where small gaps may appear.

How Can You Identify Future Cost Surprises?

Review sections related to:

• Deductible increases.

• Changes to specialty care copays.

• Updated cost rules for labs or imaging.

These updates take effect at the beginning of the new year, and knowing them in advance allows you to adjust your care plans.

Monitoring Additional Benefits

Why Should You Check Supplemental Benefits?

Certain extra benefits may shift slightly from year to year. These benefits help support your everyday health needs, but small changes can affect how you use them.

What Types Of Changes Should You Expect?

New limits or revised availability may apply to:

• Telehealth services.

• Wellness support.

• Routine care options.

Evaluating these during AEP helps you understand how the plan will support you throughout the year.

How To Maintain Coverage Stability Throughout The Year

What Steps Should You Take During AEP?

Use the full AEP timeline to:

• Review your Annual Notice of Change carefully.

• Compare plan documents with your personal healthcare needs.

• Check updated formularies and provider networks.

• Look for potential gaps that could affect your experience starting January 1, 2026.

Why Should You Act Before AEP Ends?

Waiting until the last days of AEP can limit your review time. Since AEP closes on December 7, giving yourself a structured schedule from mid‑October helps you stay organized.

Strengthening Your Coverage For 2026

Taking time now to examine small changes positions you to keep your coverage stable throughout 2026. Your careful review of cost‑sharing, prescriptions, network stability, and benefit updates helps you avoid surprises.

Staying Protected When Plans Change

As medicare plans adjust each year, spotting early signs of potential gaps makes your AEP decisions stronger. Use the AEP window to review your documents, compare options, and align coverage with your needs.

Making Your 2026 Plan As Strong As Possible

Even slight adjustments can affect your future care. By paying attention to the details, you ensure you enter the new year with confidence.

Ensuring Your Coverage Supports You Fully

By reviewing all areas of your plan each year, you maintain more control over your annual healthcare costs and access.

Bringing It All Together For A Stable Year Ahead

Use this AEP to identify small gaps before they turn into bigger issues. Taking a structured approach now helps you choose a plan that aligns with your health needs and financial comfort for the year ahead. If you want support while reviewing your choices, consider reaching out to any of the licensed agents listed on this website for guidance.