Key Takeaways
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Reviewing your Medicare options during the Annual Enrollment Period (AEP) from October 15 to December 7, 2025, gives you the chance to adjust your coverage so it fits your 2026 needs.
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You should consider rethinking your plan when your prescription costs, provider access, or expected care needs are likely to change in the coming year.
Understanding Why This Decision Matters For 2026
Every year, Medicare plans adjust important details such as premiums, deductibles, prescription drug requirements, cost sharing, and network rules. These changes apply starting January 1 of the upcoming year. During the 2025 AEP, you have a once-per-year opportunity to review those updates and decide whether staying with your current plan supports your goals for 2026. Your health needs, medication list, and expected medical visits may look different next year, which means your coverage should match those updates.
AEP only lasts about eight weeks, so thinking through your decision early helps prevent rushed choices. When you fully understand what may change and how it could affect you, you are better prepared to make a confident choice that supports your health and your budget.
When Should You Reassess Your Medicare Plan?
To understand whether you should keep your plan or switch to something that better matches your situation, use the following key points as a guide during AEP.
What Should You Look For In Your Updated Plan Materials?
Your Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) gives you a full breakdown of what will be different starting January 1, 2026. You should look closely at:
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Any increase in deductibles
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Changes in copayments or coinsurance for common services
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Adjustments in the prescription drug list
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Differences in the plan’s service area or network rules
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Updates to annual out-of-pocket maximums
If these updates suggest higher costs or reduced access to care, it may make sense to explore other options.
When Do Prescription Drug Changes Make A Difference?
Prescription drug adjustments are among the most important reasons people rethink their coverage. Formularies can shift each year. A medication that is covered in 2025 at one cost level may move to a different tier, require new authorization steps, or have different rules in 2026. Because a new year can bring a change in your own medications as well, it is important to ensure your plan supports your current and future prescriptions.
You may want to consider a different plan if:
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A medication moves to a higher tier in 2026
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Prior authorization, step therapy, or quantity limits change
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Your total yearly drug spending is expected to increase based on 2026 updates
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You expect to start a new long term medication in 2026
The Medicare Part D out-of-pocket structure also changes from year to year, and those updates can affect how quickly you reach certain spending thresholds. Reviewing these details during AEP helps you prevent avoidable costs.
How Does Provider Access Influence Your Decision?
Access to preferred doctors and specialists is central to your coverage. Plan networks can expand, shrink, or shift their agreements. If the provider you rely on most will not be part of the 2026 network, that alone may justify reconsidering your plan.
You should rethink your plan if:
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Your doctor, specialist, or clinic will be out of network next year
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You are planning a major procedure in early 2026 and want predictable costs
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You expect to see new specialists based on health changes
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You are increasing your travel schedule and may need coverage in different areas
Understanding network rules before December 7 gives you time to adjust if needed.
What If Your Health Needs Will Change Next Year?
Your 2026 health outlook matters. When you expect more frequent appointments, therapy sessions, or tests, cost sharing matters more. You may find that your current plan becomes more expensive if you anticipate new care needs.
Examples of situations where this may apply include:
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Scheduled surgeries or treatment plans lasting several months
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New chronic health conditions requiring ongoing management
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Increased need for laboratory testing or imaging
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Anticipated rehabilitation or therapy sessions
A plan that worked well for you in 2025 may not be the most suitable option for 2026 if your care requirements expand.
How Do Annual Out Of Pocket Limits Affect Your Choice?
The annual out-of-pocket maximum resets every January. Plans may adjust those limits for 2026. A higher limit may expose you to more potential medical spending throughout the year. Reviewing how these limits differ helps you understand how protected you are from major medical expenses.
If you expect more appointments, tests, or ongoing treatments in 2026, the out-of-pocket maximum becomes a key factor in your decision.
Why Should You Consider Total Projected Costs Instead Of Just Monthly Costs?
Focusing only on monthly payments can overlook the full picture. Deductibles, medical service copayments, coinsurance, and prescription drug costs add up across the year. When choosing coverage for 2026, compare the total potential expenses rather than looking at a single number.
Total yearly costs may include:
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Monthly premiums
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Deductibles
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Copayments for office visits and therapies
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Coinsurance for outpatient services
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Prescription drug spending
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Costs when reaching certain benefit phases during the year
Looking at the full twelve month view helps you understand which plan supports your financial comfort.
Does Your Current Plan Still Support Your Lifestyle?
Lifestyle changes can affect how you want your coverage to work. If you plan to travel more in 2026 or anticipate spending time in different locations, you may need a plan that offers broad access.
Consider whether you need:
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Access to providers in multiple states
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Better emergency and urgent care flexibility
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Predictable coverage during extended travel
A plan that fit your routine in 2025 may not support your movement or activities in 2026.
What Happens If You Do Nothing?
If you take no action during AEP, your current plan typically renews automatically on January 1, 2026. However, the renewed plan may have changed significantly. Staying put without reviewing the updates can lead to unexpected costs or limited access to preferred care. AEP is your chance to avoid surprise changes.
Organizing Your Review For AEP
To make the most of the AEP window, use a structured approach. Since the period runs only from mid October to early December, organizing your review early gives you better clarity.
How Can You Organize Your Review Effectively?
You can follow a simple plan:
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Gather your ANOC and 2026 plan documents.
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List your current medications and compare them to the new formulary.
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Confirm your primary doctor, specialists, and facilities in the 2026 network.
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Review expected appointments or procedures next year.
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Calculate your potential yearly spending under the updated rules.
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Compare the updated plan with alternatives available in your service area.
Why Should You Get Guidance From A Professional?
Medicare information can be detailed and sometimes difficult to compare on your own. Speaking with a licensed agent listed on this website ensures that you receive support tailored to your needs and preferences. They can help you review plan rules for 2026, understand cost changes, and compare coverage options in a clear and organized manner.
Making Confident Decisions For Your 2026 Coverage
With the right preparation, you can approach the 2025 AEP with confidence. A careful review helps ensure that your coverage lines up with your goals, your expected care needs, and your budget.
Aligning Your Plan With Your 2026 Needs
You have a limited window each year to choose coverage that fits the next twelve months. By reviewing your updated plan details, checking your prescriptions, confirming provider networks, and understanding your expected care needs, you can make an informed decision. If you feel uncertain at any point, reach out to any of the licensed agents listed on this website for guidance and clarity.
