Medicare Annual Enrollment — when and why to review the plan every year

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your father switched to a Medicare Advantage plan three years ago because the premium was lower than original Medicare with a supplement. The plan seemed fine. Everyone said he should shop around to save money, and this plan saved money. This year, he got a letter saying his plan is making changes. One of his three medications moved to a higher cost tier. His favorite orthopedist is leaving the network. His copay for physical therapy went up. The plan is "changing" and he has thirty days to decide whether to stay or switch. Or maybe he doesn't remember getting the letter. Or maybe he got it, didn't understand what it meant, and threw it away.

Medicare changes. Every year. Formularies change. Networks change. Premiums increase. Copays increase. Deductibles shift. Plans get better or worse. What worked perfectly for your parent last year might not work as well this year. And every year, Medicare gives beneficiaries a narrow window to respond to these changes.

This window matters because the decisions your parent makes during this window affect what they pay and what they have access to for the next twelve months. If your parent doesn't pay attention and doesn't make changes, they're stuck with whatever changes happened to their current plan. If your parent changes plans without reading carefully, they might end up worse off. The sweet spot is reviewing the plan every year and being intentional about whether to stay or switch.

Why Annual Enrollment Matters: Everything Changes Every Year

Medicare plans aren't static. They change every year. If you're on a Medicare Advantage plan, the network changes. Doctors leave the network. Copays increase. Sometimes benefits change—like how much physical therapy is covered, or whether certain types of care are included. The plan you have now isn't the same plan you'll have next year unless you actively review and confirm that staying makes sense.

If you're on Part D prescription drug coverage, the formulary changes every year. The formulary is the list of medications your plan covers. Medications move to higher cost tiers or are dropped entirely. Your parent's favorite diabetes medication might be on the formulary at a low copay this year, but next year the plan might prefer a different medication and moved your parent's medication to a higher cost tier. That means your parent's monthly out-of-pocket cost increases, or your parent has to switch to a different medication.

Premiums also increase most years. Your parent's Part B premium increases. Your Medicare Advantage plan premium might increase. Part D premiums increase. Even if nothing else changed, your parent would be paying more next year than they paid this year.

Deductibles shift. If your parent is in a Medicare Advantage plan with a deductible, the deductible might increase. If your parent has already paid the deductible this year, next year they start over. If your parent has original Medicare with a supplement, the supplement premiums might increase and copays might change.

When you add all these changes together, your parent's total out-of-pocket costs might increase significantly. And because all these changes happen at once, they might not happen the way your parent expects. A plan that was good this year might not be good next year.

The October-December Window: Mark Your Calendar Now

Medicare Annual Enrollment Period runs from October 15 through December 7 every year. This is when your parent can make changes to their Medicare coverage. Any changes made during this window take effect January 1 of the following year.

This is the main enrollment window. It's the most important window. If your parent misses it, they have to wait until the next year to make changes. So if your parent forgets to review their plan in November, they're stuck with whatever plan they have for the whole next year.

There are other enrollment windows, like if your parent moves or has a qualifying life event. But those don't apply to most people in most years. October through December is the window that matters.

The specific dates—October 15 through December 7,happen every year. October 15 is early enough that you can review and make decisions without rushing. December 7 is early enough that changes actually take effect on January 1. If your parent waits until December 30 to decide, it's too late. The changes won't happen until the following year.

Your job is to make sure your parent knows these dates and to help them review their plan during this window. Put it on your calendar. Send your parent a reminder in early October. Make the appointment in October to review the plan together. Get decisions made by early December so there's time to complete any changes.

What You Need to Check Every Year

Start with medications. What medications is your parent currently taking? Get a complete list. Go through the medicine cabinet if you need to. Write down the exact name of each medication, the dose, and how much your parent takes per day. This matters because the pharmacy or your parent might refer to a medication generically (like "blood pressure medicine") but there are multiple blood pressure medications, and they're not all on every formulary.

When you have the list, check the current plan's formulary. The formulary is available on the plan's website. Go through each medication and see what tier it's on. Tier one drugs have the lowest copay. Tier four drugs have higher copays. Tier five might be the highest. Look at the copay for each of your parent's medications. Add them up. That's what your parent will pay for drugs under the current plan next year if the formulary doesn't change.

Then check what the new formulary looks like for next year. Sometimes the plan puts the same drugs on the same tier. Sometimes things change. If your parent's top three medications are moving to higher cost tiers, that could mean a significant increase in drug costs. That's information you need to know when deciding whether to switch plans.

Next, check doctors. If your parent is on a Medicare Advantage plan, the doctor network might change. Is your parent's doctor still in network next year? Call the doctor's office if you're not sure. If your parent's primary care doctor is leaving the network, that might be reason to switch plans. Your parent shouldn't stay on a plan where their favorite doctor is no longer available unless the plan is otherwise really good.

Then look at costs. Get out your parent's claims from this year. How much did your parent spend out of pocket? Between premiums, deductibles, copays, and coinsurance, what was the total? Try to estimate what next year will cost based on the new plan's copays, deductibles, and premiums. If your parent's total out-of-pocket costs are going to increase significantly and there's a plan with lower costs, switching makes sense.

Don't just look at the premium. Many people focus on the premium because it's a number they see every month. But deductibles and copays matter more. A plan with a higher premium but lower deductibles and copays might actually cost less total. A plan with a lower premium but higher copays might cost more total.

When to Switch Plans (And When It's Better to Stay)

If your parent's prescription costs are increasing by more than fifty or a hundred dollars a month because of formulary changes, switching makes sense. If your parent's doctor is leaving the network and there's no comparable doctor in the remaining network, switching makes sense. If your parent is looking at a significant overall increase in total out-of-pocket costs and there's a better plan available, switching makes sense.

But switching also has a cost. You have to understand the new plan. You have to update where your parent gets prescriptions filled. You have to tell your parent's doctors about the change. You have to learn the new plan's procedures. There's effort involved in switching.

Small increases in cost probably don't justify the switching effort. If your parent's copays are going up by a few dollars for each medication and their doctor is still in network, staying might make sense. Your parent is familiar with the plan. Everything is already set up. A small cost increase is probably worth the stability.

Also consider whether your parent is really likely to switch. Some people feel overwhelmed by making changes. They'd rather know what they have than take the chance on something unknown. For people like this, switching multiple times creates stress. Once every few years to address a major problem might be appropriate, but constant switching isn't good for their peace of mind.

Ultimately, the decision to switch or stay depends on your parent's situation. If your parent's costs are increasing significantly and there's a clear alternative, switch. If the increase is small or your parent is happy with their current coverage, staying is fine. You're trying to find the balance between the best coverage and stability.

Tools That Make Comparison Easier

Medicare provides tools to help with comparison. Medicare.gov has a plan finder tool. You go to Medicare.gov, log in or provide information about your parent, and the plan finder lets you enter the medications your parent takes and the doctors your parent sees. The plan finder then shows you what different plans would charge for those specific medications and whether those doctors are in network.

This is enormously helpful because it answers the exact question you care about: "If my parent switches to this plan, how much will it cost, and will my parent's doctors still be available?" You can compare your parent's current plan to other plans available in your parent's area. You can see the total out-of-pocket costs for each plan. You can see which plans cover your parent's medications.

SHIP counselors can also help with plan comparison. If you call your state's SHIP program, a counselor can help you understand plan options and answer specific questions about your parent's situation. SHIP counselors know the plans available locally. They know which plans have good reputations and which have problems. They can help you make a good decision.

Some insurance brokers specialize in Medicare. These brokers have information about plans and can help you compare. They don't charge you a fee,they're paid by the plans. But they have time to help you think through options.

Using these tools, you can make an informed decision about your parent's Medicare coverage. You can see actual numbers, actual doctor networks, and actual medication coverage. You're not guessing. You're making decisions based on information.

Making Changes Before the Deadline

Once you and your parent have decided whether to stay or switch, you need to take action. If you're staying with the current plan, you might not need to do anything. Most plans auto-renew. Your parent will be on the same plan January 1 unless your parent takes action to change.

If you're switching plans, you have a few options. You can go online to Medicare.gov and make the change yourself. You can call the plan and request a change. You can have a SHIP counselor or insurance broker help you make the change. Whichever way you do it, make sure you understand what you're switching to and that the new plan actually covers what you need.

Some Medicare Advantage plans have lock-in periods. If your parent switches from a Medicare Advantage plan to original Medicare, they might not be able to switch back to Medicare Advantage the following year if their health situation has changed. The plan might deny enrollment. So once you switch away from Medicare Advantage, you might be stuck with original Medicare. This isn't necessarily bad,original Medicare is fine. But you should know what you're committing to before you switch.

Keep documentation of any changes you make. If you switched plans online, print the confirmation. If you called and requested a change, keep notes about who you talked to and when. If something goes wrong and the change doesn't go through, you have proof that you requested it.

And finally, once any change takes effect, follow up to make sure everything is working. Did your parent receive the card for the new plan? Is the new plan billing correctly? Can your parent access their doctors? Are prescriptions being filled under the new plan correctly? Follow up in the weeks after the change takes effect to make sure the transition actually happened.

Annual enrollment isn't optional. Your parent doesn't have to think about it, but they should. Paying attention to the plan every year helps make sure your parent isn't overpaying and isn't losing access to doctors they want to see. It takes time in October and November to review and compare. But that time spent thinking about Medicare for a few hours every year saves money and prevents problems throughout the year.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.