Medicare open enrollment can feel like a lot to navigate, especially when you’re not sure what’s changed from last year. Every fall, millions of Medicare beneficiaries across the country find themselves sorting through plan options, comparing costs, and wondering if they need to make any changes. It’s easy to feel overwhelmed — but the good news is that with a little preparation and the right information, the process becomes much more manageable. Whether you’re new to Medicare or you’ve been through enrollment before, understanding what changes each year and how to get ready can make a real difference. In this article, we’ll walk you through exactly what to expect and how to feel confident when enrollment season arrives.

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What Is Medicare Open Enrollment?

Medicare open enrollment — officially known as the Annual Enrollment Period (AEP) — runs from October 15 through December 7 each year. Any changes you make during this window take effect on January 1 of the following year. This is the primary opportunity for Medicare beneficiaries to review their current coverage and make adjustments based on their health needs and budget.

During the AEP, Medicare beneficiaries are allowed to make several important coverage decisions, including:

Switching from one Medicare Advantage (Part C) plan to another
Moving from Original Medicare (Parts A and B) to a Medicare Advantage plan, or switching back to Original Medicare
Changing your Medicare Part D prescription drug plan to one that better covers your current medications
Enrolling in a Part D plan for the first time if you previously chose not to

It is important to understand that the AEP is not the only enrollment window available. If you are turning 65 and becoming eligible for Medicare, your Initial Enrollment Period (IEP) begins three months before your birthday month and extends three months after — giving you a seven-month window to sign up. Additionally, Special Enrollment Periods (SEPs) may be available to you if you experience a qualifying life event, such as losing employer-sponsored coverage or relocating to a new service area.

Each year, insurance carriers can adjust plan premiums, covered medications, provider networks, and benefits. That means a plan that worked well for you last year may not be the best fit going forward. Reviewing your options annually is one of the smartest steps you can take to protect both your health and your finances.

To compare available plans in your area, visit Medicare’s Plan Finder tool on the official Medicare.gov website — a trusted, unbiased resource for beneficiaries nationwide.

What Can Actually Change Year to Year

One of the most important things to understand about Medicare open enrollment is that your current plan may look very different come January 1st. Insurance carriers and the Centers for Medicare & Medicaid Services review and adjust plan details every year — and those adjustments can have a real impact on your healthcare costs and access. Staying informed is the key to avoiding unwanted surprises.

Here are the types of changes that can happen between plan years:

Premiums and cost-sharing: Your monthly premium, annual deductible, copays, and coinsurance amounts are all subject to change. A plan that felt affordable last year may cost noticeably more in the coming year.
Drug formularies: This is where many people get caught off guard. Imagine your cholesterol medication moved from Tier 2 to Tier 4 — your out-of-pocket cost for that one prescription could jump from a modest copay to hundreds of dollars per month. Drugs can also be removed from a formulary entirely, requiring you to seek an exception or switch medications.
Plan networks: Doctors, hospitals, and specialists can be added to or removed from a plan’s network each year. Your primary care physician or a surgeon you rely on may no longer be in-network, potentially meaning higher costs or the need to find a new provider.
Star ratings: CMS evaluates Medicare Advantage and Part D plans annually using a five-star quality rating system. A plan’s rating can rise or fall, giving you useful insight into how well it’s performing in areas like customer service, care management, and member outcomes.
Medicare Advantage extra benefits: The dental, vision, hearing, and fitness benefits offered through Medicare Advantage plans can change significantly from one year to the next — coverage limits, covered services, and network providers may all be revised.
Part B premium adjustments: CMS sets the standard Medicare Part B premium each year. Even if nothing else about your plan changes, your overall Medicare costs can shift based on this annual adjustment.

No plan is guaranteed to stay the same, which is exactly why reviewing your coverage every fall isn’t just a good idea — it’s a financially smart habit.

How to Review Your Coverage During Open Enrollment

Medicare open enrollment runs from October 15 to December 7 each year, and making the most of it starts with a thorough review of your current coverage. Plans change every year — premiums, deductibles, drug formularies, and provider networks can all shift. Taking the time to compare your options could save you hundreds of dollars and help ensure you have access to the care you need. Follow these six steps to review your coverage with confidence.

Pull out your Annual Notice of Change (ANOC) letter. Your current plan is required to mail you this document before October 1. It outlines every change coming to your plan in the new year — including cost adjustments and benefit modifications. Read it carefully before doing anything else.
List your current doctors and verify network status. Even if your plan stays the same, provider networks can change. Contact your doctors’ offices directly or check your plan’s online directory to confirm they will still be in-network for the upcoming year.
List all your prescriptions and compare formulary coverage. Drug formularies are updated annually. Write down every medication you take, including dosage and frequency, then check whether your plan still covers them at the same tier and cost-sharing level.
Use Medicare’s Plan Finder tool. Visit Medicare.gov and use the Plan Finder to compare available plans in your area side by side. You can enter your medications and preferred pharmacies to get a clear picture of out-of-pocket costs across different options.
Consider your expected healthcare usage for the coming year. Think about any upcoming procedures, specialist visits, or new medications you may need. If your health needs have changed, your current plan may no longer be the best fit. It is also a good time to explore understanding your long-term care needs as part of your broader health planning.
Contact your State Health Insurance Assistance Program (SHIP). SHIP counselors provide free, unbiased help to Medicare beneficiaries. They can walk you through your options and answer your specific questions. Find your local SHIP counselor to schedule a no-cost consultation before the enrollment deadline.

Reviewing your coverage each year does not have to be overwhelming. By working through these steps methodically, you can make an informed decision that supports your health and your budget for the year ahead.

Part D Drug Plans: The Most Overlooked Part of Open Enrollment

When people think about Medicare open enrollment, they usually focus on their medical coverage. But Part D prescription drug plans often have the biggest impact on your annual out-of-pocket costs — and they’re frequently the last thing reviewed. That’s a costly mistake.

Part D plans can change significantly from one year to the next. Insurance carriers update their formularies — the list of covered drugs — and may shift medications between cost tiers. A drug that was in a lower-cost tier last year could move to a higher tier, or be dropped from coverage entirely. If you take regular medications and don’t review your plan annually, you could face unexpected costs starting January 1st.

The Coverage Gap: Major Changes in 2025

For years, the Medicare Part D coverage gap — commonly called the “donut hole” — created a confusing and expensive middle phase of drug coverage. Thanks to the Inflation Reduction Act, the structure has been significantly simplified. Starting in 2025, Medicare caps annual out-of-pocket drug costs at $2,000. Once you reach that threshold, your covered prescriptions cost you nothing for the rest of the year. This is one of the most meaningful improvements to Part D in the program’s history.

Don’t Ignore the Late Enrollment Penalty

If you delay enrolling in Part D after becoming Medicare-eligible and don’t have other creditable drug coverage (such as from an employer), you may face a permanent late enrollment penalty. That penalty equals 1% of the national base premium for every month you went without qualifying coverage — and it’s added to your premium for as long as you have Part D. Enrolling on time protects you from this ongoing surcharge.

How to Compare Plans Before the Deadline

Choosing the right plan takes more than a quick glance at monthly premiums. Use the following steps to make a well-informed decision:

Enter your specific medications into Medicare’s Plan Finder tool to see total estimated costs
Compare deductibles, copays, and tier structures across available plans in your area
Check that your preferred pharmacy is in-network
Ask your pharmacist for guidance — they can flag formulary changes and suggest cost-saving alternatives

Pharmacists are an underused resource during enrollment season. They understand your medication history and can help you identify plans that offer the best coverage for your specific needs. For a full overview of how drug coverage works, visit Medicare’s Part D drug coverage guide.

Medicare Advantage vs. Original Medicare: Is It Time to Switch?

One of the most important decisions you can make during Medicare open enrollment is whether your current coverage structure still fits your life. Each year, you have the opportunity to move between Original Medicare and Medicare Advantage — and understanding the differences can help you make a confident choice.

Understanding the Basics

Original Medicare (Parts A and B) is the traditional federal program. It covers hospital care and medical services, gives you access to any doctor or specialist who accepts Medicare, and works across the country. Medicare Advantage (Part C) is offered by private insurers approved by Medicare. These plans bundle hospital, medical, and often prescription drug coverage into one plan — and many include extra benefits like dental, vision, and hearing coverage.

When Switching to Medicare Advantage May Make Sense

Moving from Original Medicare to a Medicare Advantage plan could be worth considering if you:

Want to simplify coverage with an all-in-one plan
Are looking for lower monthly premiums
Could benefit from added perks like fitness programs or transportation benefits
Primarily see in-network providers and are comfortable with referral requirements

When Switching Back to Original Medicare May Make Sense

On the other hand, returning to Original Medicare might be the better fit if you:

Travel frequently or split time between states
Have complex or ongoing health needs requiring specialist access
Prefer the freedom to see any Medicare-accepting provider without network restrictions
Have experienced limited provider availability in your current Advantage plan

Don’t Forget Medigap

If you return to Original Medicare, you may want to pair it with a Medigap (Medicare Supplement) policy to help cover out-of-pocket costs. Here’s an important caveat: in most states, insurers can use medical underwriting if you’re enrolling outside of a guaranteed issue period. That means a health condition could affect your eligibility or premium. It’s smart to weigh this carefully before making the switch.

Just as you’d think carefully about protecting your income with other insurance, your Medicare structure deserves the same thoughtful review. Open enrollment is the natural moment to pause, reassess, and make sure your coverage still works as hard as you do.

Common Medicare Open Enrollment Mistakes to Avoid

Even the most organized people can stumble during Medicare open enrollment. These are not rookie errors — they are easy traps that catch beneficiaries at every experience level. Knowing what to watch for can save you money, stress, and months of frustration.

Auto-renewing without reviewing your plan. It feels simple to just let your current plan roll over, but Medicare plans change every single year. Premiums, covered services, and drug lists can all shift between January 1 and the following enrollment period. What worked well last year may cost you significantly more this year.
Focusing only on the monthly premium. A lower premium can look appealing at first glance, but the full picture includes deductibles, copays, and coinsurance. A plan with a modest monthly cost could end up being far more expensive once you factor in what you actually pay when you use your coverage.
Not checking your doctors and specialists. Provider networks change from year to year. Even if your physician was in-network last year, there is no guarantee they still are. Always confirm that your preferred doctors and any specialists you see regularly are covered under your plan before committing.
Ignoring drug formulary changes on your Part D plan. Insurance carriers regularly update the list of covered medications. A drug that was fully covered last year may have moved to a higher cost tier — or been removed entirely. Review your formulary carefully, especially if you take maintenance medications.
Missing the December 7 deadline. Open enrollment closes on December 7 each year. If you miss it, you generally have to wait until the next enrollment window, which means living with a plan that may not serve your needs for a full year.
Not exploring new plans on the market. New options enter your area regularly. A plan you have never considered before may offer better coverage, a broader network, or lower overall costs than anything currently available to you.

Taking just a few hours to review your options before the deadline can make a meaningful difference in your coverage and your budget.

Taking Control of Your Medicare Coverage

Medicare open enrollment is your annual opportunity to step back, review what you have, and make sure your coverage still aligns with your health needs and budget. Plans change, your needs change, and the good news is that you have the power to change too — once a year, during this important window.

Reviewing your options does not have to feel overwhelming. With the right information and a trusted resource by your side, the process becomes much more manageable. A licensed insurance advisor can walk you through your choices, help you compare plans side by side, and answer your questions honestly — without pressure or confusion.

At Akston Insurance, we are here to help you feel confident about your Medicare decisions. Whether you are enrolling for the first time or simply want a second set of eyes on your current plan, we would love to help. Reach out to our team today and let us guide you through the process.

Medicare Open Enrollment: What Changes Each Year and How to Be Ready