Medicare Annual Enrollment Period: Steps to Review Coverage

Every fall, millions of Medicare beneficiaries face a critical window: the Medicare Annual Enrollment Period (AEP). From October 15 to December 7, you can review your current coverage, compare plan options, and make changes that take effect on January 1. Miss it, and you are locked into your existing plan for another year, even if your prescriptions, doctors, or health needs have changed. That is why a structured review is not just recommended, it is essential. This guide walks you through the medicare annual enrollment period steps to review coverage so you can avoid surprise costs and ensure your plan still fits your life.

Understand the Annual Enrollment Period and What You Can Change

The Annual Enrollment Period, sometimes called Open Enrollment, runs each year from October 15 to December 7. During this time, anyone with Medicare can make changes to their coverage. This is not the same as the Initial Enrollment Period when you first become eligible, nor is it the Medicare Advantage Open Enrollment Period (January 1 to March 31), which allows only a single change for those already in a Medicare Advantage plan. The AEP is your broadest opportunity each year to adjust your Medicare health and drug coverage.

What exactly can you do during AEP? You can switch from Original Medicare to a Medicare Advantage plan, or vice versa. You can change from one Medicare Advantage plan to another. You can join, drop, or switch a Part D prescription drug plan. If you are in a Medicare Advantage plan that includes drug coverage (MA-PD), you can switch to a different MA-PD or to a standalone Part D plan if you return to Original Medicare. These changes are not automatic; you must actively enroll in the new plan, and your old plan will typically end when the new one begins.

It is important to note that AEP is not for everyone. If you are satisfied with your current coverage and your needs have not changed, you may not need to do anything. However, even if you are happy, plans can change their costs, networks, and formularies each year, so a quick review is always wise. The steps below will help you conduct that review efficiently.

Step 1: Gather Your Current Plan Information and Notice of Changes

Before you start comparing, collect the materials your current plan has sent you. Each fall, your plan must send an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC). These documents detail any changes to premiums, deductibles, copays, provider networks, and drug formularies for the coming year. Review these carefully. If your plan is being discontinued or leaving your area, you will receive a notice of non-renewal. Knowing these changes upfront will tell you whether your current plan still meets your needs or if you need to look elsewhere.

Also gather a list of your prescriptions, including dosages and frequencies, and the names of your preferred doctors and hospitals. This information will be the foundation for comparing plans. Without it, you risk choosing a plan that does not cover your medications or includes your providers.

Step 2: Review Your Prescription Drug Needs and Formulary Changes

Prescription drug coverage is often the most significant factor in plan satisfaction. Each Part D and Medicare Advantage prescription drug plan has a formulary, a list of covered drugs. Formularies can change every year. A drug that was covered this year might be removed or moved to a higher cost tier next year. Your plan's ANOC will indicate formulary changes, but you should verify each of your medications against the new formulary.

Use the Medicare Plan Finder tool on Medicare.gov to enter your drugs and compare estimated annual costs across plans. Pay attention to tiers, prior authorization requirements, and quantity limits. If a drug is not on the formulary, you may be able to request an exception, but it is simpler to choose a plan that covers your medications from the start. Also consider whether your pharmacy is in the plan's network; using an out-of-network pharmacy can dramatically increase your costs.

When reviewing drug coverage, think beyond the premium. A low premium plan might have high copays for your specific drugs, while a higher premium plan could save you money overall. The Plan Finder provides an estimated total yearly cost that includes premiums, deductibles, and copays, giving you a clearer picture.

Step 3: Compare Medicare Advantage and Part D Plan Updates

Medicare Advantage plans (Part C) bundle hospital, medical, and often drug coverage into one plan, frequently with extra benefits like dental, vision, and hearing. These plans can change significantly from year to year. Premiums may rise, networks may shrink, and supplemental benefits may be added or removed. If you are in a Medicare Advantage plan, review the ANOC to see what is changing.

For 2026, many Medicare Advantage plans continue to emphasize supplemental benefits such as over-the-counter allowances and fitness memberships, but availability varies by plan and county. Compare the total out-of-pocket costs, including copays for doctor visits and hospital stays, and check whether your doctors remain in the network. If you are considering switching to Original Medicare, you will need to add a standalone Part D plan and possibly a Medigap policy. Medigap policies are sold by private insurers and are not part of the AEP, but you can apply for one at any time; however, medical underwriting may apply after your initial enrollment period.

If you are on Original Medicare and want drug coverage, you must enroll in a standalone Part D plan. The same formulary and network considerations apply. Use the Plan Finder to compare Part D plans based on your drugs and preferred pharmacy. Also check whether the plan offers any extra benefits, such as discounted vaccines or medication therapy management.

Step 4: Check Provider Networks and Supplemental Benefit Changes

Even if your doctors are in your current plan's network this year, they may not be next year. Networks can change, and providers can leave plans. Before you commit to a plan, verify that your primary care physician, specialists, and preferred hospitals are in-network for the coming year. You can check the plan's provider directory or call your doctors' offices to confirm. If you have a Medicare Advantage plan, also check whether you need referrals for specialists and whether prior authorization is required for certain services.

Supplemental benefits like dental, vision, hearing, and fitness programs can be a deciding factor for many beneficiaries. However, these benefits often come with restrictions. For example, a dental allowance might be limited to certain services or a specific network. Read the details carefully and compare the value of these benefits against the plan's overall cost. Do not choose a plan based solely on a flashy extra benefit; ensure the core coverage meets your needs first.

Step 5: Use Comparison Tools and Seek Personalized Help

Once you have gathered your information, use reliable comparison tools to evaluate your options. The Medicare Plan Finder on Medicare.gov is an official resource that allows you to compare plans side by side. You can also use independent resources like InsuranceAdvisers to research and compare Medicare plan options. These tools can help you filter plans by premium, deductible, drug coverage, and network type.

For personalized assistance, consider speaking with a licensed insurance agent or a State Health Insurance Assistance Program (SHIP) counselor. SHIP counselors provide free, unbiased guidance. Licensed agents can help you enroll in a plan, but be aware that they may be compensated by insurers. Always ask whether an agent represents all plans in your area or only a select few. Quote Comparison is not connected with or endorsed by the U.S. government or the federal Medicare program, and not all plans are available in every area.

When comparing plans, create a shortlist of two or three plans that meet your criteria. For each, calculate the estimated annual cost, including premiums, deductibles, and copays for your expected healthcare usage. Factor in any supplemental benefits you value. Then review the plan's star ratings from Medicare, which indicate quality and member satisfaction. A plan with a slightly higher premium but better ratings and coverage may be worth it.

Step 6: Enroll in Your Chosen Plan Before December 7

Once you have decided, enroll in your new plan. You can do this online through Medicare.gov, by calling the plan directly, or by working with an agent. If you are switching from one Medicare Advantage plan to another, you will be automatically disenrolled from your old plan when the new one starts. If you are switching from Original Medicare to Medicare Advantage, you will remain in Original Medicare until the new plan begins. Make sure you receive confirmation from the new plan.

If you do not enroll in a new plan, you will stay in your current plan, and any changes to premiums, copays, and formularies will apply. If your current plan is being discontinued, you will be automatically enrolled in a similar plan unless you choose another. However, automatic enrollment may not be in your best interest, so it is crucial to review your options even if you are satisfied.

After you enroll, mark your calendar for January 1 to confirm your new coverage is active. Check that your new plan has sent your member ID card and that your prescriptions are being processed correctly. If you encounter any issues, contact your plan's member services immediately.

Common Pitfalls to Avoid During AEP

One common mistake is assuming your current plan will remain the same. Plans can change premiums, copays, and drug coverage annually. Another pitfall is choosing a plan based solely on a low premium without considering total costs. A plan with a $0 premium might have high copays that cost you more overall. Also, do not forget to check whether your pharmacy is in the plan's network; using an out-of-network pharmacy can lead to unexpected expenses.

Another mistake is missing the December 7 deadline. There are no extensions for the AEP (unless you qualify for a Special Enrollment Period). If you miss it, you may have to wait until the next year or the Medicare Advantage Open Enrollment Period (if you are in a Medicare Advantage plan) to make a change. Finally, be wary of unsolicited calls or aggressive sales tactics. Medicare plans cannot call you unless you have requested information. If you receive suspicious calls, report them to Medicare.

By following these medicare annual enrollment period steps to review coverage, you can make an informed decision that protects your health and your wallet. Take the time each fall to review your needs, compare plans, and enroll in the coverage that best serves you. For more guidance and to compare plans, visit Quote Comparison, where you can explore Medicare plan options and connect with licensed agents. Remember, Quote Comparison is not an insurance agency, broker, or insurer, and it does not provide medical or enrollment guidance. Coverage is arranged directly with the chosen carrier or agent.