Nearly two-thirds of Americans, around 64%, believe that their Medicare benefits could be reduced due to the current administration, a finding from a recent survey. With some changes potentially taking effect as soon as next year, higher costs might follow for many individuals.
For instance, it’s anticipated that Medicare Part B premiums will rise significantly, by about $21.50, reaching $206.50. This marks one of the steepest increases ever recorded. Additionally, premiums for Medicare Part D prescription plans may jump by as much as $50, up from the previous year’s cap of $35 set by the government. Furthermore, several major private insurers have either pulled out of the Medicare market or ceased offering their plans, claiming it’s become unprofitable.
Luckily, there’s still a way for consumers to combat these hikes and the associated reduction in services—through the Medicare Fall Open Enrollment Period. This timeframe, from October 15 to December 7, allows individuals to add, remove, or switch their Medicare plans.
Melinda Cahill, co-founder of 65 Incorporated, emphasized how crucial this enrollment period is within Medicare’s six-decade history, advising everyone to rethink their existing plans.
To assist with this, here’s a checklist to review your current Medicare plan and explore available options this fall.
1. Carefully read your annual notice of change.
Those enrolled in Medicare should have received an Annual Notice of Change (ANOC) by September, highlighting what to expect the following year. It’s important to stay informed about any plan alterations.
- Premium changes.
- Deductibles.
- Copays and coinsurance details.
- Maximum out-of-pocket expenses.
- Updates to provider networks and service areas.
- Prescription drug coverage and pharmacy affiliations.
- Medical benefits.
- Any additional benefits.
2. Ensure your prescription drugs remain covered and affordable.
Carolyn McClanahan, a physician and certified financial planner, notes that one common mistake seniors make is assuming their prescription coverage hasn’t changed. “People often neglect to check, and suddenly their needed medication isn’t on the list, or its price has spiked dramatically,” she pointed out.
Don’t rely solely on the ANOC. It’s advisable to visit your insurer’s website and investigate the new formulary, which outlines covered drugs. For 2026, Medicare prescription plans have a $2,100 out-of-pocket limit, but only for covered medications. If a necessary drug isn’t included, your potential savings could disappear quickly.
Even if a medication is listed, the cost-sharing may change. For example, a drug that had a $10 copay this year might shift to 25% coinsurance next year. If that medication’s retail price is $1,000, this means a jump from $10 to $250 in out-of-pocket expenses. “What works this year may not be reliable next year,” Cahill warns, making it prudent to assess other plans as well.
3. Check if your doctors and hospitals are still in your Medicare Advantage network.
According to Cahill, the primary uncertainty surrounding Medicare Advantage is its network. If your provider leaves the plan’s network, you could face higher costs or the need to switch doctors. With some insurance companies limiting their offerings in certain regions, checking for in-network providers is essential.
Add to that the fact that some preferred provider organization (PPO) plans are being phased out, which can further complicate your healthcare options. It’s wise to contact your primary care provider and any specialists or hospitals you frequently use to confirm they’re still available in your plan next year.
4. Focus on long-term financial security rather than just perks.
The rising costs of healthcare might entice some seniors to consider Medicare Advantage plans, which sell themselves on low premiums and additional benefits like dental care or gym memberships. However, McClanahan advises caution—these plans may limit provider access, which could become an issue later.
Your doctor could potentially leave your plan, or certain services might not be covered without prior approval. “When it comes to serious illnesses, you don’t want to find yourself in a tight spot,” she warns.
Moreover, the allure of additional, but ultimately superficial perks shouldn’t be your main deciding factor. “They’re just icing on the cake,” she says, highlighting that the primary purpose of health insurance is to safeguard against severe health conditions. It’s crucial to ensure your plan sufficiently covers essential services while keeping your deductibles low.
5. If significant changes occur, consider switching back to original Medicare.
If your Medicare Advantage plan is discontinued or you relocate, it might be worthwhile to transition back to original Medicare. You also have the option of enrolling in a Medigap policy to help cover possible out-of-pocket expenses.
Medigap insurance typically covers costs that original Medicare does not, which can be significant. “It’s risky to go without Medigap,” states McClanahan, given the financial exposure it implies.
However, if you missed the chance to enroll in Medigap earlier, securing affordable coverage can be tough due to possible medical underwriting requirements. But if major changes occur—like the discontinuation of your Medicare Advantage plan—you will have temporary rights that allow access to Medigap without facing health-related restrictions.
Once you understand your new plan, the Medicare Plan Finder tool on Medicare.gov can aid in evaluating your options. If you opt to change plans, ensure you do so before the December 7 deadline.
