Recent survey findings indicate that about 64% of Americans are concerned their Medicare benefits could be reduced under the current government. Some individuals may even see cuts as soon as next year, which could lead to increased costs.
The Medicare Administrative Commission forecasts an increase in Medicare Part B premiums by $21.50, totaling $206.50, next year—this being one of the steepest hikes in Medicare’s history. Similarly, premiums for Medicare Part D prescription drug plans might surge up to $50, a significant rise from last year’s government-set cap of $35. Additionally, many major private insurers have exited the Medicare space, citing unprofitability.
However, there is a key opportunity for consumers to combat rising expenses and dwindling benefits: the Medicare Fall Open Enrollment Period. From October 15 to December 7 annually, enrollees can add, remove, or switch Medicare plans.
“This is the most critical public offering period in Medicare’s 60-year history,” remarks Melinda Cahill, co-founder of 65 Incorporated, which offers Medicare guidance. “Everyone should reevaluate their plans.”
To assist with this, here’s a checklist to help you analyze your current Medicare plan and explore available options this fall.
1. Carefully review the Annual Notice of Change.
Medicare recipients should have received their Annual Notice of Change (ANOC) by September, outlining alterations to their plans for the next year. It’s crucial to pay attention to any modifications.
- Premiums
- Deductibles
- Copays and coinsurance
- Maximum out-of-pocket expenses
- Provider network and service areas
- Prescription drug coverage and pharmacy networks
- Medical benefits
- Other benefits
2. Check your prescription drugs for coverage and cost.
Carolyn McClanahan, a physician and certified financial planner, emphasizes that seniors often make the mistake of not verifying their prescription drug coverage. “Many users just assume everything is fine, but their medication might not be covered, or costs have risen significantly,” she points out.
Don’t just rely on the ANOC; Cahill encourages checking the insurance company’s website for the updated formulary. While Medicare prescription drug plans set an out-of-pocket cap of $2,100 for 2026, that only applies to covered drugs, so if your necessary medication isn’t on the list, those savings may be lost.
Even if a drug is covered, the cost-sharing structure can vary. For instance, a medication with a $10 copay this year may shift to a 25% coinsurance next year. If the retail price of that drug is $1,000, your costs would spike from $10 to $250. “What works this year might not work at all next year,” Cahill warns. Comparing coverage across plans is advisable.
3. For Medicare Advantage members, confirm your healthcare providers are in-network.
Cahill notes that the network of providers is a significant factor in Medicare Advantage plans. Network changes can happen anytime, meaning you might need to find a new provider or incur higher out-of-network costs if yours drops from the plan. Some insurance companies are also limiting the areas where they offer plans.
Moreover, some preferred provider organization (PPO) plans, which allow more flexibility in choosing out-of-network providers, are being terminated by various insurers. It’s a good idea to contact your primary care physician and any specialists or hospitals you expect to visit next year to ensure they remain in your network.
4. Focus on benefits and long-term security.
Increasing costs might push some seniors toward enrolling in Medicare Advantage Plans, which promote their low premiums and added benefits like dental care and gym memberships. However, McClanahan warns against basing your decision solely on these perks.
These plans typically lower premiums by restricting your options for healthcare providers and types of treatments available. Your doctor could leave the plan at any time, and certain services may require prior authorization for coverage. “When health complications arise, waiting to find better treatment can backfire,” she adds.
As for the extra benefits that come with Medicare Advantage plans, Cahill advises not to let those sway your decision. “They’re just embellishments. The primary purpose of health insurance is to safeguard against serious health issues,” she states. Before considering those extras, ensure that the fundamental coverage meets your needs and that you keep deductibles and out-of-pocket limits manageable.
5. If significant changes arise, think about reverting to Original Medicare.
If you have Medicare Advantage and experience a plan discontinuation or relocation, consider switching back to Original Medicare. You might also want to look into Medicare Supplemental Insurance (Medigap) plans to cover out-of-pocket costs, as these can be significant with Original Medicare.
It’s crucial to have a Medigap plan, according to McClanahan, as Original Medicare exposes you to higher financial risks. If you missed applying for Medigap upon enrolling in Medicare, obtaining affordable coverage can be tricky due to medical underwriting. However, if significant changes occur, such as your Medicare Advantage plan ceasing operations in your area, temporary protections grant you easier access to Medigap coverage without additional costs based on health.
Once you’ve assessed any plan changes, you can utilize Medicare.gov’s Plan Finder tool to compare your options. If you decide to switch, make sure to enroll in a new plan by the December 7 deadline.
