What Medicare users should think about during open enrollment

The Medicare open enrollment period kicked off on October 15, but there’s an important detail for beneficiaries looking to renew their health plans. Since the federal government has been shut down since October 1, some aspects might be affected.

This enrollment season will run until December 7 and continues despite the ongoing government shutdown, as per the Centers for Medicare and Medicaid Services.

Philip Moeller, the author of *Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs*, cautions that it might be wise to wait before finalizing your 2026 coverage due to potential disruptions in timely information access caused by the shutdown.

“I really recommend holding off on decisions regarding coverage for next year,” he stated.

Moeller also noted that any changes made near the end of the public bidding process will be effective from January 1.

“Don’t rush these decisions,” he advised.

From now until December 7, Medicare beneficiaries have the chance to change their coverage. The available options depend on whether you’re enrolled in Original Medicare, typically consisting of Part A (hospital insurance) and Part B (medical insurance), or in a Medicare Advantage plan, which is a private plan approved by Medicare.

During this time, you can switch from Original Medicare to Medicare Advantage or the other way around, change your Medicare Advantage plans, or explore new Medicare Part D prescription drug coverage if you’re on Original Medicare.

While it may be tempting to stick with your existing plan, Juliette Cubansky, an associate director at KFF, advises reviewing your coverage in light of any potential changes that might raise your out-of-pocket costs, particularly concerning preferred doctors and prescriptions.

In 2022, the average out-of-pocket medical expenses for Medicare beneficiaries accounted for 39% of per capita Social Security income, according to KFF research.

“The open enrollment period is a great chance for beneficiaries to assess their current plans and see if there’s a better fit available,” Cubanski remarked.

Moeller pointed out that while some Medicare providers are expanding their services in certain areas, others are leaving or scaling back. “It’s crucial this year to do your research,” he emphasized.

The current federal government shutdown “might not drastically disrupt” Medicare’s offerings, Cubansky stated.

However, individuals reaching out to 1-800-Medicare for assistance could face delays, she noted.

Other resources, like the Medicare plan finder and various Medicare Advantage and drug plan portals, are still operational.

That said, the shutdown could hinder access to certain Planfinder information, according to Moeller. He mentioned that staffing shortages might result in delays with the 800 Medicare number.

Medicare.gov affirms that “critical activities and updates related to Medicare Open Enrollment will continue during the government shutdown.” However, they did not provide further details regarding the impact of the shutdown on enrollment.

Seeing the potential constraints on information access, Moeller stressed the importance of waiting to make coverage decisions.

As beneficiaries weigh the choice between Original Medicare and a private Advantage plan, experts suggest considering both sides of the coin.

Medicare Advantage plans often come with no extra premiums beyond the Part B premiums and offer various additional perks, according to Cubansky.

However, while some plans might provide dental coverage, it’s crucial to understand exactly what that includes—just annual cleanings or perhaps a more comprehensive range, like bi-annual cleanings or dentures?

It’s true that Medicare Advantage often has limitations on accessing specific services and providers, Cubansky noted. Additionally, these private plans usually come with more prior authorization requirements, which can complicate care access.

Meanwhile, traditional Medicare is becoming “increasingly unaffordable” for some, according to Cubansky. Those needing extensive medical services may discover traditional Medicare can incur higher costs.

Moreover, unlike Medicare Advantage, traditional Medicare lacks caps on out-of-pocket medical expenses, highlighting another significant difference.

On the topic of Medicare Advantage, Moeller mentioned that beneficiaries would have opportunities this year to enroll in plans. He noted the Medicare plan finder will offer additional information about perks like vision, hearing, and dental services available in these plans.

Individuals interested in Advantage plans will also gain access to detailed data on doctors, hospitals, and other healthcare professionals in the provider network. Moeller mentioned that such information will primarily be hosted on insurance websites.

There may be “some challenges” with the new information available, Moeller warned, but beneficiaries will have a chance to reevaluate during the open enrollment for Medicare Advantage, which runs from January 1 to March 31.

For those under Original Medicare, the option to buy Medicare Part D for prescription drug coverage is available. If you have Medicare Advantage, you might leverage these benefits through your private plan.

Regardless, reviewing your options for next year is crucial, especially regarding whether your prescriptions will be covered.

“If any plan doesn’t include all your necessary medications, I’d suggest moving on,” Moeller advised. “Ensuring your medications are covered is essential.”

Moeller also emphasized that there are several non-premium Part D plans that can help lower monthly costs, although he noted that annual deductibles for these options are on the rise. He mentioned the possibility of out-of-pocket expenses hitting higher tiers.

“It’s important to remember that the overall annual cost should guide your decisions,” Moeller reiterated.

While some regions are seeing a rise in zero-premium Part D plans, the total number of available plans is declining, Cubansky mentioned.

Additionally, the out-of-pocket cap for Part D drugs is set to rise from $2,000 in 2025 to $2,100 in 2026. However, this cap only pertains to drugs covered by the plan, so any treatments purchased outside it wouldn’t contribute to that limit.

“Shopping around can uncover options you might not have considered,” Cubansky observed. “Sometimes your existing plan may not be the best choice.”