(NerdWallet) – Nearly two-thirds of Americans (64%) believe Medicare benefits will be reduced under the current administration, according to a report Latest NerdWallet Poll. For some, there could be a reduction in benefits next year — along with higher prices.
Medicare Part B premiums are expected to rise $21.50 to $206.50 next year according to Medicare trustees — one of the largest premium increases in Medicare history. Medicare Part D prescription drug plans can increase premiums by up to $50, up from a cap set by the government last year of $35. Many of the largest private insurers are scaling back their Medicare offerings or exiting the market entirely due to a lack of profitability.
Consumers have one key defense against rising costs, shrinking provider networks, and disappearing benefits: Medicare open enrollment period. Each year from October 15 to December 7, you can add, drop, or switch Medicare plans.
“This is the most significant open enrollment period in the 60-year history of Medicare,” says Melinda Coghill, co-founder of 65 Incorporated, which provides Medicare guidance. “Everyone should review their plan.”
Here’s a Medicare open enrollment checklist to help you review your plan and compare your options this fall.
1. Read your annual change notice carefully
Medicare enrollees should have received an Annual Notice of Change (ANOC) in the mail in September detailing changes to their plan for the upcoming year. Note any changes to your plan:
- beloved.
- For discount.
- Copayment and coinsurance.
- Maximum out of pocket.
- Provider network and service area.
- Prescription drug coverage and pharmacy network.
- Medical benefits.
- Other benefits.
2. Make sure your prescribed medications are still covered and affordable
The biggest mistake seniors can make is not reconsidering their prescription drug coverage, says Carolyn McClanahan, a physician and certified financial planner (CFP). “A lot of people have let it go, and their medications may not be on the formulary or the cost has gone up too much,” McClanahan says.
Don’t rely on your ANOC alone. Coghill urges consumers to visit their insurance company’s website and look for their drugs in the plan’s new formulary, or list of covered drugs. While Medicare prescription drug plans come with a cap of $2,100 for out-of-pocket costs in 2026, this cap only applies to covered drugs. If the drug you need isn’t on your plan’s formulary, it could easily wipe out your savings.
Even if your medications are covered, you may be in a different cost-sharing tier, Coghill warns. For example, a drug that came with a $10 copayment this year may turn into a 25% coinsurance next year. If the retail price of this drug was $1,000, the cost would jump from $10 to $250. “Plans that worked this year may not work for you next year at all,” says Coghill, so you may want to compare your coverage with others. Prescription drug plans.
3. Make sure your doctors and hospitals are still in network if you’re on Medicare Advantage
“The main advantage of Medicare Advantage is plan networks,” because they can change at any time, Coghill says. If your medical provider is suddenly excluded from your plan’s network, you will either have to find a new provider or face expensive out-of-network costs. As insurance companies decline their offers, the area(s) in which your plan works may shrink.
Furthermore, preferred provider organization (PPO) plans, which give enrollees more freedom to see out-of-network providers, are being closed by some insurers. Contact your primary care doctor and any specialists or hospitals you plan to visit and make sure they will still be in your plan’s network next year.
4. Go beyond the perks and prioritize long-term financial security
Higher costs may tempt seniors to sign up Medicare Advantage Plans Which boast low premiums and additional perks such as dental allowances and gym memberships. But McClanahan warns against trying to save money this way.
Premiums are often low because the plan limits who you can see and where you can go for care. Your doctor can drop your plan at any time, and you may not be covered for certain services if you can’t get pre-approved. “You can shoot yourself in the foot down the road when you get sick and need better care,” she says.
When it comes to the extras offered by Medicare Advantage plans, Caughill doesn’t recommend letting that be a deciding factor either. “They’re like sprinkles,” she says. “The reason any of us have health insurance is because of cancer, strokes, heart attacks, chronic conditions and car accidents.” Make sure you have enough coverage for these things before you “add the sprinkles,” and prioritize keeping your deductibles and maximum out-of-pocket costs low.
5. When big changes happen, consider going back to original Medicare
If you are on Medicare Advantage and your plan is discontinued or leaves your area, you may want to consider switching to Original Medicare And get a Medicare Supplement Insurance Plan, or Medigap plan.
Medigap The plans help cover out-of-pocket costs, which are unlimited in Original Medicare. “You should never sign up for traditional Medicare without having a Medigap plan,” McClanahan says, because that puts you at high financial risk.
If you missed out on Medigap when you joined Medicare, you’re often under Medicare underwriting, which can make it difficult to get an affordable policy. But some important changes, such as when your Medicare Advantage plan turns off or stops working in your area, temporarily give you “guaranteed release rights.” This means that Medigap insurance companies cannot deny you or charge you more because of your health.
Once you’ve reviewed your plan changes, you can use the Medicare Plan Finder tool on Medicare.gov to compare options and decide if it makes financial sense Changing medical care plans. If you ultimately decide to switch, sign up for your new plan by the December 7th deadline.