Your Medicare Health Plan Worked This Year. Will It Still Work for You Next Year?

What to look for during Medicare Open Enrollment, from your doctors and prescriptions to costs and coverage changes

If your Medicare coverage works well for you, it can be easy to let Open Enrollment periods come and go without taking a closer look. However, plans can change from year to year, including costs, benefits, drug coverage, and other important details. Your healthcare needs may have changed, too, and what worked well for you last year may not be the best fit for the year ahead.

The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During this time, you can review your current coverage, compare plan options, and make certain changes for the coming year.

Keep in mind that there’s no single Medicare plan that’s right for everyone. The coverage that works best for you depends on your health needs, lifestyle, budget, and priorities.

AEP and OEP: Know the difference

The Annual Enrollment Period (AEP) runs from October 15 through December 7. During AEP, you can make certain changes to your Medicare health and prescription drug coverage for the following year. Changes generally take effect on January 1.

If you’re already enrolled in a Medicare Advantage plan, you have another opportunity to make a change during the Medicare Advantage Open Enrollment Period (OEP), January 1 through March 31. During OEP, you can switch to another Medicare Advantage plan or return to Original Medicare. You can learn how Medicare Advantage plan types compare on Medicare’s website.

Before you compare plans

Before you start comparing plans, gather a few key pieces of information: the names of your physicians and specialists, your preferred hospital and pharmacy, your current medications, and the information your current plan sent you about next year’s coverage.

Having these details readily available can make it easier to evaluate your options and focus on the plans that best meet your needs.

If Adventist Health is part of your care journey in Central and Southern California, or you'd like it to be, you can also visit our Adventist Health Care Network webpage to learn more about participating Medicare Advantage plans and explore network options that may provide access to the physicians, hospitals, and services you value most.

Medicare’s Plan Compare Tool can help you review Medicare Advantage and Part D plans.

As you compare plans, here are some questions to consider.

Will my Medicare coverage look the same next year?

Even if you plan to keep your current coverage, don’t assume it will be exactly the same. Each fall, your Medicare plan sends you an Annual Notice of Change (ANOC) outlining changes that will take effect in January. Reviewing that notice can help you spot differences in costs, benefits, drug coverage, and other plan details before deciding whether your current coverage still meets your needs.

Can I continue seeing my doctors and using the hospitals I prefer?

For many people, keeping the doctors they know and trust is an important factor when choosing a health plan. Look beyond your primary care physician and consider specialists, your hospital, and other providers or facilities you use regularly.

Note: Provider participation can change, so it’s a good idea to confirm with the healthcare plan or a licensed agent before enrolling.

What healthcare costs should I expect?

Monthly premiums are only part of what you may spend on healthcare. Look at deductibles, copayments, coinsurance, prescription costs, and other expenses associated with the healthcare services you use.

Think about how you used healthcare this past year and whether you expect your needs to change. If you now see specialists or receive ongoing treatment, pay close attention to those costs.

If you’re considering Medicare Advantage, also review the plan’s out-of-pocket limit for covered Medicare services. Original Medicare doesn’t have an annual out-of-pocket limit unless you have supplemental coverage to help pay those expenses.

Will my prescriptions be covered?

If you take prescription medications, check whether they’re covered and what you can expect to pay out-of-pocket. Costs can vary based on the plan, medication, and pharmacy you use.

Medicare’s Plan Compare Tool allows you to enter your prescriptions and preferred pharmacies so you can compare estimated costs across available plans. If you don’t have an account, you’ll need to enter your zip code and select Medicare drug plan (Part D) to estimate prescription costs.

Which additional benefits will I use?

Dental, vision, hearing, fitness, transportation, and other supplemental benefits can add value and may help distinguish one plan from another. As you compare options, look beyond the list of benefits to understand participating providers, coverage limits, and any potential out-of-pocket costs.

While additional benefits can be appealing, it's important to focus first on what matters most to your health and well-being. Access to your physicians, hospitals, prescription medications, and ongoing care will often have the greatest impact on your healthcare experience throughout the year.

Making your decision

The right Medicare plan starts with understanding what matters most to you. As you compare your options, consider whether the coverage you're evaluating provides access to Adventist Health.

Wherever you are in your Medicare journey, taking time to review your choices can help you make a confident and informed enrollment decision. To learn more about participating Medicare Advantage plans and Adventist Health Care Network options in Central and Southern California, visit AdventistHealth.org/CareNetwork.

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