How To Review Your Medicare Coverage Each Year To Make Sure It Still Fits
Your Medicare plan may have worked perfectly last year, but that does not mean it still fits your needs today. Plan benefits, provider networks, prescription drug coverage and premiums can change. Even if you love your current coverage, reviewing it annually helps you avoid surprise costs and ensure you are getting the right care at the right price. The annual Medicare open enrollment period runs from October 15 to December 7 each year, and during this time, people with Medicare can review features of Medicare plans offered in their area and make changes to their Medicare coverage, which go into effect on January 1 of the following year.
Although many people keep the same Medicare coverage from year to year, plan benefits, provider networks, prescription drug coverage and premiums can change. This makes an annual review more than just a good habit—it is a practical step to protect your health and your wallet.
Why Annual Review Matters
Reviewing your Medicare coverage annually can help ensure your plan still aligns with your health needs, prescription medications, providers, and budget. Your situation may shift throughout the year. You might develop a new health condition, start taking different medications, move to a new area, or find that your doctors have left your plan's network. In many cases, your current plan will automatically renew, however, costs, benefits, provider networks, and drug coverage may change, so it is important to review your options before deciding to stay with your current plan.
Even small changes can have a big impact. Even relatively small changes could affect your health care costs, benefits or access to care. Without reviewing your plan, you could miss important savings or end up paying far more than necessary.
Getting Started: Locate Your Annual Notice
If you are enrolled in a Medicare Advantage plan or a standalone Medicare Part D prescription drug plan, you should receive an Annual Notice of Change, commonly called an ANOC, in late September, and the Annual Notice of Change explains updates to your coverage that will take effect in the new calendar year. Your plan provider sends this document by September 30 each year, outlining any changes that will take effect the following January.
Read this notice carefully. It will tell you what has changed, so you can decide if your plan still works for you. Do not ignore it, even if you assume nothing will change. An easy way to know if Medicare Part D formulary changes will impact you is to review your Annual Notice of Changes, your plan provider sends this document by September 30 each year, and it details any prescription coverage changes, including the name of the medication, the reason for the change, and alternative drugs available.
Review Your Current Plan's Costs and Benefits
Before deciding to keep your current coverage, review possible changes to your monthly plan premium, copayments, coinsurance and deductibles, and medical and prescription drug benefits. Ask yourself whether these costs still fit your budget for the coming year. Premium increases are common, and your out-of-pocket costs may rise as well.
Do not assume automatic renewal means your plan is the best choice. Do not assume your plan works the same way next year. Take time to understand exactly what you will pay for the services you use most often.
Check That Your Doctors and Specialists Are Still In Network
Check if your doctors are still in network, since out-of-network care may cost more. Provider networks can change year to year. A doctor who was in your plan last year may no longer be, or a specialist you rely on may have moved to a different insurance plan. If you have established relationships with specific healthcare providers, confirm they are still in your plan before renewing.
This step is especially important if you manage a chronic condition or see a specialist regularly. Having to switch providers mid-year can disrupt your care and increase your costs significantly.
Review Your Prescription Drug Coverage in Detail
Check Your Current Medications 📋
Review your medications, and make any needed changes to your drug list, which may make it easier to compare each plan's prescription drug coverage and decide whether you need to switch. Write down every prescription you take, including the name, dosage, and how often you take it.
Verify all your medications are still covered and have not moved to higher-cost tiers. A medication can be covered under your plan but moved to a tier with a higher copay or coinsurance, which could significantly increase your expenses.
Understand Drug Tiers and Formulary Changes
Medicare drug plans may update their covered drug lists each year, and plans may add or remove a drug from its formulary or move a drug into a different tier. Every year, Medicare prescription drug plans can change which medications they cover, how much beneficiaries pay, and the restrictions attached to certain prescriptions.
A medication may move to a different tier, require prior authorization, or have new coverage requirements that could affect what you pay. Even if a drug is still on your plan's list, the cost may have changed. After you confirm the medication is in the formulary, make sure to review the dosages covered, if the drug tier has changed, your co-pay or co-insurance costs for next year, and if there are new requirements like prior authorization, step therapy, or quantity limits before you can access the drug.
Compare Your Options During Open Enrollment
If you are enrolled in a Medicare Advantage plan, the Annual Enrollment Period is an opportunity to review both your medical and prescription drug coverage and determine whether the plan continues to meet your needs. These changes include switching from traditional Medicare to a Medicare Advantage plan (or vice versa), switching between Medicare Advantage plans, and electing or switching between Medicare Part D prescription drug plans.
Use this window to explore other plans in your area. You may find a plan that better matches your medications, doctors, or budget. Remember that changes you make during open enrollment take effect on January 1.
Medicare Coverage Options: A Quick Comparison
| Medicare Type | How It Works | Key Consideration |
|---|---|---|
| Original Medicare (Part A & B) | Part A helps pay for inpatient hospital and skilled nursing care, some home care and end-of-life hospice care, and Part B covers doctors' services, diagnostic screenings, durable medical equipment, lab tests, outpatient care and preventive services. | Does not include prescription drugs; you must add Part D separately |
| Medicare Advantage (Part C) | Medicare Advantage plans, known as Part C, are sometimes referred to as all-in-one packages for Original Medicare services, and they cover Part A and Part B, and most include Part D (prescription drugs) as well. | Usually has a provider network; may offer additional benefits like dental or vision |
| Part D (Prescription Drug) | Medicare Part D is the part of Medicare that pays for outpatient prescription drugs, original Medicare parts A and B do not cover most medications you pick up at a pharmacy, and plans are sold by private insurance companies that Medicare approves, which is why premiums, covered drugs and pharmacy prices differ from one plan to the next. | Essential if you take prescription medications; review formulary changes annually |
Take Action: Your Annual Review Checklist
- ⏰ Mark the dates: Open Enrollment runs from October 15 to December 7. Do not wait until the last week.
- 📬 Find your Annual Notice of Change: Look for it in September or early October. Review it carefully for premium, copay, and coverage changes.
- 📋 List your medications: Write down every prescription, including the name, strength, and dosage. Check if each is covered and at what cost under your plan.
- 👨⚕️ Verify your doctors: Call your doctors' offices or check your plan's website to confirm they are in-network for the coming year.
- 💰 Calculate total costs: Consider premiums, deductibles, copays, and coinsurance for the care you use most often. Compare this to other plans in your area.
- 🔍 Use plan comparison tools: Medicare offers an interactive online tool that allows for comparison of coverage and costs for all plans in a geographic area, and the tool lets users input their own list of medications and then calculates personalized projections of the enrollee's annual costs under each plan option.
- ✅ Make your choice by December 7: If you decide to switch plans, enroll before the deadline. Changes take effect January 1.
What Happens If You Miss the Deadline
If you miss the Annual Enrollment deadline, your current plan renews automatically for 2027, with the changes in your Annual Notice of Change. This means you will automatically stay in your current plan even if it no longer fits your needs. While this is not necessarily bad if you are happy with your plan, you will have missed your chance to switch until the next enrollment period arrives.
In rare cases, life events like moving or losing insurance may qualify you for a Special Enrollment Period that lets you change coverage outside the regular enrollment window. You may be able to make changes to your prescription drug plan and Medicare Advantage coverage if certain life events happen, which can include things like moving out of your plan's coverage area or losing your insurance, and you can make changes during Special Enrollment Periods, but the timeframes may vary.
Moving Forward With Confidence
Reviewing your Medicare coverage each year does not have to be overwhelming. Start by reading your Annual Notice of Change, checking your medications and doctors, and comparing a few key costs. A little time spent now can save you far more later. Your healthcare needs and circumstances change—your Medicare plan should change with them. The annual enrollment period gives you the power to adjust your coverage to fit where you are today, not where you were last year.