Medicare’s annual Open Enrollment period runs through Dec. 7, with coverage changes taking effect Jan. 1, 2027.
Retirees should compare total costs, prescription coverage and access to doctors before switching plans.
Moving from Medicare Advantage to Original Medicare requires special attention because getting a Medigap policy may involve health screening.
October brings Autumn leaves, spiced pumpkin drinks, and if you’re retired, Medicare Open Enrollment. Between Oct. 15 and Dec. 7, people on Medicare can select a new plan or keep the one they have.
During that time, beneficiaries can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join, switch or drop a Part D prescription drug plan. Changes generally take effect Jan. 1.
For retirees living on fixed incomes, the decision should begin with a review of their current coverage and expected medical needs.
Medicare health and drug plans can change their costs, benefits, and provider and pharmacy networks each year. A plan that worked well in 2026 may offer a different value in 2027. The Annual Notice of Change, sent by Medicare Advantage and drug plans each fall, outlines upcoming changes in costs, coverage or service area.
Look beyond the premium
A Medicare Advantage plan advertising a $0 monthly premium still has other costs. Beneficiaries generally must continue paying their Part B premium and may face deductibles, copayments and coinsurance when they receive care.
Retirees should compare what they would spend during a typical year and what they could owe if their health deteriorated. Medicare Advantage plans have annual limits on spending for covered Part A and Part B services. Original Medicare has no annual out-of-pocket ceiling without supplemental coverage.
That makes hospital stays, specialist visits, outpatient treatment and the plan’s maximum out-of-pocket amount important parts of the comparison.
Check every prescription
Retirees should enter their current medications, dosages and preferred pharmacies into Medicare’s Plan Finder. The tool estimates monthly and annual drug costs, helping beneficiaries compare plans based on the prescriptions they actually take.
Check whether each medication is covered, its cost-sharing requirements and any restrictions. Pharmacy choice matters, too: some plans offer lower prices at preferred pharmacies, while using an out-of-network pharmacy can mean paying the full cost.
Confirm access to care
Before switching Medicare Advantage plans, retirees should verify that their doctors, specialists and preferred hospitals participate in the specific plan being considered.
They should also check referral and prior authorization requirements. Medicare Advantage plans may require approval before covering certain services, and nonemergency care outside the network may cost more or lack coverage.
For retirees who spend part of the year in another state, those restrictions deserve particular attention. Original Medicare generally allows beneficiaries to use any doctor or hospital accepting Medicare nationwide.
Understand the Medigap issue
One potentially costly mistake is assuming that leaving Medicare Advantage guarantees access to Medicare Supplement Insurance, commonly called Medigap.
The fall enrollment period does not provide an annual guaranteed right to buy Medigap. Its federal open enrollment protection generally lasts six months, beginning when someone is at least 65 and enrolled in Part B.
Outside that window, insurers may use medical underwriting, potentially denying an application or charging more. Certain circumstances provide guaranteed purchase rights, and some states offer additional protections. Retirees considering the move should establish their eligibility, price and coverage start date before completing the switch.
Get help before enrolling
Beneficiaries can compare options through Medicare.gov or seek free, personalized counseling through their State Health Insurance Assistance Program. Medicare also provides assistance at 1-800-MEDICARE.
A useful comparison should answer three practical questions: Can the retiree keep receiving needed care, are current prescriptions covered affordably, and could the household manage the costs of a serious illness?