Medicare Open Enrollment 2026: What You Need to Know Before Choosing Your 2027 Coverage
Medicare's Annual Election Period is here. Learn when you can make changes, how Medicare Advantage and Supplement plans differ, and why reviewing your prescription coverage could save you money.
If you're enrolled in Medicare, you've probably noticed an increase in television commercials, mailers, and advertisements about Medicare plans. There's a good reason for that: Medicare's Annual Election Period (AEP) is underway.
But with so many plans, benefits, and coverage options available, how do you know whether your current Medicare coverage is still the best choice?
On a recent episode of Health Matters with the Medicine Center Pharmacy, we welcomed Tricia Witts, Sales Supervisor at PrimeTime Health Plan, to help answer some of the most common questions about Medicare enrollment.
With more than 28 years of experience in Medicare, Tricia shared valuable information about enrollment deadlines, Medicare Advantage plans, Medicare Supplement insurance, prescription drug coverage, and what beneficiaries should consider before making a change.
The discussion was based on program content reviewed and approved through the Medicare marketing review process, helping provide listeners with information they can use as they evaluate their options.
What Is Medicare's Annual Election Period (AEP)?
Medicare's Annual Election Period is the time each year when eligible Medicare beneficiaries can review and make changes to their Medicare Advantage and prescription drug coverage.
The Annual Election Period runs from October 15 through December 7 every year.
Changes made during this period generally take effect on January 1 of the following year.
During AEP, you can:
Switch from Original Medicare to a Medicare Advantage plan.
Switch from one Medicare Advantage plan to another.
Leave a Medicare Advantage plan and return to Original Medicare.
Join, change, or drop a standalone Medicare Part D prescription drug plan, subject to eligibility and enrollment rules.
If you're satisfied with your current plan, you generally don't need to take action to remain enrolled. However, that doesn't mean you should skip reviewing your coverage.
Why Should You Review Your Medicare Plan Every Year?
One of the most important messages from our conversation with Tricia was that Medicare plans can change from one year to the next, even when your personal healthcare needs stay the same.
Your insurance company sends an Annual Notice of Change (ANOC) explaining important changes to your plan for the upcoming year.
Those changes might include:
Monthly premiums and deductibles
Copays and coinsurance for medical services
Prescription drug formularies and medication costs
Participating physicians, hospitals, and pharmacies
Dental, vision, hearing, and other supplemental benefits
A plan that worked well for you this year may not provide the same value next year.
Our advice? Take time to review your Annual Notice of Change before the December 7 deadline, especially if you take prescription medications regularly.
Understanding Your Medicare Coverage Options
Before choosing a plan, it's helpful to understand how the different parts of Medicare work together.
Original Medicare: Parts A and B
Original Medicare is administered by the federal government and includes two primary components.
Medicare Part A (Hospital Insurance) generally helps cover inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home healthcare services.
Medicare Part B (Medical Insurance) helps cover physician visits, outpatient services, preventive care, medical equipment, and other medically necessary services.
Original Medicare allows beneficiaries to visit most healthcare providers nationwide who accept Medicare.
However, Original Medicare generally includes deductibles and coinsurance and does not have an annual out-of-pocket maximum for covered Part A and Part B services.
That's one reason many beneficiaries consider additional coverage.
Medicare Supplement Insurance (Medigap)
Medicare Supplement plans, also called Medigap, are offered by private insurance companies to help pay certain out-of-pocket costs associated with Original Medicare.
Depending on the plan, this may include deductibles, copayments, and coinsurance.
A Medicare Supplement policy works alongside Original Medicare rather than replacing it.
For some beneficiaries, the appeal is the flexibility to receive care from healthcare providers across the country who accept Medicare, without the provider networks commonly associated with Medicare Advantage plans.
Medigap policies generally require a separate monthly premium and do not include outpatient prescription drug coverage. Beneficiaries who need prescription coverage typically enroll in a separate Medicare Part D plan.
It's also important to understand that Medigap enrollment rules are different from Medicare Advantage enrollment rules. Depending on your circumstances, switching to or purchasing a Medigap policy may involve medical underwriting.
Medicare Advantage: Part C
Medicare Advantage plans are offered by private insurance companies approved by Medicare.
These plans provide your Medicare Part A and Part B benefits through the plan, rather than through Original Medicare, and many include Part D prescription drug coverage.
Medicare Advantage plans may also offer additional benefits not typically covered by Original Medicare, including:
Routine dental, vision, or hearing benefits
Fitness memberships
Certain over-the-counter allowances
Meal delivery following qualifying hospital stays
Other supplemental services, depending on the plan
An important feature of Medicare Advantage plans is an annual out-of-pocket maximum for covered Part A and Part B medical services. Once a beneficiary reaches the applicable maximum, the plan generally pays the full cost of covered medical services for the remainder of the year.
However, Medicare Advantage plans may use provider networks, require referrals for certain services, or require prior authorization.
Those differences deserve careful consideration before enrolling.
HMO, PPO, and HMO-POS: What's the Difference?
Not all Medicare Advantage plans work the same way.
HMO (Health Maintenance Organization): Generally requires members to use participating healthcare providers, except in certain circumstances such as emergencies.
PPO (Preferred Provider Organization): Offers more flexibility to see providers outside the network, although doing so may result in higher out-of-pocket costs.
HMO-POS (Health Maintenance Organization with Point-of-Service): Combines an HMO structure with certain out-of-network coverage options, subject to the plan's specific rules.
During our Health Matters conversation, Tricia explained that PrimeTime Health Plan offers an HMO-POS option with access to participating healthcare providers and hospitals.
For retirees who travel frequently or spend winters in another state, understanding how a plan handles emergency care, urgent care, and routine out-of-network services is especially important.
Before enrolling, always confirm that your preferred physicians, specialists, hospitals, and pharmacies participate in the plan you're considering.
Medicare Part D: Why Prescription Drug Coverage Matters
At Medicine Center Pharmacy, we encourage patients to pay particular attention to their prescription drug coverage during AEP.
Medicare Part D helps cover eligible prescription medications and is available through standalone prescription drug plans or Medicare Advantage plans that include drug coverage.
One of the most important things to understand is that not every Part D plan covers the same medications at the same cost.
Each plan maintains a formulary, which is its list of covered prescription medications.
Medications are commonly organized into tiers that help determine how much a beneficiary pays.
For example, one plan may place a commonly prescribed blood pressure medication on a preferred generic tier with a low copay, while another plan may place the same medication on a different tier with a higher cost.
Even when two plans cover the same prescription, the patient's out-of-pocket expense can be different.
Plans may also have different requirements, including prior authorization, quantity limits, or step therapy.
What About the Medicare Part D Coverage Stages?
Medicare Part D prescription coverage generally includes three stages:
Deductible stage: Depending on the plan, beneficiaries may pay toward a deductible before certain coverage benefits begin.
Initial coverage stage: Beneficiaries pay applicable copayments or coinsurance for covered medications.
Catastrophic coverage stage: After reaching the annual qualifying out-of-pocket threshold, beneficiaries pay no additional cost-sharing for covered Part D medications for the remainder of the calendar year.
The specific deductible and annual out-of-pocket threshold can change from year to year.
For beneficiaries concerned about paying for expensive medications early in the year, the Medicare Prescription Payment Plan may provide an option to spread eligible out-of-pocket prescription costs into monthly payments throughout the calendar year.
This program doesn't reduce the total cost of medications, but it may help make those expenses more manageable.
Additional assistance may also be available to eligible beneficiaries through Medicare's Extra Help program.
What Happens If You Miss the December 7 Deadline?
Missing Medicare's Annual Election Period doesn't necessarily mean you have no options, but your ability to make changes may be limited.
For individuals already enrolled in Medicare Advantage, there is a separate Medicare Advantage Open Enrollment Period from January 1 through March 31.
During that period, eligible beneficiaries can make one change, such as switching to another Medicare Advantage plan or returning to Original Medicare, with the option to join a standalone Part D plan.
This enrollment opportunity is not available to everyone with Original Medicare or a Medicare Supplement policy.
Certain life events, including moving outside a plan's service area or losing qualifying coverage, may also create a Special Enrollment Period.
Because enrollment rules vary depending on your current coverage and circumstances, it's important to understand your options before making a decision.
Five Questions to Ask Before Choosing Your Medicare Plan
Before enrolling in a new plan or allowing your current coverage to renew, consider these questions:
Are my doctors and hospitals covered? Check provider networks, particularly if you receive care from specialists or multiple healthcare systems.
Are my prescription medications covered? Review the formulary, drug tiers, pharmacy network, and any coverage restrictions.
What will my total annual costs look like? Consider premiums, deductibles, copays, coinsurance, and potential out-of-pocket expenses—not just the monthly premium.
Will my coverage work when I travel? Understand the difference between emergency coverage and routine medical care outside your plan's service area.
Do the additional benefits meet my needs? Dental, vision, hearing, fitness, and other supplemental benefits can be valuable, but they should not be the only reason to select a plan.
The lowest-premium plan isn't necessarily the least expensive option when you consider your total healthcare needs.
Learn More About Medicare With Health Matters
Choosing Medicare coverage is an important decision, and you don't have to navigate the process without information and support.
We appreciate Tricia Witts from PrimeTime Health Plan joining us on Health Matters with the Medicine Center Pharmacy to help explain the Annual Election Period and the differences between Medicare coverage options.
For more information about PrimeTime Health Plan and its Medicare Advantage options, visit www.pthp.com or call 330-363-7407.
You can also explore Medicare coverage options and compare available plans through the official Medicare website at www.medicare.gov or call 1-800-MEDICARE.
Listen to the Full Health Matters Episode
Want to learn more about Medicare enrollment, prescription drug coverage, and the questions you should ask before selecting a plan?
Listen to our conversation with Tricia Witts on Health Matters with the Medicine Center Pharmacy, available through your favorite podcast platform.
At Medicine Center Pharmacy, we believe informed patients make better healthcare decisions. Our goal is to help you better understand your medications, your coverage, and the resources available to support your health.
Remember: Medicare's Annual Election Period ends December 7. Don't wait until the last minute to review your coverage.
Thanks for listening today! We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsor Aultman Health System. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.
Disclaimer: This article is intended for general educational purposes and is not an endorsement or recommendation of any specific Medicare plan. Plan benefits, provider networks, formularies, eligibility, and costs vary. Medicare enrollment and Medigap eligibility rules may differ based on individual circumstances. Contact Medicare, your plan provider, or a licensed insurance professional for guidance about your coverage options.