Key Takeaways
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Reassessing your Medicare coverage during the Annual Enrollment Period helps you stay prepared for changes in your health, costs, and plan rules.
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Even when you feel satisfied with your current plan, a quick review ensures it still protects your needs for the upcoming year.
Understanding Why AEP Matters Each Year
The Annual Enrollment Period runs from October 15 to December 7 each year. This is the only time many beneficiaries can make changes to their Medicare Advantage or Medicare Part D plans for the upcoming year. What you choose during this window takes effect on January 1. Even if you feel mostly satisfied with your current plan, it is still useful to reassess your coverage for the new year. Plans adjust benefits, costs, and rules annually, and small changes may affect your healthcare experience in ways you do not expect.
Evaluating your plan each year does not mean you are unhappy with it. Instead, it shows that you understand how important it is to remain informed. A quick review offers clarity and ensures you start the new year with confidence.
When Should You Reevaluate Your Plan?
Have Your Health Needs Shifted Since Last Year?
Your health can change gradually or suddenly. Maybe you developed a new condition, started new medications, or your doctor recommended additional testing or ongoing monitoring. Even if you feel your current plan has served you well, check whether next year’s benefits continue to support these medical needs.
Review areas such as:
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Covered treatments
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Limits on therapy sessions
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Outpatient visit cost structure
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Prescription drug tiers
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Pharmacy rules
A new health need may require a different structure of coverage. Small gaps today can become larger expenses later, so identifying them early ensures you make a well-informed decision.
Are Your Prescription Drugs On Track With Next Year’s Requirements?
Medication needs shift often, even when your general health feels stable. During AEP, plans update their formularies. Prescription drugs can move to different tiers, new restrictions may appear, and dosage limits may be revised. These changes take effect on January 1.
Review:
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Tier changes
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Step therapy
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Prior authorization rules
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Quantity limits
Your prescription list is one of the most important tools you can review during AEP. Even if you take only a handful of medications, checking them once a year makes a meaningful difference.
Have Your Providers Remained In The Plan’s Network?
Provider networks change each year. A doctor or specialist you rely on may be in your network this year but out of network next year. This affects costs, convenience, and continuity of care.
Confirm:
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Your primary doctor’s status
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Your specialists’ status
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Hospital inclusion
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Access to preferred outpatient centers
It only takes a few minutes to verify this information, but it helps prevent disruptions later.
Did Your Plan Adjust Its Rules, Benefits, Or Costs For 2026?
Plans review their structure annually, which means the out-of-pocket responsibilities you have today may be different next year. These updates appear in the Annual Notice of Change, typically sent each September.
Look for changes in:
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Deductibles for medical and drug coverage
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Copayments and coinsurance for common services
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Out-of-pocket limits
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Coverage for preventive or ongoing treatments
Even when changes seem small, they may add up across a full year. Reviewing these details helps you determine whether staying with your current plan still supports your budgeting priorities.
Are You Spending More Than Expected During The Year?
Sometimes a plan meets your needs on paper, yet your overall spending rises due to frequency of care, medication adjustments, or unexpected appointments. If you feel your monthly expenses have slowly increased, reviewing alternatives may provide relief.
Consider evaluating whether a plan with different cost-sharing rules aligns better with your current usage.
Has Your Routine Changed In Ways That Affect Your Healthcare?
Your healthcare needs do not depend only on medical conditions. Lifestyle updates also matter. If you travel more now, spend part of the year in different locations, or rely on telehealth more frequently, it helps to check whether your current plan supports these habits.
Common areas to review include:
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Telehealth coverage details
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Access to urgent care
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Travel-related access adjustments
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Availability of remote support options
Your plan should support the way you live, not force you to make adjustments.
Do You Want To Compare Your Current Plan Against Other Options?
Even if you feel mostly satisfied, comparing your plan against available options once a year is practical. You might discover a plan that fits your new habits or medical needs more efficiently.
Beneficiaries who compare their options each year often find improvements in:
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Cost structures
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Prescription drug arrangements
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Provider access
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Extra supportive services
You do not have to make a change, but comparison is always worth the time.
How Much Time Should This Review Take?
An effective review does not require a full day. A structured approach usually takes between 30 and 60 minutes. Break it into clear steps:
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Review your Annual Notice of Change.
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Check your medications against next year’s formulary rules.
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Confirm your doctors and hospitals remain in network.
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Evaluate your current costs over the past year.
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Compare available plan options.
By approaching it in small pieces, the process feels easier and more organized.
What Questions Should You Ask Yourself During This Review?
Asking the right questions helps you identify whether your current plan remains aligned with your needs. These questions guide your thinking:
Are My Health Conditions Managed Efficiently With This Coverage Next Year?
If upcoming treatments or expected doctor appointments increase, your plan should support these requirements without unnecessary financial strain.
Does This Plan Support My Prescription Needs Without Added Barriers?
Double check upcoming rules for refills, approval requirements, and tiers. This prevents surprises next year.
Have Any Of My Doctors Changed Their Contracts For The New Year?
Provider network updates are common. Confirm early so you avoid finding out after January.
Are There New Restrictions I Need To Be Aware Of?
Some plans adjust coverage rules annually. Even if you stay satisfied overall, specific limits may affect your care.
Does This Plan Still Feel Like The Best Fit For My Lifestyle?
Your health and your daily routine should not feel constrained by your coverage.
Putting Your Review Into Action
Once you complete your review, you can decide whether staying in your current plan or switching to a different one makes more sense for the upcoming year. If your plan still serves your needs, confirming it gives you peace of mind. If you see opportunities for improvement, AEP gives you the space to make a thoughtful change.
You can complete these steps anytime between October 15 and December 7. Once the window closes, your decisions take effect on January 1.
Ensuring A More Confident Choice For 2026
Reevaluating your coverage even when you are mostly satisfied ensures your plan follows your healthcare needs, not the other way around. Taking time to review your options protects your comfort, clarity, and peace of mind for the year ahead. It ensures that you start 2026 in a strong position with coverage that works for you.
If you want support reviewing your options, reach out to any of the licensed agents listed on this website for personalized guidance.
