Key Takeaways
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Your out-of-pocket costs from last year can reveal patterns, trends, and coverage gaps that help you make far more confident choices during the Annual Enrollment Period (AEP).
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Reviewing these expenses in a structured way can guide you toward a plan that matches your medical needs, routine care, and medication usage for 2026.
Looking Back At Your Costs To Make Better Decisions
Every year, the Annual Enrollment Period runs from October 15 to December 7. During this time, you can review your current Medicare coverage and make changes for the upcoming year. A strong way to approach this process is by looking closely at your out-of-pocket spending from last year. These numbers show how well your current plan supported your needs and whether a different option may serve you better.
This comparison allows you to understand what changed, what stayed the same, and what might need improvement. When you use your real expenses as a guide, you remove guessing and replace it with clear information that helps you make better decisions.
Why Past Spending Matters More Than You Think
Past out-of-pocket spending helps you see your coverage in action. Premiums, deductibles, copayments, coinsurance, and pharmacy costs all work together over the year. Seeing how those numbers added up gives you a direct sense of how comfortable or stressful your healthcare costs felt.
Looking back at your recent experience also prepares you to handle any adjustments that appear in your plan’s Annual Notice of Change (ANOC). This is especially important because plan formulas, drug tiers, covered services, and cost structures often change each year.
What Should You Review First From Last Year’s Expenses?
How Much Did You Spend On Routine Care?
Start by listing the cost of any regular medical visits. This can include:
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Primary care appointments
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Specialist visits
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Preventive screenings
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Diagnostic tests
Look at how often you received care and how much you paid each time. If your costs grew larger than expected or if you anticipate needing more appointments next year, this is a signal to consider plan options that support higher care usage.
Were Your Prescription Costs Higher Than Expected?
Medication usage is often one of the biggest sources of yearly spending. Review:
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Monthly copayments
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Coinsurance percentages
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Medication tiers
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Any times you reached higher cost phases
If your drug list changed or your medication needs increased over the year, your past spending can guide you toward a plan that better supports your current prescriptions.
Did You Reach Your Deductible Early Or Not At All?
Deductibles affect how soon your plan begins to share costs with you. If you reached your deductible early last year, you may want a structure that supports higher yearly expenses. If you never reached it, you may prefer a plan with a lower monthly cost paired with a deductible that matches your usage.
Were There Any Unexpected Bills?
Unexpected bills often happen because of:
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Out-of-network providers
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Services requiring prior authorization
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Changes in covered services
If you experienced any surprise costs, review the details to see how a different plan structure might help you avoid them.
How Your Spending Patterns Reveal What You Actually Need
What Types Of Care Did You Use Most Often?
Look at how your care habits compare with your plan’s coverage structure. For example:
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Frequent specialist visits may require a plan with lower specialist copayments.
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Multiple diagnostic tests may signal the need for predictability in cost-sharing.
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A high number of medications may require strong drug coverage.
Using this information helps you decide which type of plan supports your patterns, not just your expectations.
Did Your Health Needs Change Over The Year?
Even small changes in your health can shift your ideal coverage. If your doctor recommended ongoing treatments, monitoring, or new medications, review whether your current plan aligns with these needs.
Did You Delay Care Because Of Cost?
If high costs discouraged you from scheduling appointments, switching plans may help reduce barriers to routine care.
Comparing Last Year’s Spending With The Plan Changes For 2026
AEP allows you to adjust your coverage before the new year begins. To make the most informed decision, compare your last year’s spending with what the 2026 plan changes include. Review your ANOC letter carefully to check for adjustments in:
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Cost-sharing for common services
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Deductible amounts
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Copayments for specialists
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Pharmacy tiers and coverage rules
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Network changes
You want to see whether any increased costs may affect you based on your historic spending.
How To Use Your Expense Review To Narrow Down Options
Which Costs Impacted You The Most?
Identify the areas where your costs felt the highest or most uncomfortable. These become your top priority when comparing plan options.
Does The New Year Bring Predictable Or Unpredictable Needs?
If you expect consistent care, you may want a plan with steady cost-sharing. If your needs change often, a plan with more coverage flexibility may be beneficial.
What Are The Most Important Cost Areas To Compare?
Focus on the areas that directly affected you last year:
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Deductibles
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Copayments for regular visits
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Coinsurance for ongoing treatments
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Pharmacy coverage and medication tiers
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Out-of-pocket maximums
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Network strength and availability
When you compare these areas across plans, you can align your choice with your actual healthcare patterns.
How To Organize Your Past Costs For AEP Review
A structured approach can make your comparison easier. You can organize last year’s spending into four groups:
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Routine care
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Specialist care
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Prescription drugs
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Unexpected or one-time medical needs
This breakdown helps you see which category took the largest portion of your spending, making it easier to focus your attention during AEP.
How Upcoming 2026 Coverage Rules May Affect Your Analysis
While your previous expenses give you strong guidance, AEP also brings updates that may influence your choice. Plan costs, cost-sharing levels, and covered services may shift. This is why comparing your historic expenses to new plan documents is an effective strategy.
When reviewing your options for 2026, always consider whether the plan structure matches what you actually used this past year. That comparison provides a dependable foundation for making your decision.
Pulling Everything Together For A Stronger AEP Decision
Looking at your spending gives you real measurements of how your plan performed. Using this information during AEP can help you avoid unexpected bills, reduce unnecessary costs, and find a plan that supports your medical needs for the entire year.
Strengthening Your Choices This AEP
Reviewing your out-of-pocket expenses from last year helps you make decisions based on real patterns instead of guesswork. When you compare those costs with the upcoming 2026 plan changes, you set yourself up for a stronger and more confident AEP experience.
If you are unsure which direction to take, consider reaching out to any of the licensed agents listed on this website. They can help you understand your options and talk through the details that matter most to your personal healthcare needs.
