Is my Medicare coverage still the right fit this year?

Maybe. Medicare coverage can drift even when nothing changes on your end, because Medicare Advantage and Part D plans can change costs, networks, drug lists, and rules every January 1. A yearly second look is usually a short check: costs, drugs, and, for Medicare Advantage, doctors.

Revised: 8/17/26
Jason Baar
Fee-Only Medicare Advisor
NPN #2033715

Your plan can change even if you did nothing

Many people on Medicare keep the same coverage for years because it worked when they first chose it. That is understandable. The problem is that the plan does not stay still.

Medicare Advantage plans can change premium, in-network providers, drug formulary, copays, prior-authorization rules, and supplemental benefits every January 1. A formulary is the plan's covered drug list. Prior authorization means the plan requires approval before it will cover certain care or medications.

Standalone Part D drug plans can also change premium, formulary, drug tiers, and pharmacy network every January 1.

Medigap is different. Medigap is Medicare Supplement insurance used with Original Medicare. Federal law locks the benefits of each lettered plan. Plan G is Plan G, year after year. What changes is the premium, which usually creeps up with medical inflation and, in most states, age.

So the yearly review depends on what kind of coverage you have.

The September letter is the place to start

By September 30, every Medicare Advantage or Part D plan sends an Annual Notice of Change, usually called the ANOC. This letter tells you what your plan is changing for next year, including costs, benefits, covered drugs, pharmacy rules, and sometimes provider or network changes. It is dense. It is table-heavy. It can look like junk mail.

It is also usually the most useful piece of fall Medicare mail.

You do not need to read every page. For most people, the review starts with three lines.

First, check next year's premium and copays. Near the front, the ANOC usually has a this-year and next-year summary table. Look for the monthly premium, annual deductible, primary-care copay, specialist copay, and, for Medicare Advantage, the in-network out-of-pocket maximum.

Second, check the drugs you actually take. The ANOC lists formulary changes. A drug may be removed, moved to a different tier, or changed from preferred to non-preferred. A move from tier 3 to tier 4 can meaningfully change annual cost. A dropped drug means this is the year to shop.

Third, if you have Medicare Advantage, check your doctors. The ANOC points you to the plan's provider directory, but the better check is a five-minute call to each doctor's billing office. Ask: "Are you contracted with [exact plan name] for next year?" That beats an online directory.

Have your plan ID and drug names in front of you. If all three checks look fine, the review is done for the year. If one does not look fine, that is what the Annual Election Period is for.

The fall window is for changes

The Annual Election Period runs October 15 through December 7.

During that window, people on Medicare can compare Medicare Advantage and Part D options for the next year. Medicare.gov's Plan Finder does the drug-plan math across every plan in a zip code, using the medications and pharmacies entered.

This does not mean everyone should change plans. Often the answer is to stay put. The point is to make that decision with next year's numbers, not last year's memory.

If you have Medigap, the second look is shorter

For Medigap, the check is not about benefits. Every Medigap plan with the same letter is identical by federal law. Every Plan G is the same Plan G.

The check is price.

Premium spreads for identical coverage can run hundreds of dollars a year, so it can make sense to compare quotes for your current plan letter across every carrier writing that letter in your state.

The catch is underwriting. Underwriting means the insurance company reads your health history before deciding whether to issue the policy, what to charge, or whether to exclude conditions. Outside a protected window, switching Medigap carriers usually means underwriting.

The safe sequence matters. Apply for the new policy first. Wait until it is issued with an effective date in hand. Then, and only then, cancel the old policy, timed so there is no gap.

Never cancel first. A denied application after cancellation can leave no clean way back. A no from one carrier is not a no from every carrier, but if the answer is no across the board, keeping the more expensive current policy beats losing coverage.

A few recent rules may affect an old choice

If your current plan choice predates 2025, a few things have changed.

Part D out-of-pocket costs now cap at $2,100 per year on covered drugs. Once you hit that cap, covered drugs cost $0 for the rest of the calendar year. The old donut hole and the old 5%-forever catastrophic phase are gone.

Every drug plan must now offer the Medicare Prescription Payment Plan. It is free and optional. It spreads pharmacy bills into monthly payments, with the same annual total. You opt in through the plan directly, not at the pharmacy.

IRMAA, Medicare's income surcharge, also changed. The first 2026 tier starts above $109,000 single or $218,000 joint. A return to work, a big capital-gains year, or a Roth conversion can push a household into a tier.

January has one escape hatch for Medicare Advantage

If you are on a Medicare Advantage plan on January 1, there is a separate Medicare Advantage Open Enrollment Period from January 1 through March 31.

You get one election. You can switch Medicare Advantage plans, or you can return to Original Medicare with a standalone Part D plan.

The Medigap piece is separate. Leaving Medicare Advantage in this window does not automatically guarantee a Medigap policy without underwriting. That depends on whether a protected window applies.

Carriers have no marketing incentive to advertise this period, but it exists for people who find a January surprise after the new plan year starts.

The yearly rhythm

Keep the ANOC when it arrives around September 30.

Read the three lines in mid-October: costs, drugs, and, for Medicare Advantage, doctors.

Use October 15 through December 7 if something needs to change.

If you have Medigap, compare fresh quotes on your same plan letter every couple of years.

If you have Medicare Advantage and January brings a surprise, January 1 through March 31 may give you one chance to fix it.

For more plain-English Medicare PDFs, visit the Free Medicare Guides library.