As November arrives, many people are preparing for the holidays and looking ahead to a new year. It is also an important time to review healthcare coverage. The Annual Enrollment Period (AEP), which runs from October 15 through December 7 each year, gives eligible individuals an opportunity to review their current coverage and make certain changes for the upcoming year.
While it may be tempting to keep the same coverage year after year, a plan that worked well in the past may not meet your needs in the same way moving forward. Plan benefits, costs, provider networks, and prescription drug coverage can change from one year to the next. Reviewing these details before the enrollment deadline can help you understand your options and make informed decisions about your healthcare.
What Is the Annual Enrollment Period?
The Annual Enrollment Period is the yearly period when people with eligible coverage can make specific changes to their healthcare plans. The AEP period runs from October 15 through December 7, and changes made during this time generally take effect on January 1 of the following year, provided the plan receives the enrollment request by December 7.
During this period, eligible individuals can make several types of changes, including:
Joining, switching, or dropping a Medicare Advantage plan.
Switching between Original Medicare and a Medicare Advantage plan.
Joining, switching, or dropping a prescription drug plan if eligible.
Adding or dropping prescription drug coverage where permitted.
The options available to you depend on your current coverage and the type of change you want to make. It is important to understand how a potential change may affect your healthcare benefits before enrolling in a different plan.
The December 7 deadline is especially important because the Annual Enrollment Period does not remain open indefinitely. Waiting until the last few days may leave less time to compare options, verify provider participation, and review prescription costs.
Source: Medicare.gov — Open Enrollment.
Why Review Your Coverage Every Year?
Healthcare needs and plan details can change over time. Reviewing your coverage annually gives you an opportunity to determine whether your current plan still aligns with your medical needs, prescription medications, preferred providers, and budget.
Even if you have been satisfied with your coverage, it is important not to assume that every benefit or cost will remain the same in the coming year. Plans may adjust premiums, deductibles, copayments, covered services, and other terms.
Your own circumstances may change as well. You might begin taking a new prescription, develop a need for a specialist, move to a different area, or anticipate more frequent medical appointments.
An annual review helps you consider both sides of the equation: what your plan offers and what you expect to need from it.
1. Review Your Plan's Costs
One of the most important parts of reviewing healthcare coverage is understanding the total cost of using the plan.
Monthly premiums are only one part of the picture. Depending on the type of coverage, you may also have deductibles, copayments, coinsurance, and other out-of-pocket expenses. These amounts can vary by plan and may change for the upcoming year.
For example, a plan with a lower monthly premium may have higher costs for certain services or prescriptions. Another plan may charge a higher premium but provide different cost-sharing arrangements for the care you use most often.
When reviewing your options, consider:
Monthly premiums: How much will you pay to maintain your coverage?
Deductibles: How much may you need to pay before certain benefits begin covering costs?
Copayments and coinsurance: What portion of medical services or prescriptions will you be responsible for paying?
Out-of-pocket limits: If your plan includes a limit, what expenses count toward it, and what is the limit for the upcoming year?
Additional costs: Are there services, treatments, or medications that may result in expenses not covered by your plan?
It is also important to distinguish between the costs covered by different types of plans. Original Medicare and Medicare Advantage plans do not have identical cost-sharing rules. Reviewing the specific terms of your coverage is essential to understanding your potential expenses.
Source: Medicare.gov — Understanding Health Plan Costs.
2. Check Your Doctors, Hospitals, and Provider Networks
Having access to your preferred healthcare providers can be an important consideration when selecting coverage.
Provider networks vary by plan. Some plans generally require members to use doctors, hospitals, and other providers within a network for non-emergency care. Other plans may offer out-of-network coverage under certain conditions, sometimes at a higher cost.
Before selecting coverage for the upcoming year, verify that your primary care physician, specialists, and preferred hospitals participate in the plan you are considering.
Do not rely solely on the fact that a provider accepted your coverage last year. Network participation can change, and a provider may participate in one plan but not another offered by the same insurance company.
If you regularly see a specialist or receive care at a particular hospital, confirm that the provider and facility are covered under the specific plan you are reviewing. It is also helpful to ask about referral requirements and whether prior authorization may be needed for certain services.
Taking time to check these details can help reduce the possibility of unexpected expenses or disruptions in care.
Source: Medicare.gov — Compare Original Medicare and Medicare Advantage.
3. Review Prescription Drug Coverage
Prescription medications are another important part of an annual healthcare review. The plan that covered your medications at an acceptable cost this year may not provide the same coverage or pricing next year.
Prescription drug plans can differ in their formularies, which are lists of covered medications. They may also have different deductibles, copayments, coinsurance amounts, and preferred pharmacies.
When reviewing prescription coverage, make a current list of the medications you take, including their dosages. Then check how each medication is covered under the plans you are considering.
Pay attention to the following details:
Whether each medication is included on the plan's formulary.
The cost of each prescription under the upcoming year's benefits.
Whether your preferred pharmacy is in the plan's network.
Whether a medication has coverage restrictions, such as prior authorization or step therapy.
Whether mail-order options are available and how their costs compare.
If you take several medications, comparing these details may be especially valuable. A difference in the cost of one prescription may seem small, but the combined cost of several medications over an entire year can add up.
Remember that prescription drug coverage is not identical across all healthcare plans. Some plans include it as part of their benefits, while people with Original Medicare generally obtain it through a separate prescription drug plan if they choose to enroll.
Source: Medicare.gov — Choose How to Get Drug Coverage.
4. Understand Changes to Your Plan's Benefits
Healthcare plans may update their benefits and coverage rules each year. These changes can affect how much you pay, which services are covered, and how you access care.
Before making a decision, review your plan's information for the upcoming year. Pay particular attention to changes involving deductibles, copayments, covered services, provider networks, and prescription drug benefits.
You should also review any additional benefits offered by your plan and understand their eligibility requirements, limitations, and coverage rules. Benefits that are available under one plan are not necessarily included in another.
A plan comparison should consider the full range of coverage that matters to you, rather than focusing on one advertised benefit or a single cost.
The Annual Enrollment Period is an opportunity to review these details and determine whether your existing coverage continues to fit your circumstances.
5. Compare Your Options Carefully
Reviewing your current plan is important, but understanding how it compares with other available options can provide additional perspective.
Start by identifying what matters most to you. This may include access to specific doctors, prescription costs, predictable medical expenses, flexibility when seeking care, or coverage for particular healthcare services.
Next, compare plans using the same criteria. Review their official benefit information, provider networks, drug coverage, premiums, and cost-sharing requirements.
If you are considering a change from Original Medicare to a Medicare Advantage plan, or the reverse, make sure you understand how the two arrangements differ. Original Medicare generally allows you to visit any doctor or hospital in the United States that accepts Medicare, while Medicare Advantage plans may have provider networks and different rules for accessing non-emergency care.
If you are considering returning to Original Medicare, you should also review your prescription drug coverage needs and whether you want supplemental coverage. The rules for obtaining Medicare Supplement Insurance, also known as Medigap, can vary depending on your circumstances and timing. Do not assume that you can purchase or return to a particular supplemental policy at any time without restrictions.
The goal is not simply to find a different plan. It is to understand the available options and select coverage that aligns with your healthcare needs and financial circumstances.
Source: Medicare.gov — Compare Coverage Options.
A November Checklist for Reviewing Your Coverage
As you review your healthcare options, use the following checklist to organize the process:
Gather your current plan information and the documents outlining next year's benefits.
Make a list of your doctors, specialists, and preferred hospitals.
Review your current prescription medications and dosages.
Compare premiums, deductibles, copayments, coinsurance, and applicable out-of-pocket limits.
Confirm provider network participation and pharmacy arrangements.
Review changes to covered services and prescription drug benefits.
Compare available options based on your healthcare needs and expected expenses.
Complete any enrollment changes by December 7, if you decide a change is appropriate.
You can use the official Medicare.gov plan comparison tool to research available plans and review coverage information. The website also provides educational resources to help explain enrollment rules and coverage options.
Looking Ahead to the New Year
The Annual Enrollment Period is an important opportunity to review healthcare coverage before the next calendar year begins. With the December 7 deadline approaching, November is a practical time to examine your existing benefits, identify potential changes, and compare the options available to you.
Taking a closer look at costs, provider networks, prescription medications, and plan benefits can help you make a more informed decision about your coverage for the upcoming year.
Even if you ultimately decide to keep your current plan, reviewing its updated terms can help you understand what to expect when January arrives. Healthcare coverage is an important part of preparing for retirement, and making time for an annual review can help you plan more confidently for the year ahead.
Important reminder: The Annual Enrollment Period generally runs from October 15 through December 7. Review your available options and complete any desired enrollment changes before the applicable deadline. For official information about eligibility, enrollment periods, and plan options, visit Medicare.gov.
Sound Retirement Solutions provides educational information to help individuals understand their healthcare options. This article is for educational purposes only and does not recommend a specific plan. Sound Retirement Solutions is not affiliated with Medicare or the U.S. government.
