Your Medicare plan can change every year, even if you don't change anything
Many people choose Medicare coverage once and then leave it alone. That can feel simpler, especially when the coverage worked well during the year.
Still, Medicare health and drug plans can change their costs, coverage, provider networks and prescription drug lists from one year to the next. A plan that fit last year may not fit the same way next year, even when your health and prescriptions have not changed. Open Enrollment gives you a set time to review those moving parts before the new year begins.
When is Medicare Open Enrollment?
Medicare Open Enrollment runs from October 15 through December 7 each year. Changes made during this period generally take effect January 1, as long as the plan receives the enrollment request by December 7.¹
There is also a separate Medicare Advantage Open Enrollment Period from January 1 through March 31. It is only for people already enrolled in Medicare Advantage. During that period, they may make one change to another Medicare Advantage plan or return to Original Medicare, with the option to join a separate Part D drug plan. It is not a second general enrollment period for everyone.¹
What can you change during Open Enrollment?
During the October 15 through December 7 window, you may switch from Original Medicare to Medicare Advantage or move from Medicare Advantage back to Original Medicare. You may also switch Medicare Advantage plans or join, switch or drop a Part D prescription drug plan.¹
Medigap works differently. Your federal Medigap Open Enrollment Period is generally a one-time, six-month period that begins when you are 65 or older and enrolled in Part B. Outside that window, an insurer may be allowed to review your health history, charge more or deny an application unless you have a guaranteed-issue right or additional protection under state law.² Before leaving coverage, find out whether you can obtain the replacement coverage you want and when it would begin.
This is one reason a coverage change should not be treated as a simple price comparison. The rules, timing and ability to reverse the decision can be different depending on the type of coverage involved.
What should you review in your Annual Notice of Change?
If you are enrolled in a Medicare health or drug plan, the plan sends an Annual Notice of Change each fall. Medicare says the notice should arrive in September. It explains changes in coverage, costs and other plan details that will take effect in January.³
Start by comparing the notice with how you actually used coverage this year. Look at the premium, deductible, copays, coinsurance and provider network. Check whether your doctors, hospitals and pharmacies remain in network when a network applies. A familiar plan name does not mean every detail stayed the same.
Then review every prescription. Confirm that each medication is still covered, whether its formulary tier changed and whether new rules such as prior authorization, quantity limits or step therapy may apply. Also check your preferred pharmacy because the amount you pay can vary by pharmacy and plan rules.
How do Part B and Part D costs work in 2026?
For calendar year 2026, the standard Medicare Part B premium is $202.90 per month and the annual Part B deductible is $283.⁴ Some people pay more for Part B because of income-related adjustments. These are federal Part B figures, not the premium or cost-sharing terms of any individual Medicare Advantage, Medigap or prescription drug plan.
For Part D, the 2026 annual out-of-pocket threshold is $2,100 for covered prescription drugs.⁵ Once a person reaches that threshold through qualifying out-of-pocket spending, the person generally owes no additional cost sharing for covered Part D drugs for the rest of the year. Plan premiums and costs for drugs that are not covered do not count the same way, so the $2,100 figure should not be read as a cap on every prescription-related expense.
These figures apply to 2026. Medicare amounts and individual plan terms can change for a later calendar year, which is another reason to use the current Medicare materials when reviewing coverage.
Why does income from two years ago affect your premiums?
Higher-income Medicare beneficiaries may pay an Income-Related Monthly Adjustment Amount, commonly called IRMAA, in addition to their Part B and Part D premiums. Social Security generally uses modified adjusted gross income from the federal tax return two years before the premium year. For example, 2026 Medicare premiums are generally based on 2024 tax information.⁶ This two-year lookback is why the years just before Medicare deserve careful tax planning.
A Roth conversion, a large traditional IRA withdrawal or capital gains from an asset sale may increase modified adjusted gross income and may affect Medicare premiums two years later. That does not automatically make the transaction a mistake. It means the potential Medicare effect belongs in the planning discussion before the transaction is completed.
If household income later falls because of a qualifying life-changing event, Social Security may allow a person to request a new IRMAA determination.⁶ The facts and documentation matter, so do not assume the adjustment will change automatically.
How does Medicare fit with the rest of your retirement plan?
Healthcare costs compete with housing, taxes, travel and everyday spending for the same retirement income. A useful retirement plan accounts for premiums as recurring expenses and keeps a separate allowance for deductibles, copays, coinsurance, dental care, vision care and other costs that may not be fully covered.
Federal retirees have another layer to consider because FEHB and Medicare can coordinate in different ways. Whether to keep each part of coverage depends on personal circumstances, family coverage and expected healthcare use. Our information for federal employees explains how healthcare decisions connect with the broader federal retirement picture.
The same planning principle applies to anyone approaching age 65. Medicare should not sit in a separate box from Social Security timing, tax planning and retirement withdrawals. Our Medicare planning resources can help you understand where the coverage decision fits.
We don't offer Medicare plans ourselves. Plan selection is its own specialty, so we coordinate with and refer clients to licensed local and national Medicare brokers who focus on it. That lets us keep your coverage decision connected to your income, tax and Social Security planning while the plan choice stays with a specialist.
What should you do before December 7?
Use a short checklist instead of trying to compare everything from memory:
· Read your Annual Notice of Change and mark every cost or coverage change that may affect you.
· List your current prescriptions, dosages and preferred pharmacies, then verify coverage for the coming year.
· List the doctors, hospitals and other providers you want to keep, then check networks directly.
· Compare available coverage using Medicare.gov Plan Compare.
· Review recent and expected income for possible IRMAA effects, especially after a Roth conversion, IRA withdrawal or taxable asset sale.
Don't wait until the last evening if you expect to make a change. Give yourself time to verify prescriptions and providers, understand how the new coverage begins and keep confirmation of any enrollment request.
Our advisors are happy to help you see how Medicare costs fit into your retirement income plan and to connect you with a licensed Medicare broker for plan selection. Schedule a complimentary consultation.
Sources
1. Medicare.gov
2. Medicare.gov
3. Medicare.gov
4. Centers for Medicare & Medicaid Services
5. Centers for Medicare & Medicaid Services
6. Social Security Administration
This article is for educational purposes only and should not be considered individualized investment, tax or legal advice. Advisory, planning and brokerage services may differ in cost, scope, standard of care, compensation structure and conflicts of interest. Review your situation with a qualified financial professional before making decisions.