Fall is a time when many people choose their health insurance coverage for the coming year, and Medicare is no exception. From October 15 to December 7, people enrolled in Medicare can choose to keep their current coverage or switch. Options include switching from Original Medicare to Medicare Advantage (MA) or vice versa, choosing a new stand-alone Part D prescription drug plan, or choosing a different MA plan with or without Part D coverage.
Fall Open Enrollment Guide
Choosing coverage can be intimidating and complicated. Medicare Rights offers your Medicare Open Enrollment Guide to help you make a successful decision by detailing the options available to you during open enrollment, the timeline, and questions to ask before enrolling. This resource is available for free through Medicare Interactive, our online education platform (registration required).
Comparing options is crucial
Each year, we urge people on Medicare to evaluate whether their current coverage is working for them and compare it to other options. Financial and health situations change every year, and so do health plans.
Does Original Medicare meet your needs?
People with original Medicare should check the 2026 Medical insurance and you manual. All Medicare families should receive this booklet in late September, but you can also download it from Medicare.gov. People who call 1-800-MEDICARE (1-800-633-4227) can also request a copy. This brochure explains what Original Medicare will cover for the upcoming year.
Reminder: For those who have Original Medicare and Medigap and are considering an MA plan, switching to an MA plan may make it difficult or impossible to re-enroll in Medigap. Check with your local State Health Insurance Assistance Program (SHIP) to learn about your state's regulations.
Switching to an MA plan may make it difficult or impossible to rejoin Medigap.
Does your MA or Part D plan meet your needs?
If you have an MA or stand-alone Part D plan, you should carefully read any Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). You should receive these documents in late September, either in hard copy or via email.
The ANOC or EOC identifies planned changes for 2026:
- Benefits and Coverage Rules
- cost
- Formulary (list of covered drugs) and coverage limitations
- network changes
If you want to keep your medical provider, make sure your doctor and/or pharmacy remains in the plan's network. It can be helpful to double check with the provider to make sure they accept the plan, or with the plan to make sure they have a contract with the provider.
Need to switch?
If you need or want to switch to a new plan, the questions are much the same.
For MA plans, make sure your provider is in network and compare costs, coverage, and benefits.
For a Part D plan, whether stand-alone or part of an MA plan, you should check the formulary to make sure your prescriptions are covered and check to see if your preferred pharmacy is a preferred pharmacy as well as an in-network pharmacy.
Where to go for help
Your local State Health Insurance Assistance Program (SHIP) provides one-on-one, impartial Medicare assistance. There are 54 ships (one for each of the 50 states, Puerto Rico, Guam, the District of Columbia, and the U.S. Virgin Islands).
Visit www.shiphelp.org and click the orange “Find Local Medicare Help” button in the upper right corner to contact your SHIP.
You can also access Medicare directly through the Medicare Plan Finder or by calling 1-800-MEDICARE.
Medicare Rights can provide additional assistance to answer your questions and resolve issues you may have during open enrollment. Please call our national helpline at 800-333-4114.
