What to Review During Medicare Annual Enrollment

Medicare coverage can change from one year to the next, and so can your healthcare needs. During Medicare Open Enrollment, which runs from October 15 through December 7, eligible beneficiaries can review their Medicare health and drug coverage and make certain changes. The most important things to check are your doctors, prescriptions, pharmacy, premiums, deductibles, provider rules, and benefits. Reviewing these details before December 7 can help you avoid surprises in the coming year.

TL;DR: What Should You Check?

Before you decide to keep or change your coverage, take a close look at these seven areas:

You may decide to stay with your current coverage after reviewing everything. That's okay. The point is to make that choice with the latest information in front of you.

Why a Yearly Medicare Review Matters

It is easy to think of Medicare enrollment as a one-time task.

Pick a plan. Get your card. Move on.

Real life doesn't work that way.

Your doctor may retire. You may start taking a new medication. Your pharmacy may change. Your healthcare spending may look very different from last year. At the same time, your plan can change its costs, benefits, covered drugs, or provider arrangements.

Medicare itself encourages beneficiaries to review their coverage each year because plan costs, benefits, and providers can change.

That is why Medicare Open Enrollment is worth paying attention to.

It gives you a set period to step back and ask:

"Does my current coverage still make sense for me?"

1. Start With the Plan's Cost Changes

Don't look at only one number.

A premium can go up. A deductible can change. Copayments can change too.

When reviewing your coverage, look at the complete cost picture.

Check these numbers

• Monthly premium
• Deductible
• Copayments
• Coinsurance
• Prescription costs
• Other regular healthcare expenses

For prescription coverage, CMS has set the defined-standard Medicare Part D deductible at $700 for 2027, up from $615 in 2026. Some plans may have lower deductibles or no deductible.

The point isn't to find the plan with the smallest number on the page.

Think about how you actually use healthcare.

A plan with a higher premium could still work better for someone who uses more medical services. Another person may have different priorities.

2. Check Your Doctors Before You Change Anything

Your doctor may be one of the biggest reasons you chose your current coverage in the first place.

So check again.

Don't assume that because your physician was available last year, nothing has changed.

Medicare recommends checking whether your doctors and pharmacies are in a plan's network when comparing coverage.

Make a short list

Write down:

• Primary care doctor
• Specialists
• Preferred hospital
• Clinics you visit regularly

Then check the new plan's provider information.

This matters especially when reviewing Medicare Advantage coverage because provider networks and plan rules can affect where and how you receive care.

If keeping a particular doctor is important to you, put that near the top of your review list.

3. Go Through Your Prescription List

This is one of the easiest things to postpone.

Don't.

Take the bottles from your medicine cabinet, or use your current medication list, and check every prescription.

Medicare drug plans maintain formularies, which are lists of covered medications. Plans can also have different rules and cost-sharing for covered drugs.

Check each medication for:

• Coverage
• Drug tier
• Cost
• Quantity limits
• Prior authorization requirements
• Pharmacy availability

Your prescription list may have changed since last year, so don't rely on memory.

One new medication could make a major difference in your annual drug costs.

4. Look at Your Pharmacy

Here's another detail people often overlook.

Your preferred pharmacy may not be the only place you can fill a prescription, but the pharmacy you choose can affect what you pay.

Medicare specifically recommends checking whether your pharmacies are part of a plan's network when comparing plans.

Ask:

Is my pharmacy still in the network?

Is it a preferred pharmacy under this plan?

Would another nearby pharmacy cost less?

Don't wait until January to find out.

5. Read the Changes to Your Benefits

A plan can keep the same name while some of its details change.

That's why looking only at the plan name isn't enough.

Check the information your plan sends about the coming year and look for changes to:

• Covered services
• Copayments
• Deductibles
• Provider networks
• Prescription coverage
• Extra benefits
• Coverage rules

Your plan documents are more useful than assumptions based on what the plan offered last year.

If something matters to you, confirm that it is still included.

6. Check the Benefits You Actually Use

Many Medicare Advantage plans may include benefits beyond the basic medical coverage, depending on the plan.

You might have access to dental, vision, hearing, fitness, or other benefits.

But here's the question worth asking:

Do I actually use them?

A long list of extras can look impressive. That doesn't automatically mean the plan is a good fit for your situation.

Maybe your dental benefit matters a lot.

Maybe it doesn't matter at all.

Maybe keeping your current specialist is much more important.

Rank the things that matter to you instead of judging a plan by the number of benefits listed in a brochure.

7. Review Your Provider and Referral Rules

Not all Medicare coverage handles providers the same way.

Some Medicare Advantage plans may have network restrictions or referral requirements. Others may give you more flexibility.

Medicare recommends checking how a plan handles doctors, hospitals, pharmacies, and referrals before joining.

Ask yourself:

• Do I need referrals to see specialists?
• Can I use an out-of-network provider?
• What will I pay if I do?
• Which hospitals are available?
• Are there nearby specialists for the care I may need?

These details can have a bigger effect on your day-to-day healthcare experience than a flashy plan benefit.

8. Think About What Changed in Your Life

This part is about you, not the brochure.

Maybe you moved.

Maybe you retired.

Maybe your health changed.

Maybe you started seeing a specialist.

Maybe you're taking five prescriptions instead of two.

Maybe you're helping a spouse or parent with healthcare.

Those changes matter.

Your coverage should be reviewed against your current situation, not the person you were when you first enrolled.

Your Personal Review List

Ask:

Health: Has anything changed?

Doctors: Am I seeing someone new?

Medication: Am I taking different prescriptions?

Location: Am I living somewhere different?

Budget: Has my healthcare spending changed?

Lifestyle: Am I traveling more?

These questions can reveal gaps that a standard plan comparison might miss.

9. Understand What You Can Change During Open Enrollment

Medicare Open Enrollment runs from October 15 through December 7 each year. During this period, eligible beneficiaries can make certain changes to Medicare health and drug coverage.

Depending on your current coverage, you may be able to:

• Join a Medicare Advantage plan
• Switch Medicare Advantage plans
• Drop Medicare Advantage and return to Original Medicare
• Join, switch, or drop a Medicare drug plan

Medicare says changes made during Open Enrollment take effect January 1 of the following year when the plan receives the enrollment request by December 7.

That makes the deadline important.

Don't make December 7 your research day.

Make it your decision deadline.

10. Don't Ignore Other Health Coverage

Some people have other insurance in addition to Medicare.

That could include employer or union coverage, retiree coverage, or other health insurance.

Before making a change, check how the other coverage works with Medicare.

The 2026 Medicare & You handbook specifically advises people with employer or union coverage to contact their benefits administrator before making changes or signing up for other coverage.

A quick conversation before changing coverage can prevent an expensive misunderstanding.

What Should You Do Before December 7?

Here's a simple timeline.

A Few Weeks Before Open Enrollment

Gather your plan information, medication list, provider names, and recent healthcare costs.

During October

Start comparing the changes for the coming year.

During November

Check doctors, prescriptions, pharmacies, costs, and benefits carefully.

Before December 7

Make your decision and complete any enrollment change that applies to you.

Medicare recommends comparing plans in your area and entering the prescriptions you take when using its plan comparison tools.

The One-Page Medicare Review

You don't need a complicated spreadsheet.

A simple page can be enough.

If everything still looks good, you may keep your current coverage.

If something stands out, investigate it before making a change.

What If You Don't Want to Change Plans?

You don't have to change just because Open Enrollment arrives.

Medicare's annual review is about understanding your choices.

If you've compared your coverage, checked the changes, and you're happy with what you have, your coverage can continue. Medicare's yearly review guidance specifically notes that you don't need to make a change simply because Open Enrollment is here.

Sometimes staying is the right decision.

The important thing is knowing why.

Don't Let "It Was Fine Last Year" Make the Decision

That may be the biggest mistake of all.

Last year's plan was based on last year's doctors, prescriptions, costs, and priorities.

This year's decision should be based on this year's reality.

You don't need to switch.

You don't need to stay.

You need to check.

Conclusion

Knowing what to review during Medicare Annual Enrollment can turn a confusing yearly task into a simple health coverage checkup. Start with your doctors, prescriptions, pharmacy, plan costs, benefits, provider rules, and any changes in your own life. Then compare the latest information before Medicare Open Enrollment closes on December 7.

The goal isn't to chase a new plan every year.

It's to avoid going into January with a plan that changed while you weren't looking.

Take an hour.

Ask the questions.

Read the changes.

Then decide.

Want Someone to Review the Details With You?

Start With Clarity65

Sometimes the hardest part isn't finding Medicare information. It's figuring out which parts actually matter to you.

Clarity65 works with independent licensed agents who review plan options with consumers, explain the differences in plain English, and look at factors such as doctors, prescriptions, location, and costs. The company also offers annual plan reviews because Medicare decisions don't end the day you enroll. These services are part of Clarity65's current operating model, as reflected on its homepage and About page.

You may look over everything and decide to keep your current coverage.

You may find that something has changed.

Either way, getting the facts before the deadline is a lot better than discovering an important change after January 1.

Frequently Asked Questions

Raul Gonzalez

Licensed Agent

Independent licensed Medicare advisor dedicated to plain-English guidance and personalized plan comparisons across leading national carriers.

Clarity65 is not connected with or endorsed by the U.S. government or the federal Medicare program.