Medicare open enrollment: what to check and what to ask

That last part is the reason to spend an hour on this. Plans change every year. A drug that cost $10 this year can cost $90 next year. A doctor who was in your network can leave it. Many people never check, and find out in January at the pharmacy counter.

Here is what to look at, the questions to ask, and where to get free help.

2027 at a glance

What's different this year

A few changes make 2027 a year worth checking closely.

Stand-alone drug plan premiums are shifting. A temporary federal program that held down premiums for stand-alone drug plans, the kind you add to Original Medicare, ends after 2026. The average premium barely moves, but some people will pay $50 or more a month extra if they keep the same plan, according to an analysis by KFF. For 2027, there are no $0-premium stand-alone drug plans for people who don't get Extra Help.

There are fewer plans to choose from. The average person with Medicare can pick from 9 stand-alone drug plans in 2027, down from 11, and 35 Medicare Advantage plans, down from 39, according to KFF.

Some plans are ending. If your plan won't be offered in 2027, you should have gotten a letter explaining your options. Read it closely. You have the right to choose a different plan.

Most Medicare Advantage premiums are holding steady. Medicare estimates that about 8 in 10 Medicare Advantage members can keep their plan for the same or a lower premium. The premium is one part of what you pay, so check the rest too.

Gather three things first

1. Your Annual Notice of Change. Your plan had to mail it by September 30. It lists everything changing on January 1. If you can't find it, call the number on your member card and ask for another copy.
2. Your medication list, with doses. Every prescription you take. When you compare drug plans, the dose matters as much as the name.
3. A list of your doctors, hospitals, and pharmacy. Include specialists you see even once or twice a year.

What to check

Your drugs

Look up each one in the plan's 2027 drug list, called the formulary. Check three things. Is it still covered? What tier is it on? Does it now need prior authorization or step therapy?

Your doctors and hospitals

If you have Medicare Advantage, check that each doctor and hospital is in the plan's network for 2027. Plan directories are often out of date, so call the doctor's office and ask directly.

Your pharmacy

Make sure your pharmacy is in network for 2027. Some plans charge less at pharmacies they call "preferred."

Your total cost for the year

Add up the premium, the deductible, and what you'd pay for your actual drugs and visits. The plan with the lowest premium often costs more over a full year once you count copays. Medicare's Plan Finder does this math for your drugs when you enter your list.

The extras you actually use

Dental, vision, hearing, and fitness benefits change often. If you rely on one, check what it covers in 2027 and whether there is a yearly dollar limit.

Rules about getting care

Check whether you'll need a referral to see a specialist, and which services need prior authorization.

Time away from home

If you spend part of the year in another state, check how the plan covers care there.

Questions to ask before you switch

Write down every answer, along with the name of the person you talked to and the date.

To your doctor's office

• Will you be in network with this plan in 2027?
• Do you accept Original Medicare?
• Are you planning to leave any plan networks next year?

To your pharmacy

• Will you be in network with this plan in 2027?
• Are you a preferred pharmacy for it?

To the plan

• Is each of my drugs on your 2027 formulary? On what tier, and with any limits?
• What would I pay in total for my drugs next year?
• What is the most I could pay out of pocket for medical care in a year?
• Do I need referrals to see specialists?
• Which of my regular services need prior authorization?

To yourself

• Did my health change this year, or might it next year? A planned surgery or a new diagnosis can change which plan makes sense.
• Did I have trouble getting care this year, like denials, long waits, or a doctor I couldn't see?
• Am I paying for extras I never use?

Medicare Advantage or Original Medicare: what to know before switching

During open enrollment you can switch in either direction. The two work differently.

Original Medicare lets you see any doctor in the country who accepts Medicare, and very few services need prior authorization. It has no yearly limit on what you pay out of pocket, so many people add a Medigap policy to cover that gap and a Part D plan for drugs.

Medicare Advantage plans are run by private insurance companies. Most use networks, most require prior authorization for some services, and every plan has a yearly limit on out-of-pocket costs for medical care. Many include extras like dental or vision.

The part most people miss: Medigap can be hard to get back

Switching from Medicare Advantage to Original Medicare during open enrollment is simple. Buying a Medigap policy to go with it may be harder. In most states, outside a few protected situations, Medigap insurers can turn you down or charge you more because of your health. Only four states, Connecticut, Maine, Massachusetts, and New York, guarantee broader access for people 65 and older.

There are exceptions. If you joined Medicare Advantage for the first time within the past 12 months, or you dropped a Medigap policy to try Medicare Advantage within the past 12 months, you generally have a right to buy Medigap. Ask your state's SHIP counselor about your situation before you switch.

Two more things to check before leaving Medicare Advantage

• Retiree benefits. If your former employer's retiree coverage comes through a Medicare Advantage plan, leaving it may mean losing those benefits for good.
• Drug coverage. Original Medicare doesn't include drug coverage. If you go without it and don't have other coverage that counts, you can owe a late penalty when you sign up later.

Help paying for it

Extra Help lowers what you pay for drug coverage. If your income and savings are limited, apply through Social Security at ssa.gov/extrahelp.

Medicare Savings Programs can help pay your Part B premium and other costs. You apply through your state's Medicaid office.

The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments. The total stays the same. It can help if large costs early in the year are hard to manage. Ask your drug plan about it.

Where to get free, unbiased help

Your State Health Insurance Assistance Program (SHIP). Free, one-on-one counseling from trained counselors who don't sell insurance. Find yours at shiphelp.org or call 877-839-2675. Appointments fill up in November, so call early.

Medicare. Call 1-800-MEDICARE (1-800-633-4227), or use the Plan Finder at medicare.gov/plan-compare to compare plans side by side using your own drug list.

A note on agents and brokers. Licensed agents can be helpful, and they're usually paid by insurance companies. Some get paid more for certain kinds of plans. Ask which plans they represent and how they're paid.

Watch for scams

Fraud picks up during open enrollment. A few rules straight from Medicare:

• Medicare will never call you to sell you anything or come to your home.
• Don't give your Medicare number to anyone who calls you, unless you called them first.
• Don't join a plan over the phone unless you made the call.
• Mailers and TV ads that look official often come from insurers or sales companies. The official sources are Medicare.gov and 1-800-MEDICARE.

To report a suspected scam, call 1-800-MEDICARE. If you're in a Medicare Advantage or drug plan, you can also call 1-877-7SAFERX (1-877-772-3379).

If you're helping a parent

Open enrollment is one of the most common times adult children step in.

• Get permission on file first. Medicare and the plan usually won't discuss your parent's coverage with you without their written OK. Medicare has its own authorization form for this.
• Sit down together with the Annual Notice of Change, the medication list, and the doctor list.
• Make calls together when you phone the plan or a SHIP counselor, so your parent can give permission on the spot.
• Keep it their decision. Your job is to help them see the options clearly.

A simple timeline

In most cases, joining a new plan ends your old one automatically. If you're leaving Medicare Advantage for Original Medicare, ask Medicare or your SHIP counselor exactly which steps to take.