If you have Medicare, or you’re helping a parent, spouse, or loved one make coverage decisions, mark your calendar: Medicare Annual Open Enrollment runs from October 15 through December 7.
During this window, people with Medicare can review and change their Medicare Advantage or Part D prescription drug coverage for the upcoming year. Changes made during this period generally take effect January 1, 2027.
The important thing to remember is that Medicare plans can change every year. Premiums, deductibles, copays, provider networks, covered prescriptions, and extra benefits may all look different from one year to the next, even if you have been happy with your current plan.
That is why it is worth taking a fresh look before December 7. Here are five plain-English questions to ask before choosing your coverage.
1. Do my doctors and prescriptions still match the plan?
A plan may look affordable until you discover that your preferred doctor is no longer in the network, or that one of your prescriptions moved to a higher-cost tier.
Before renewing or changing coverage, make a list of:
- Your primary care doctor
- Specialists you see regularly
- Preferred hospitals and pharmacies
- Every prescription you take
- The dosage and frequency of each medication
Then check whether your doctors and facilities are in the plan’s network. If you are considering a Medicare Advantage plan, this is especially important because many plans use specific networks and service areas.
You will also want to check the plan’s formulary, which is the list of medications it covers. Look for:
- Whether each prescription is covered
- Which tier each medication falls into
- Whether you need prior authorization
- Whether you must try another medication first
- Whether mail-order or preferred pharmacies offer a lower cost
Medicare provides an official Plan Compare tool to help you review available options. Still, plan websites and formularies can be difficult to interpret. A careful side-by-side review can help you avoid surprises after January 1.
2. What will this plan actually cost me all year?
It is easy to focus on the monthly premium. But the premium is only one part of your total healthcare spending.
When comparing plans, look at the complete picture:
- Monthly premium
- Annual medical deductible
- Prescription drug deductible
- Primary care and specialist copays
- Hospital costs
- Prescription copays or coinsurance
- Out-of-pocket maximum
- Costs for out-of-network care
- Extra benefits that may have restrictions or limits
A plan with a low or $0 monthly premium may still cost more if you regularly visit specialists, take several medications, or need frequent medical care. On the other hand, a plan with a higher premium could be a better fit if it reduces your costs when you use healthcare services.
Try to estimate your likely total annual cost, not just what will come out of your bank account each month. Think about your typical appointments, prescriptions, and healthcare needs from the past year. Then consider whether anything may change in the year ahead.
It is also important to understand the difference between Original Medicare and Medicare Advantage costs. Original Medicare generally involves Part A and Part B costs, and many people add a Medicare supplement policy and a separate Part D plan. Medicare Advantage plans combine Medicare coverage through a private plan and may include prescription coverage, but you will pay according to that plan’s cost structure.
There is no single “best” setup for everyone.
3. Is Original Medicare or Medicare Advantage a better fit for my life?
Medicare coverage is personal. The right choice depends on how you receive care, where you live, how often you travel, and how predictable you want your expenses to be.
With Original Medicare, you can generally see any provider in the United States who accepts Medicare. Many people pair it with:
- A Medicare supplement, also called Medigap
- A standalone Part D prescription drug plan
With Medicare Advantage, you receive Medicare benefits through a private plan. Many Medicare Advantage plans include prescription coverage and may offer additional benefits, but they typically use provider networks and plan rules.
When comparing the two approaches, ask yourself:
- Do I want the flexibility to see Medicare-accepting providers across the country?
- Am I comfortable using a network?
- Do I prefer one plan that combines medical and prescription coverage?
- Would a supplement’s premium be worthwhile for more predictable out-of-pocket costs?
- Do I expect to need regular specialist or hospital care?
- Are there benefits such as dental, vision, or hearing coverage that matter to me?
The answer may be different for two people living in the same household. Your neighbor’s plan, or your sibling’s plan, may not be the right plan for you.
That is why our approach at Jett Insurance is simple: one size does not fit all. As an independent agency, we can compare options from multiple insurance companies instead of starting with one carrier and trying to make it fit.
4. If I travel or spend winters out of state, will I still be covered?
If you travel frequently, spend part of the year in another state, or are a “snowbird,” make travel coverage part of your Medicare comparison.
Original Medicare generally allows you to receive covered care anywhere in the United States from a provider who accepts Medicare. Medicare Advantage plans work differently. Routine care may be tied to a local network or service area.
Before choosing a plan, ask:
- Is my destination included in the plan’s service area?
- Are there in-network providers where I spend the winter?
- Does the plan cover routine out-of-network care?
- Will out-of-network care cost significantly more?
- What happens if I am away for several months?
- Are emergency and urgent care covered while traveling?
- Does the plan offer any travel-related benefits, and what are the limits?
Emergency and urgently needed care is generally covered when you travel within the United States, but that does not necessarily mean routine appointments will be covered at the same cost.
If you spend extended periods away from home, read the plan’s service-area and travel rules carefully. A plan that works well in Indiana may not be convenient if you regularly receive care in Florida, Arizona, or another state.
5. Am I missing savings I may qualify for?
Some Medicare beneficiaries qualify for programs that help reduce premiums, deductibles, or prescription costs. It is worth checking, especially if your income or household circumstances have changed.
Ask whether you may qualify for:
- Medicare Savings Programs, which may help pay Medicare premiums and, in some cases, other Medicare costs
- Extra Help, which helps eligible people with Medicare prescription drug expenses
- A different plan with similar coverage at a lower overall cost
- Medicaid or other assistance programs
Medicare says that people who qualify for a Medicare Savings Program may automatically qualify for Extra Help with prescription drug costs. You can learn more through the official Medicare Savings Programs page and Extra Help information.
Eligibility rules can be confusing, and assistance programs may depend on income, resources, household size, and other factors. If you are unsure, ask questions rather than assuming you will not qualify.
Indiana residents can also contact the state’s free, unbiased State Health Insurance Assistance Program, or SHIP, for Medicare counseling.
What if I love my current plan?
You should still review it.
Your plan may change its premium, deductible, prescription coverage, network, pharmacy arrangements, or extra benefits for the upcoming year. Watch for your plan’s Annual Notice of Change and compare it with your healthcare needs.
If your doctors, prescriptions, costs, and travel habits still line up, staying put may be the right decision. But you will not know that until you check.
Also, be careful about timing. The October 15–December 7 Annual Enrollment Period is different from the Initial Enrollment Period for someone first becoming eligible for Medicare at age 65. If you are approaching 65, recently retired, or losing employer coverage, make sure you understand which enrollment window applies to you.
We can review your options with you
Medicare questions are something our team handles every year. You do not have to sort through plan names, formularies, networks, and cost charts alone.
At Jett Insurance, we are happy to sit down with you, or with a family member helping you, and go through your options side by side at no cost. We can compare plans from multiple carriers and help you focus on what matters most: your doctors, prescriptions, budget, travel plans, and peace of mind.
Call us at 765-987-7019, use our contact page, or stop by our office at 114 W Main St, Lewisville, IN 47352.
Please reach out before December 7 so you have time to review your choices and make an informed decision for the year ahead.