Enrolling in Medicare? Here’s what to consider before the Dec. 7 deadline.
The Medicare open enrollment window has arrived, giving millions of seniors across the U.S. the chance to revisit their coverage choices. Even if you’re happy with your plan, experts say it’s still worth exploring your options.
Health plans change every year, meaning people could see updates to premium costs, prescription drug coverage and available providers in their network. New plans also come online, expanding the already broad list of coverage options.
“There’s really no one who can’t benefit from at least taking some time to take a look,” Alex Cottrill, senior policy analyst with KFF’s program on Medicare policy, told CBS News.
People enrolled in Medicare Advantage or a Part D prescription drug plan typically receive an “Annual Notice of Change” in September outlining any updates to their coverage, according to Medicare.gov, the government website for the program.
“Pay attention to those notices, and frankly, even if you don’t receive an annual notice of change, you still want to review your current plan and make sure that it is the right one for you,” said Jessica Rivkin, vice president of Reliance Medicare Advisors, an insurance agency that helps people enroll in Medicare Advantage plans.
Americans now have less than a month to make their Medicare choices, with open enrollment set to close Dec. 7. Here are some considerations as you navigate the process.
Choosing between Medicare and Medicare Advantage
One of the biggest decisions people face when enrolling in Medicare is whether to choose traditional Medicare or Medicare Advantage, a comprehensive plan in which private insurers are paid to manage your care.
By contrast, people who enroll in regular Medicare plans must separately select a Medicare Part D prescription drug plan and Medigap, private insurance people can layer on top of their plan to help defray out-of-pocket costs.
“You only have to pick one plan rather than having these modular options that you have in traditional Medicare,” Cottrill said of Medicare Advantage.
A drawback of Medicare Advantage is its more stringent requirements. Some plans only allow you to visit in-network providers. If the plan does allow you to go out-of-network, you may face steeper cost-sharing rates, Cottrill said.
“That’s a consideration for people who have either a preferred provider that they really want to stay with …or people who have really complex health needs where they have to see maybe a lot of different specialists, or they need a very specialized type of care,” he told CBS News.
For those leaning towards Medicare Advantage, Cottrill said it’s worth double-checking that the providers you need are covered by the plan. People should also consider what it might mean for the Medigap coverage, he said.
If people enroll in Medicare Advantage and later switch back to traditional Medicare, they may face higher premiums due to their age or pre-existing conditions, compared to someone who enrolled in Medigap through a traditional Medicare plan from the outset, according to Cottrill.
Comparing plans
Cottrill said a good place to start is Plan Finder, a tool offered by the Centers for Medicare & Medicaid Services (CMS) that allows people to compare Medicare Advantage plans and Part D plans and to see whether providers are in-network.
The website, however, is just a jumping-off point. People should still conduct independent research to ensure their coverage needs are met, Cottrill said.
“If something is really crucial for somebody’s care, they should reach out to the plan directly, talk to their provider directly and don’t just rely on the website,” he told CBS News.
For general information, people can contact 1-800-Medicare, the CMS-run helpline for Medicare information, or consult their State Health Insurance Assistance Program, which provides more tailored counseling.
Seniors may also consider working with a broker who can help sort through the different options. But they should keep in mind that these people may have a financial stake in their decision, Cottrill said.
“They’re often paid on commission,” he said. “That’s not to say that they can’t be helpful, but it’s worth getting a second opinion from someone who doesn’t have that financial stake.”
Enrollment timeline
The plan you choose during open enrollment takes effect on Jan. 1, 2027, for the full calendar year.
While the deadline to make changes is Dec. 7, some people have some extra wiggle room. Medicare Advantage enrollees can switch to another Medicare Advantage plan from Jan. 1 through March 31 during a separate enrollment period.
“You can also choose to leave your Medicare Advantage plan and return to original Medicare during that same time frame, with the option of also enrolling in a Part D plan,” said Will Kinkead, associate vice president of Reliance Medicare Advisors.
Some people also qualify for special enrollment periods if they move or lose access to their current health care coverage and need to make a change.
As people research Medicare plan options, they may find they need to chase down details from their providers or consult with an expert. So it’s important not to wait until the last minute to start the enrollment process, Rivkin said.
“This can be a really complicated decision for some people, so take the time to get comfortable with the questions you have, what you need in 2027, and make sure that you’re getting all of your needs covered,” she told CBS News.
