Medicare Open Enrollment: 5 Questions to Ask About Coverage

Medicare decisions can feel overwhelming, especially when plan names, networks, prescriptions, and costs all compete for attention. The good news is that you do not need to compare every plan in the country. You need to understand the options available where you live and identify which one best fits your health needs, medications, preferred providers, and budget.

Medicare Open Enrollment runs each year from October 15 through December 7. During this period, people with Medicare can make certain changes to their health and drug coverage. Changes made during Open Enrollment generally take effect January 1 of the following year. Review the official Open Enrollment guidance at Medicare.gov.

Why review your coverage every year?

Keeping the same plan may feel like the simplest choice, but plan costs and benefits can change from one year to the next. Your own circumstances can change, too: a new prescription, a new diagnosis, a different doctor, or a change in how often you need care may affect which coverage works best for you.

A yearly review does not mean you must switch plans. It gives you the information to decide whether your current coverage still meets your needs.

Five questions to ask before choosing coverage

1. Are my doctors, specialists, and hospitals included?

Provider access can differ depending on whether you use Original Medicare or a Medicare Advantage plan. Some Medicare Advantage plans use provider networks and may charge more for non-emergency care outside the network. Before making a change, confirm that the doctors and facilities important to you will still be available under the plan you are considering.

2. Are my prescriptions covered—and at what cost?

Make a current list of every prescription you take, including dosage and preferred pharmacy. Drug coverage, pharmacy networks, deductibles, copayments, and coinsurance can vary by plan. Medicare’s Plan Compare tool allows you to enter your prescriptions and pharmacies to estimate monthly and yearly costs. Compare plans at Medicare.gov.

3. What could I pay over the entire year?

A low monthly premium does not always mean the lowest total cost. Compare premiums, deductibles, copayments, coinsurance, prescription costs, provider access, and applicable out-of-pocket limits. Consider the services you realistically expect to use—not only the price advertised most prominently.

4. Have my health or caregiving needs changed?

Think about what has changed since your last review. Are you seeing new specialists? Managing a new condition? Helping a spouse or parent coordinate medications and appointments? A plan that worked well last year may not be the best fit for a new situation.

5. Am I using an unbiased source of help?

Medicare advertising can be difficult to sort through. Start with official, unbiased resources. Medicare.gov and 1-800-MEDICARE (1-800-633-4227) can provide federal Medicare information. Arizona’s State Health Insurance Assistance Program, known as SHIP, offers free, objective counseling to Medicare beneficiaries, families, and caregivers. The statewide SHIP helpline is 1-800-432-4040. Learn about Arizona SHIP through the Arizona Department of Economic Security.

A simple preparation checklist

• Your Medicare card and current plan information
• Your plan’s Annual Notice of Change and Evidence of Coverage
• A current list of prescriptions, dosages, and pharmacies
• A list of doctors, specialists, hospitals, and other providers you want to keep
• Notes about expected care, travel, or caregiving needs for the coming year
• Your questions about premiums, deductibles, copayments, networks, referrals, and drug coverage

Education can make a complicated decision more manageable

The Foundation at Glencroft is developing Medicare education content and plans to share details about upcoming learning opportunities as they are confirmed. Our goal is not to choose a plan for anyone. It is to help older adults, families, and caregivers know which questions to ask and where to find reliable assistance.

This article is for general educational purposes and is not medical, legal, tax, or insurance advice. The Foundation at Glencroft is not an insurer or insurance broker. Plan availability, costs, benefits, networks, and individual eligibility vary. Confirm current information with Medicare, the plan, or an appropriately qualified and unbiased counselor before making coverage decisions.