Every fall, millions of retirees get a thick stack of mail and a reminder from Medicare: it’s Open Enrollment season! Between new plan letters, premium changes, and drug coverage updates, it can feel like alphabet soup — Part A, Part B, Part C, Part D.
But reviewing your coverage each year really matters. Medicare changes regularly, and so can your health needs. Whether you’re happy with your current plan or just starting to compare options, knowing what to look for can help you avoid surprises in the year ahead.
What Is Medicare Open Enrollment and When Does It Happen?
📖 Medicare Open Enrollment — The period from October 15 to December 7 each year, when you can review, change, or switch your Medicare health and drug plans.
During this time, you can:
- Switch from Original Medicare to a Medicare Advantage plan (Part C)
- Move from Medicare Advantage back to Original Medicare
- Change from one Medicare Advantage plan to another
- Add, drop, or switch a Part D prescription drug plan
Changes you make take effect on January 1 of the following year.
💬 What happens if I do nothing during Medicare Open Enrollment? If you don’t make any changes, you’ll generally stay in your current plan — but that doesn’t mean your costs or coverage will stay the same. Premiums, deductibles, and prescription lists often change each year.
📌 Read our blog post – How Health Costs Fit Into Your Retirement Plan
What Should You Review During Medicare Open Enrollment?
Even if you’re satisfied with your current coverage, it’s smart to take a few minutes each fall to check:
- Premiums and deductibles. Are your monthly costs or out-of-pocket limits increasing?
- Prescription coverage. Make sure your current medications are still covered and check for changes in your plan’s drug tier or preferred pharmacy list.
- Doctor networks. If you’re in a Medicare Advantage plan, confirm your doctors and specialists are still in-network for next year.
- Added benefits. Advantage plans often adjust dental, vision, hearing, or fitness benefits. See what’s changing.
- Income-related premiums. Higher-income retirees may see changes in their IRMAA (Income-Related Monthly Adjustment Amount), which affects Parts B and D premiums.
💡 Tip: Review your “Annual Notice of Change” — the letter your plan mails each fall. It summarizes next year’s costs and benefits, so you can easily compare with other options.
What’s New for Medicare in 2025 and 2026?
Medicare rules and costs change annually. A few updates on the horizon could impact retirees beginning in 2025 and 2026:
- Prescription drug costs: Out-of-pocket drug expenses will be capped at $2,000 starting in 2025 (and indexed for inflation in 2026). This new limit replaces the “donut hole” phase for most enrollees.
- Insulin and vaccines: The $35 monthly insulin cap and free adult vaccines continue in 2026.
- Part D deductibles: Deductibles are rising to $615 in 2026.
- Payment flexibility: Medicare’s “Prescription Payment Plan,” which allows monthly payment installments for drug costs, will automatically renew in 2026 for those already enrolled.
- Medicare Advantage changes: Expect new restrictions on certain “extra” benefits and continued oversight of prior-authorization rules to make them easier for patients.
These updates are designed to make prescription costs more predictable for beneficiaries— but they also mean your total spending could change depending on your plan and medication needs.
📌 Read our blog post – Balancing Health and Wealth in Financial Planning
Can You Switch Back to Original Medicare Later?
Yes — but there are rules and time limits.
- You can switch from a Medicare Advantage plan back to Original Medicare during Open Enrollment (October 15–December 7).
- You’ll also get another chance between January 1 and March 31 (the Medicare Advantage “Do-Over” period).
- If you return to Original Medicare and want to buy a Medigap policy for extra coverage, you may need to go through underwriting, depending on your state and timing.
💬 What if I missed Open Enrollment? If you missed it, you can make limited changes between January and March if you’re currently in a Medicare Advantage plan. Otherwise, you’ll need to wait until the next enrollment window or qualify for a Special Enrollment Period (for example, if you move or lose employer coverage).
How Does Medicare Fit Into Financial Planning?
For many retirees, Medicare is one of the biggest line items in their budget — and it’s not always as predictable as it sounds. Premiums can rise with income, out-of-pocket costs vary by plan, and supplemental coverage options can change annually.
That’s why reviewing your plan each fall isn’t just about healthcare — it can be an important part of financial planning. Keeping an eye on what’s changing can help you better plan your cash flow and avoid unexpected costs in retirement.
If you’d like to talk about how healthcare costs fit into your broader retirement plan, schedule a complimentary introductory meeting.
Jordan Hickey is a CERTIFIED FINANCIAL PLANNER® professional who helps clients create personalized financial plans. Based in Glastonbury and Wilton, CT, Jordan offers guidance on retirement, insurance, investments, and overall wealth management. Schedule a complimentary introductory meeting with Jordan.
This material is being provided for information purposes only and is not a complete description, nor is it a recommendation. The information has been obtained from sources considered to be reliable, but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of the author, and not necessarily those of Raymond James. Expressions of opinion are as of this date and are subject to change without notice. Raymond James and its advisors do not offer tax or legal advice. You should discuss any tax or legal matters with the appropriate professional.