Once a year, a small window opens to reshape your healthcare coverage. If you’re over 65 or soon will be, the Medicare open enrollment period is that window, running from October 15 to December 7. It’s your opportunity to make sure your healthcare keeps up with your life.
Any decisions you make during this window will go into effect on January 1st of the following year. Even if you haven’t experienced significant changes in your health, it’s worth taking a thoughtful look at your options now, while there’s still time to update your coverage for the new year.
What Can You Do During Medicare Open Enrollment?
During the open enrollment period, you can do the following:
Switch from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C), or vice versa.
Join, drop, or change a Medicare Part D prescription drug plan.
Drop your coverage entirely (though this isn’t typically recommended unless you have alternative, credible coverage).
Make changes that better align with your evolving health needs, budget, or provider preferences.
The annual open enrollment period is different from your initial enrollment period (which happens around your 65th birthday) and special enrollment periods (which follow certain life events). Open enrollment is your yearly opportunity to adjust your Medicare coverage to better align with your current health needs and lifestyle.
Evaluating Coverage
Even if you're relatively satisfied with your coverage, it's smart to review it every year. Plan specifics like deductibles, premiums, and coverage change each year, and your health needs are likely to change throughout retirement as well.
Start by reflecting on how well your current plan served you over the past year. Has your health status changed? If you've experienced a new diagnosis, added prescriptions, or had a shift in preferred providers, your existing coverage may no longer be the best fit for your needs moving forward.
It’s also worth reviewing your prescription drug coverage to ensure your current medications are still covered and remain affordable. Even if your health hasn’t changed, your plan might have—premiums, deductibles, and co-pays often increase from year to year, sometimes without warning.
Even if you’re happy with your current plan, it’s worth reviewing other options available in your area. You might find coverage that offers better benefits or lower costs. Open enrollment is your annual chance to ensure you’re not overpaying—or leaving yourself under-covered for essential services and care.
Medicare offers a plan finder tool at https://www.medicare.gov/plan-compare that allows you to plug in your medications and ZIP code to compare what’s available. Using this tool, you can check for things like out-of-pocket maximums, coverage for routine dental or vision, and in-network providers.
Original Medicare vs. Medicare Advantage
As you’re evaluating coverage options, one big decision to consider is whether you want original Medicare coverage or Medicare Advantage.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). It’s federally managed and offers plan participants broad access to doctors and hospitals. You’re generally responsible for covering the deductible, co-pays, and uncovered services, though you may be able to mitigate some costs by incorporating a Medigap policy as well.
Medicare Advantage (Part C) must provide at least the same coverage as Original Medicare, but it’s offered through private insurers. Some Part C plans also include additional benefits such as dental, vision, or fitness memberships. Even if you opt for Medicare Advantage, you can still obtain a Part D prescription coverage policy. However, provider networks may be more limited, and out-of-pocket costs can vary widely.
What About Medigap?
If you’re enrolled in Original Medicare, you can purchase a Medigap policy to help cover some costs Medicare doesn’t. Unlike other Medicare-related decisions, you don’t need to wait for open enrollment to make changes to a Medigap policy. You can enroll or drop Medigap coverage at any time during the year.
Keep in mind, you can’t have a Medigap policy if you’re enrolled in Medicare Advantage. If you're considering switching from Original Medicare to Advantage during the open enrollment period, this will impact any existing Medigap coverage you have. Should you choose to switch back to Original Medicare in the future, you could have problems obtaining new Medigap coverage, since most require underwriting. Certain changes in health or diagnosis could make you ineligible for coverage.
While you don’t necessarily have to make changes or decisions regarding a Medigap policy during this open enrollment period, it’s still worth considering what role they may play in your health coverage moving forward, especially since they’ll impact your monthly out-of-pocket costs.
Other Opportunities to Enroll or Change Medicare
While the fall open enrollment period is the most widely known window for adjusting Medicare coverage, it’s not your only opportunity to enroll or make changes:
Initial Enrollment Period (IEP)
Your initial enrollment period starts three months before your 65th birthday and ends three months after, lasting a total of seven months. During this time, you’ll need to enroll in Part A and/or Part B Original Medicare, even if you decide to join a Medicare Advantage plan instead of keeping the original coverage.
If you're still working and covered by an employer plan by the time you turn 65, it's worth speaking with a financial advisor before deciding whether to enroll or delay. Some individuals choose to enroll in Part A (which is typically premium-free) while deferring Part B until they retire, depending on the quality and cost of their current employer coverage.
Special Enrollment Periods (SEPs)
Other than open enrollment, you may be able to change coverage during a special enrollment period.
You’ll be eligible for a special enrollment period if you experience a qualifying life event such as:
You move and no longer live in your plan’s service area.
You lose coverage from another source, like COBRA or Medicaid.
You go back to work and are offered a health plan through your employer or union.
Your plan changes or terminates (ex. Medicare cancels its contract with the plan provider).
During a special enrollment period, you typically have a limited time (usually 60 days) to take action and make changes to your plan. Missing this window could result in losing coverage or having to wait until the next open enrollment period to make updates.
Don’t Ignore Open Enrollment
It’s natural to assume that if your health hasn’t changed, your plan doesn’t need to either. But every year, insurance companies make adjustments to premiums, drug formularies, provider networks, and out-of-pocket limits. Even minor changes can result in significantly higher costs or limited access to care.
Open enrollment is your annual opportunity to confirm that your current plan still fits. If it doesn’t, now’s the time to make a proactive change for the coming year.
If you need help reviewing your Medicare coverage or addressing the rising costs of healthcare in retirement, don’t hesitate to reach out to our team today.
The Hatlestad Group is an independent wealth management firm based in Edina, Minnesota, primarily serving successful head-of-household women, late-career executives, and pre-retirees. With a tailored approach to fee-only comprehensive wealth management, they empower clients to live out their next chapter with vision, wisdom, and resources, creating a purposeful and meaningful future. They can be reached by phone at (763) 259-3637, via email at info@thehatlestadgroup.com, or by visiting their website at thehatlestadgroup.com.
This material has been prepared in collaboration with Crystal Marketing Solutions, LLC, and has been edited with the assistance of artificial intelligence tools. The information presented is based on sources believed to be reliable and accurate at the time of publication. This material is for educational purposes only and does not necessarily reflect the views of the author, presenter, or affiliated organizations. It should not be construed as investment, tax, legal, or other professional advice. Always consult a qualified professional regarding your specific situation before making any decisions.