5 Medicare Moves to Make Before Dec. 7

Medicare Open Enrollment begins Oct. 15 and runs through Dec. 7, giving beneficiaries an annual opportunity to review Medicare Advantage and prescription-drug coverage for the coming year. The temptation is to do nothing, especially when the current plan seemed to work reasonably well in 2026. But Medicare plans can change premiums, drug formularies, pharmacy arrangements, provider networks and cost sharing from one year to the next, which means automatically renewing can leave someone with significantly different coverage in January.

The review does not have to become a complicated annual project. Most beneficiaries can focus on a handful of questions involving medications, doctors, premiums and worst-case costs before deciding whether the existing plan still fits. CMS projects relatively stable Medicare Advantage and Part D premiums overall for 2027, but national averages say very little about what will happen to an individual plan in a particular ZIP code.

1. Read the Annual Notice of Change Before Doing Anything Else

The Annual Notice of Change, commonly called the ANOC, is one of the most important Medicare documents beneficiaries receive each fall. It explains what will change in the existing Medicare Advantage or Part D plan on Jan. 1, including premiums, deductibles, copayments, covered benefits and other plan rules. Someone who throws it away because the insurance-company name has not changed can easily miss a significant increase in what the plan will cost next year.

Start by comparing the 2027 premium with what you are paying now, but do not stop there. A plan can keep its premium low while increasing the deductible, changing specialist copays, moving medications to more expensive tiers or altering supplemental benefits. The right comparison is therefore not simply this year’s premium versus next year’s premium, but the total expected cost of actually using the plan.

Medicare Advantage beneficiaries should also look for changes to hospital copays, outpatient procedures, rehabilitation, skilled nursing and other services that can become expensive during a serious illness. A plan that saves $20 a month in premiums can still be more expensive overall if a major medical event exposes the beneficiary to substantially higher cost sharing. Open Enrollment is the time to evaluate that risk before the new benefit year begins.

2. Recheck Every Prescription and Pharmacy

Prescription coverage deserves a fresh review every year because Part D formularies can change even when a beneficiary’s medications do not. A drug that was preferred in 2026 can move to a higher tier in 2027, require prior authorization or no longer appear on the formulary in the same way. Preferred pharmacy arrangements can also change, meaning the pharmacy someone has used for years may no longer offer the plan’s lowest available price.

CMS projects the average standalone Part D premium at about $36 per month in 2027, up less than $1 from 2026. That does not mean every beneficiary will pay $36, because CMS also says 88% of beneficiaries who do not receive the low-income subsidy will have access to a basic Part D plan costing $10.30 or less, while many enhanced plans will also be available below $6. The large variation is exactly why comparing plans based solely on premium can be misleading.

The drug itself can easily matter more than the premium. A $5-a-month plan that treats one expensive medication unfavorably may cost far more over the year than a $30 plan with better formulary placement. Medicare’s Plan Finder allows beneficiaries to enter their actual medications and preferred pharmacies, making it possible to compare estimated annual drug and premium costs rather than guessing from the advertised monthly price.

The Part D benefit is also changing again in 2027. CMS has set the standard Part D deductible at $700 and the annual out-of-pocket threshold for covered Part D drugs at $2,400 for 2027. Those figures make it even more important to look at the entire year’s expected spending instead of choosing a plan based on the first month’s premium.

3. Medicare Advantage Members Should Recheck Doctors and Hospitals

A Medicare Advantage plan can look nearly identical on paper while becoming much less useful if a preferred doctor or hospital leaves the network. Network changes are particularly important for people receiving ongoing specialty care because switching physicians can be far more disruptive than paying a slightly higher monthly premium. Beneficiaries should confirm directly with both the plan and the medical provider that the provider intends to participate in the specific plan in 2027.

The same review should include referrals, prior authorization requirements and the plan’s maximum out-of-pocket exposure for Part A and Part B services. Medicare Advantage plans are required to cap annual cost sharing for covered Medicare medical services, but individual plans can set different limits within federal rules. A low-premium plan may therefore be attractive during healthy years while still exposing the beneficiary to thousands of dollars in copays and coinsurance during a year with significant medical care.

Supplemental benefits deserve scrutiny as well. Dental allowances, over-the-counter benefits, transportation and vision coverage can change from year to year, and the headline benefit may come with restrictions on providers or the amount that can actually be used. Those extras can be valuable, but they should not outweigh the fundamentals of doctor access, hospital coverage, prescription drugs and potential medical costs.

4. Think Carefully Before Switching Between Medicare Advantage and Medigap

Open Enrollment allows someone in Medicare Advantage to switch to another Medicare Advantage plan or return to Original Medicare. The important complication is that returning to Original Medicare does not automatically guarantee access to whatever Medigap policy the beneficiary wants. Outside the federal Medigap Open Enrollment Period and specific guaranteed-issue situations, an insurer may be allowed to ask medical questions and deny an application depending on state law.

That makes the order of operations extremely important. Someone planning to leave Medicare Advantage for Original Medicare should determine whether they can obtain the desired Medigap coverage before assuming the transition will be easy. Dropping Medicare Advantage and then discovering that Medigap coverage is unavailable or prohibitively expensive can leave the beneficiary with Original Medicare’s deductibles and 20% Part B coinsurance without a supplemental policy.

There is a federal 12-month “trial right,” but it is narrower than many Medicare discussions make it sound. Someone who dropped a Medigap policy to join Medicare Advantage for the first time generally has a one-time 12-month period in which certain rights to return to Medigap may apply, and someone who joined Medicare Advantage when first eligible for Medicare at 65 may also have specific rights if they return to Original Medicare within the first year. It is not a universal rule allowing every longtime Medicare Advantage enrollee to move into Medigap without underwriting whenever they choose.

State law can provide broader protections than federal law, which is why beneficiaries should check their own state’s rules rather than assuming advice from another state applies to them. Some states have birthday rules or other guaranteed switching opportunities for existing Medigap policyholders, while others rely much more heavily on medical underwriting outside protected windows. The ability to change later should therefore be part of today’s Medicare decision.

5. Compare Total Cost, Not Just the Monthly Premium

The Medicare decision is often framed as an argument between Medicare Advantage and Original Medicare with Medigap, but the financial structure of the two choices is fundamentally different. Medicare Advantage plans frequently have low or even $0 additional premiums, but members generally pay copays and coinsurance as they use medical services until reaching the plan’s applicable annual out-of-pocket limit. Medigap requires an additional monthly premium, but depending on the standardized plan selected, it can substantially reduce the unpredictable cost sharing left by Original Medicare.

Plan G is one of the more comprehensive Medigap options available to people newly eligible for Medicare. It covers most standardized Original Medicare gaps, including Part B excess charges, but it does not pay the annual Part B deductible. Plan N also covers many major gaps but can require copayments of up to $20 for certain office visits and up to $50 for emergency-room visits that do not result in an inpatient admission, and it does not cover Part B excess charges.

People who became newly eligible for Medicare on or after Jan. 1, 2020 generally cannot buy Medigap Plans C or F, which are the plans that can cover the Part B deductible. Someone who became eligible earlier may still be able to buy those plans if available, but price matters because an older Plan F policy can sometimes cost considerably more than another standardized option. The letter on the Medigap card should therefore not be treated as permanent simply because the policy has been held for years.

Medigap also does not include prescription-drug coverage in policies sold today, so someone using Original Medicare with a modern Medigap plan generally needs a separate Part D plan if drug coverage is desired. That creates another premium, but again the correct comparison is the total cost of the complete package rather than one component by itself.

Don’t Assume Medigap Means Every Doctor Will Take You

One major advantage of Original Medicare with Medigap is that there is no Medigap provider network in the same sense used by Medicare Advantage plans. If a doctor or hospital accepts Original Medicare, the standardized Medigap policy generally works alongside Medicare to pay whatever portion of covered cost sharing the policy is designed to cover. That can be attractive to retirees who travel frequently or receive care in multiple states.

It would still be inaccurate to say that virtually every doctor in America is guaranteed to accept Medicare. Some physicians do not accept Medicare patients, and some may not accept new Medicare patients even though they participate in the program. The practical advantage is that Original Medicare usually offers much broader geographic access than a local Medicare Advantage network, not that every provider must accept it.

This distinction can be especially important for retirees who divide time between different states. Someone living part of the year in Florida and part in Pennsylvania, for example, may value the portability of Original Medicare differently from someone who rarely receives care outside a local health system. Coverage should fit how the beneficiary actually uses health care rather than an abstract comparison of benefits.

Don’t Switch to Medicare Advantage Assuming You Can Easily Undo It

A healthy beneficiary may look at a $0-premium Medicare Advantage plan and wonder why they should continue paying a substantial Medigap premium. For some people, switching can make financial sense, particularly when the Advantage network includes their doctors and the plan’s cost sharing fits their risk tolerance. The mistake is assuming the change can always be reversed later after health deteriorates.

Federal trial rights provide protection in specific first-time situations, but once those protections expire, returning to Medigap can become much more difficult. Health conditions can matter where underwriting is permitted, and individual states have different rules governing when insurers must accept applicants. Someone considering dropping a Medigap policy should therefore understand the path back before giving up coverage that may be difficult to replace.

This is one of the most consequential Medicare decisions because the immediate savings are easy to calculate while the future flexibility is harder to value. Paying less today can be attractive, but the ability to change coverage after a serious diagnosis may eventually matter much more than the premium savings that motivated the original switch.

Medicare Open Enrollment Is Not a Requirement to Change Plans

Beneficiaries do not have to change Medicare Advantage or Part D plans every year. If the existing coverage continues to fit medications, providers, budget and health needs, staying put can be perfectly reasonable. The purpose of Open Enrollment is to create an annual opportunity to compare, not an annual obligation to switch.

That distinction can help prevent unnecessary changes driven by advertising. Medicare beneficiaries are flooded with marketing every fall, and a new plan may highlight dental benefits, grocery allowances or a low premium without explaining how doctors, medications or hospital costs compare with the existing coverage. A plan should solve a real problem in the current coverage rather than simply offer a more appealing commercial.

CMS expects more than 99% of beneficiaries to have access to at least one Medicare Advantage plan in 2027 and 97% to have at least 10 choices. Having more options can improve competition, but it also makes it easier to become distracted by features that are less important than core medical coverage.

The Dec. 7 Deadline Matters

For most Medicare beneficiaries making ordinary annual Medicare Advantage or Part D changes, Dec. 7 is the end of the fall Open Enrollment window. Elections made during this period generally take effect Jan. 1, 2027, which makes procrastination risky if medications or plan benefits are changing substantially.

There are other opportunities to change coverage in certain circumstances. Medicare Advantage members have another Medicare Advantage Open Enrollment Period from Jan. 1 through March 31, and Special Enrollment Periods can apply after events such as moving or losing other qualifying coverage. Those additional windows have their own rules and should not be viewed as a universal extension of the Dec. 7 deadline.

The most effective approach is therefore straightforward: read the Annual Notice of Change, enter current prescriptions into Medicare’s Plan Finder, verify doctors and hospitals, understand the Medigap rules before changing coverage and compare the total financial exposure rather than simply the premium. Those five steps can identify most of the problems that turn into expensive surprises after Jan. 1.

Medicare choices rarely stay completely static from one year to the next, and neither do retirees’ health needs. Taking an hour to review coverage before Dec. 7 can be much easier than discovering in January that a medication has become expensive, a specialist is out of network or a Medigap policy cannot be obtained after leaving Medicare Advantage. The goal is not to find a theoretically perfect plan, but to make sure the coverage entering 2027 still matches the health care and financial risks you actually have.