Medicare Open Enrollment: What to Review Every Year
Medicare open enrollment is the one time each year a parent can change their Medicare Advantage or Part D drug plan, and most families skip it entirely, which is exactly how the costly mistakes happen: a plan that fit last year can change its network, its premiums, or its drug coverage this year. This page is the annual review: what to check, what can change, and the five questions that catch the mistakes.
the plan that was right last year is only a starting point
The Medicare annual review
Premiums, networks, and drug formularies change every year, so the annual review is a forty-minute check, not a re-signing of what the family already has: five questions, every year, in the open-enrollment window.
- Q1Have the premiums changed?Pull up the plan's annual notice and compare this year's premium to last year's: the change is often small, which is the easiest thing to miss.
- Q2Are the doctors still in the network?Networks change every year: call the two or three most important doctors' offices and ask directly. A plan whose main doctor left is a plan that stopped fitting.
- Q3Are the drugs still covered, and at what cost?Check each prescription against this year's formulary: covered, at what tier, with what copay. A drug moved to a higher tier is a real cost change and the cause of surprise bills.
- Q4-5Do the costs fit, and is there a better plan?Compare the out-of-pocket maximum, copays, and deductible against the expected year, then spend forty minutes on the government's plan comparison tool: a plan that is cheaper and covers the same drugs and doctors is a free win.
The rule, in one sentence: the plan that was right last year is only a starting point, because premiums, networks, and drug formularies change every year, so the annual review is a forty-minute check, not a re-signing of what you already have.
Why the annual review matters
Medicare Advantage and Part D plans are private contracts that reset every year: the premium can change, the doctor network can change, and the drug formulary (which medications are covered and at what tier) can change. A parent who does not review can keep paying for a plan whose doctors left the network or whose drugs moved to a much more expensive tier, and they will not know until a bill arrives. The annual open-enrollment window is the one chance to fix it without a special reason. See Medicare Advantage vs. Medigap for the difference between the two paths, and Medicare for adult children for the parts.
The five questions to answer every year
- Have the premiums changed? Pull up the plan's annual notice and compare this year's premium to last year's. The change is often small; it is still the easiest thing to miss.
- Are the parent's doctors still in the network? Networks change every year. Call the two or three most important doctors' offices and ask directly whether they accept the current plan this year. A plan whose main doctor left is a plan that stopped fitting.
- Are the parent's drugs still covered, and at what cost? This is the one that causes the surprise bills. Check each prescription against the plan's formulary for this year: covered, at what tier, and with what copay. A drug moved to a higher tier is a real cost change.
- Do the costs still fit the parent's expected year? Compare the out-of-pocket maximum, the copays, and the deductible against how much care the parent actually used and expects to use. A healthy year favors one plan; a year with planned surgery or a new diagnosis favors another.
- Is there a better plan for the same or less? The government's plan comparison tool (see Sources) shows all the plans in the parent's area with this year's numbers. Forty minutes with that tool is the whole review; a plan that is cheaper and covers the same drugs and doctors is a free win.
The review checklist (print this)
Where to do it (free, official, no commission)
- The Medicare plan comparison tool (see Sources) is the official way to see this year's plans, premiums, and drug coverage side by side.
- State Health Insurance Assistance Program (SHIP) counselors answer questions and review plans for free, and they do not sell anything. A counselor is the best first call for a confused family.
- Beware the enrollment-season calls. Open enrollment brings a wave of "Medicare representative" calls offering to "review your plan." Legitimate help does not cold-call and does not ask for a Medicare number or card over the phone. See impersonation scams and repeated scam targeting: this is one of the peak seasons for both.
When the parent should not switch
The review can also end in "stay put," and that is a fine outcome. Switching has its own costs: a new network to learn, a new formulary, and the risk that a plan change interacts badly with a Medigap policy (see the decision guide for the switching rules, which are stricter than people think). The goal of the review is an informed stay or an informed switch, not a change for its own sake.
Related
- Medicare Advantage vs. Medigap: the fork the review applies to.
- Medicare for adult children: the parts, the gaps, and the checks.
- Paying for long-term care: what Medicare does not cover, in the money map.
- Impersonation scams: the enrollment-season calls to refuse.
Sources
- Medicare.gov: Medicare Plan Finder (retrieved August 2026)
- Medicare.gov: Medicare Costs (retrieved August 2026)
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