Should I Change My Medicare Coverage During Open Enrollment?
Medicare Open Enrollment runs October 15 – December 7 each year. It's your annual opportunity to review your coverage — and in some cases, make changes that take effect January 1. Here's how to think through the decision.
For many Medicare beneficiaries, Open Enrollment passes without much thought. But a lot can change in a year — plan costs, your health needs, your prescription drugs, and your preferred providers. Taking even a short time to review your coverage each fall can help ensure you're not paying for benefits you don't use, or missing coverage you actually need.
The questions below follow a practical decision framework to help you evaluate whether a change makes sense for your situation.
Main Open Enrollment
Oct 15 – Dec 7
Changes take effect January 1
Medicare Advantage OEP
Jan 1 – Mar 31
Switch Advantage plans or return to Original Medicare
Have Your Plan Costs or Health Care Costs Recently Increased?
If your Medicare premiums, copays, or out-of-pocket expenses have risen — or if you're paying for coverage you rarely use — Open Enrollment is a good time to compare alternatives.
When comparing plans, look beyond just the monthly premium. Consider copays, coinsurance rates, deductibles, and the plan's annual out-of-pocket maximum, which can significantly affect your total costs if you need more care in a given year.
Has Your Coverage or Your Need for Services Changed?
If you're anticipating dental, vision, or hearing expenses, it may be worth considering whether a Medicare Advantage plan could provide that coverage more cost-effectively than your current plan.
Conversely, if your health status has changed and you now require more frequent specialist visits or procedures, confirm that any plan you're considering covers those services at an acceptable cost.
Do You Require Access to Specific Providers or Prescription Drugs?
This is one of the most important practical questions. If you have preferred physicians, specialists, or hospitals — including out-of-state providers — verify that any plan you're considering includes them in-network.
The same applies to prescription drugs. Drug formularies (the list of covered medications) and the tier your drugs fall under can vary significantly between plans — and can change from year to year. Always verify that your current prescriptions are covered at an acceptable cost before switching plans.
What Type of Coverage Do You Currently Have?
Your options during Open Enrollment depend on your current enrollment:
Original Medicare (Part A & Part B)
You can switch to a Medicare Advantage plan between October 15 and December 7. You can also add, drop, or change a Medicare drug plan (Part D) during this window.
Medicare Advantage (Part C)
You can switch to a different Medicare Advantage plan (with or without drug coverage) or return to Original Medicare during the October 15 – December 7 Open Enrollment Period, or during the Medicare Advantage Open Enrollment Period (January 1 – March 31).
Medicare Supplement (Medigap)
Medigap plans can technically be changed at any time — but outside of guaranteed issue periods, you may be subject to medical underwriting, which could result in higher premiums or denied coverage. Timing matters here.
No Medicare Drug Plan (Part D) Yet
You can join a Medicare drug plan between October 15 and December 7. Enrolling during this window may help limit any late enrollment penalties that can accumulate from coverage gaps.
Even If Nothing Has Obviously Changed, an Annual Review Is Still Worth It
Plan details can change each year even when your health needs haven't. Premiums adjust, formularies change, networks shift. A plan that was the right fit last year may not be the best option for next year.
Taking time each fall to review your plan against available alternatives — even if you ultimately decide to keep what you have — is a reasonable habit that can prevent unwelcome surprises.
Don't Forget: IRMAA Can Affect Your Medicare Premiums
If your income is above certain thresholds, you may pay more for Medicare Part B and Part D through IRMAA (Income-Related Monthly Adjustment Amount) surcharges — based on your income from two years prior.
This is one reason Medicare planning works best as part of a coordinated retirement income and tax strategy, not as a standalone decision.
Read: Medicare IRMAA Surcharges in 2026 →Use the Decision Guide
The flowchart below walks through the key questions step-by-step to help you determine whether a change during Open Enrollment may make sense for your situation. You can download a copy to review at your own pace or share with a family member.
Complimentary Guide
2026 Medicare Open Enrollment Decision Guide
A step-by-step decision flowchart to help you evaluate whether to change your Medicare coverage this Open Enrollment period.
Important Disclosure: Securities and advisory services offered through LPL Financial, a registered investment advisor, member FINRA/SIPC. This material is for educational purposes only and is not intended to provide individualized investment, tax, or legal advice. Individual circumstances vary. Consult the appropriate financial, tax, or legal professional regarding your specific situation. Source: fpPathfinder.com, “2026 · Should I Change My Medicare Coverage During Open Enrollment?” Licensed for the sole use of Thomas Sweeney, ChFC®, CRPC® of TS Wealth Advisors. Used with permission.
Complimentary Guide
2026 Tax Cheat Sheet
Medicare IRMAA surcharge tiers, Part B premiums, tax brackets, and retirement limits — all the 2026 numbers on one page.
Written by
Tom Sweeney, ChFC®, CRPC®
Founder, TS Wealth Advisors · 30 years of experience in wealth management
At TS Wealth Advisors, we work with a Medicare specialist to help clients evaluate their coverage options and factor Medicare costs — including IRMAA — into their broader retirement income and tax strategy.
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