Fall is the time when many people choose what health care coverage they will have in the coming year, and Medicare is no exception. From October 15 to December 7, people with Medicare can choose to retain their current coverage or make a switch. Options include switching from Original Medicare to Medicare Advantage (MA) and vice versa, picking a new standalone Part D prescription drug plan, or choosing a different MA plan with or without Part D coverage.
A Guide for Fall Open Enrollment
Choosing coverage can be intimidating and complex. Medicare Rights offers Your Guide to Medicare Open Enrollment to help inform successful decision-making through details about what options you have during open enrollment, timelines, and questions to ask before enrolling. This resource is available for free through our online educational platform Medicare Interactive (requires registration).
Comparing Options Is Vital
Every year, we urge people with Medicare to assess how their current coverage works for them and compare it to other options. Financial and health circumstances can change from year to year, and health plans change, too.
Does Original Medicare Fit Your Needs?
People with Original Medicare should review the 2026 Medicare & You handbook. All Medicare households should have received this handbook in late September, but you can also download it from Medicare.gov. Callers to 1-800-MEDICARE (1-800-633-4227) can also request a copy. The handbook explains Original Medicare’s coverage for the coming year.
Reminder: For those who have Original Medicare and a Medigap who are considering an MA plan, switching to an MA plan may make it difficult or impossible to re-enroll in Medigap. Check with your local State Health Insurance Assistance Program (SHIP) to learn about your state’s rules.
Switching to an MA plan may make it difficult or impossible to re-enroll in Medigap.
Does Your MA or Part D Plan Fit Your Needs?
If you have MA or a standalone Part D plan, you should read through any Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). You should have received these documents in late September, either as a hard copy or via email.
The ANOC or EOC identifies plan changes for 2026:
Benefits and coverage rules
Costs
Formulary (list of drugs covered) and coverage restrictions
Network changes
If you have providers you want to keep, make sure your doctors and/or pharmacies are still in the plan’s network. It’s helpful to double-check with providers to be sure they accept that plan, or with plans to be sure they contract with that provider.
Need to Make a Switch?
The questions are much the same if you need or want to make a switch to a new plan.
For MA plans, be sure your providers are in the network and compare costs, coverage, and benefits.
For Part D plans, whether standalone or part of an MA plan, you should look at the formularies to be sure your prescriptions are covered and check if your preferred pharmacies are preferred and in-network.
Where to Go for Help
Your local State Health Insurance Assistance Program (SHIP) provides one-on-one unbiased Medicare assistance. There are 54 SHIPs (one in each of the 50 states, Puerto Rico, Guam, the District of Columbia, and the U.S. Virgin Islands).
Visit www.shiphelp.org and click on the orange “Find local Medicare help” button in the upper right corner to contact your SHIP.
You can also go directly to Medicare through Medicare Plan Finder or by dialing 1-800-MEDICARE.
And Medicare Rights can provide additional assistance, answering your questions and troubleshooting issues you may be having during open enrollment. Call our national helpline at 800-333-4114.
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