The leaves are turning, the holidays are approaching, and another vital season has arrived: the Medicare Annual Enrollment Period (AEP). From October 15 to December 7, this is your yearly opportunity to review, compare, and change your Medicare coverage for the upcoming year. For many, simply keeping the same plan seems easiest, but the truth is, a passive approach could cost you thousands in unexpected medical and prescription expenses.
At TheBenefits.Guru Insurance Services, we want to empower you to be an informed and confident consumer. Even if you love your current coverage, plan benefits, costs, and provider networks can—and often do—change every January 1st. Don’t “set it and forget it.” A few minutes of review now can save you a year of headaches later.
First Step: Don’t Ignore Your Annual Notice of Change (ANOC)
Before you begin comparing new options, the single most important document to review is the Annual Notice of Change (ANOC) from your current plan. Your plan is required to send this to you by the end of September.
The ANOC details every change coming in 2026: adjustments to your premium, changes in co-pays, modifications to your plan’s prescription drug list (formulary), and any shifts in the doctor and hospital network. For example, a specialist you saw all year might drop out of your plan’s network, or a crucial medication might move to a higher cost-sharing tier. Ignoring this document is one of the biggest mistakes a beneficiary can make.
Key Changes Coming in 2026
The year 2026 brings several important changes, mainly focused on lowering out-of-pocket costs for prescription drugs:
- Prescription Drug Cap at $2,100: Under Part D drug coverage, your out-of-pocket costs will be capped at $2,100 for the entire year. Once you hit this limit, you will no longer have to pay a co-payment or co-insurance for covered Part D drugs for the rest of the year. This is a tremendous benefit for anyone with high prescription costs, offering a new sense of financial security.
- Lower Insulin and Vaccine Costs: The cost for a month’s supply of covered insulin is capped at $35, and recommended adult vaccines (like flu, shingles, and pneumonia) will continue to be covered at no cost-share to you.
- Drug Price Negotiation: Price negotiation under the Inflation Reduction Act is taking effect, potentially leading to lower costs for some high-cost Part D drugs.
Choosing Your Plan: The 4 C’s of Comparison
The sheer number of plan choices can be overwhelming. To simplify your review, we recommend focusing on the 4 C’s:
- Coverage: Does the plan cover what you need? Make a list of your:
- Prescriptions: Check the plan’s formulary to ensure all your medications are covered, and note the cost-sharing tier.
- Providers: Verify that your current doctors, specialists, and hospitals remain in the plan’s network.
- Extras: If you rely on dental, vision, hearing, or fitness benefits, make sure they are still part of your coverage package.
- Cost: Look beyond the monthly premium. The lowest premium doesn’t always mean the lowest total cost. Compare the following:
- Deductibles (how much you pay before the plan starts to pay).
- Co-pays and Co-insurance for doctor visits and hospital stays.
- Annual out-of-pocket maximum (the most you’ll pay for in-network care).
- Example: A plan with a $0 premium might have a $5,000 maximum out-of-pocket, while a plan with a $50 premium might have a much lower maximum of $3,000. Which one offers more peace of mind?
- Convenience: How does the plan fit your lifestyle? If you travel often, a national network might be vital. Check if your preferred local pharmacies are in the network or if mail-order options are available and cost-effective.
- Confidence/Customer Service: Check the Medicare Star Ratings (1 to 5 stars) for plans in your area. This rating reflects the quality of care and customer service provided by the plan, offering a valuable indicator of reliability.
Understanding Your Paths: Medicare Advantage vs. Medigap
When making changes, it’s important to remember your two main paths for coverage (you cannot have both at the same time):
- Medicare Advantage (Part C): These all-in-one plans replace Original Medicare. They often have low or $0 premiums and include Part D and extra benefits (like dental/vision). However, they generally require you to stay within a specific local network (HMO or PPO) and require co-pays for services.
- Original Medicare + Medigap (Supplemental): Medigap policies work alongside Original Medicare to cover your share of costs (deductibles, co-pays). They offer national flexibility (any doctor who accepts Medicare) but come with a separate monthly premium and require you to purchase a stand-alone Part D plan.
Deciding between the network flexibility of Medigap and the lower monthly cost/extra benefits of a Medicare Advantage plan is a personal decision based on your health and budget.
The December 7 deadline will be here sooner than you think, and late changes are generally not permitted. Don’t leave your 2026 healthcare to chance. Let the professionals at TheBenefits.Guru Insurance Services help you navigate the changes, compare your options, and find the plan that offers the best coverage and value for your specific needs. Contact us today for a complimentary, personalized plan review—your health and wallet will thank you!