Key Takeaways

• Making changes to your Medicare plan during Open Enrollment requires careful evaluation of costs, coverage, and provider networks.

• Missing the deadline or making uninformed decisions could result in higher expenses and coverage gaps for the upcoming year.

Why Open Enrollment Matters More Than You Think

The Annual Open Enrollment Period (October 15 to December 7) is your once-a-year opportunity to adjust your Medicare coverage. Whether you need a different prescription drug plan, want to switch between Original Medicare and Medicare Advantage, or need better supplemental coverage, this is your chance to make changes. But before you jump into a new plan, take the time to ask yourself these key questions.

1. Has Your Health or Prescription Needs Changed?

Your healthcare needs in 2025 may be different from last year. Perhaps you have been prescribed new medications, developed a chronic condition, or need more frequent medical visits. Since different Medicare plans cover medications, treatments, and specialist visits differently, review your current plan’s coverage to ensure it still meets your needs.

What to Do:

• Check your current plan’s coverage limits and drug formulary.

• Compare how other plans cover your new medical needs.

• Make sure any new medications are included in your plan’s drug list.

2. Are Your Preferred Doctors and Hospitals Still in Network?

Medicare plans can change their provider networks each year. The doctor or specialist you visited last year may no longer be covered under your current plan in 2025. If you want to keep seeing your preferred healthcare providers, verify that they are still in-network.

What to Do:

• Call your doctor’s office and ask if they accept your plan next year.

• Review your plan’s provider directory for updated network listings.

• If your doctor is out of network, consider switching to a plan that includes them.

3. Are Your Out-of-Pocket Costs Increasing?

Medicare plans can change their costs every year, including premiums, deductibles, and co-pays. While your plan may have been affordable in 2024, it might not be the best option in 2025. Even small cost increases can add up over time.

What to Do:

• Review your Annual Notice of Change (ANOC) to see if your costs are rising.

• Compare plan costs, including deductibles and maximum out-of-pocket limits.

• Consider whether another plan offers better value for your budget.

4. Do You Need Additional Benefits?

Some Medicare Advantage plans may offer extra benefits beyond standard Medicare coverage, such as dental, vision, and hearing. However, plan benefits can change each year. If you rely on these services, make sure your current plan still includes them in 2025.

What to Do:

• Check your plan’s benefits to confirm what is covered.

• Compare other plans that may offer more comprehensive benefits.

• If your current plan is cutting benefits, consider switching.

5. Are There Better Plan Options Available?

Even if you are satisfied with your current plan, you should still shop around. Every year, Medicare plans adjust their coverage, pricing, and benefits. There might be a plan that offers better coverage at a lower cost.

What to Do:

• Use the Medicare Plan Finder tool to compare options.

• Look at factors like provider access, drug coverage, and cost-sharing.

• Ensure your preferred pharmacies and providers are included.

6. Have Medicare Rules or Policies Changed?

Medicare undergoes annual updates that can impact coverage, costs, and benefits. For 2025, key changes include a $2,000 cap on out-of-pocket prescription drug costs and an increase in Medicare Part B premiums. Staying informed about policy updates ensures you make the best choices.

What to Do:

• Read about Medicare changes for 2025.

• Consider how these changes may affect your healthcare expenses.

• Adjust your plan selection accordingly.

7. Have You Experienced a Major Life Change?

Life events such as retiring, moving to a different state, or changes in household income can affect your Medicare choices. If your circumstances have changed, you may need a different plan that better fits your new situation.

What to Do:

• Determine whether your current plan is still the best fit.

• Check for eligibility for special enrollment periods (SEPs).

• Review your coverage to ensure it meets your new needs.

8. Are You Prepared to Make a Decision Before the Deadline?

The Open Enrollment Period ends on December 7. If you miss this deadline, you will be locked into your current Medicare plan for another year unless you qualify for a special enrollment period. Last-minute decisions can lead to rushed choices that might not serve you well.

What to Do:

• Start reviewing your options early to avoid last-minute stress.

• Speak with a licensed agent to clarify any doubts.

• Submit any changes before the deadline to ensure smooth coverage in 2025.

Making the Right Choice for 2025

Your Medicare plan should work for you—not the other way around. Taking the time to evaluate your coverage, costs, and benefits ensures you are set up for the best healthcare experience possible in 2025. If you have any uncertainties, get in touch with a licensed agent listed on this website for expert guidance tailored to your specific needs.