Key Takeaways
-
You benefit from reviewing your Medicare coverage every AEP because plans adjust costs, benefits, and networks each year.
-
You protect yourself from unexpected expenses by checking changes in drug coverage, provider access, and annual limits.
Understanding Why Annual Review Matters
Even when your Medicare plan feels perfect, the Annual Enrollment Period from October 15 to December 7 gives you the chance to confirm that it still meets your needs for the upcoming 2026 coverage year. Plans update their rules, costs, and benefits annually, and these updates may affect how well your current coverage fits your health and budget. By reviewing key details every year, you make sure the coverage you rely on stays aligned with your medical needs and financial expectations.
What Should You Look At First?
Your first step is to focus on information that affects your daily healthcare experience. These areas determine how smoothly your care continues in 2026. Reviewing them in a structured way helps you avoid surprises once the new plan year begins.
Are Your Providers Still In Network?
A plan that worked perfectly this year may not guarantee the same access next year. Provider networks can change without notice.
Check the following:
-
Your primary care doctor
-
Specialists you see regularly
-
Clinics or medical groups you depend on
-
Preferred hospitals in your area
-
Outpatient facilities you may need in the upcoming year
If any of these move out of network, you may face higher costs or may need to switch to different providers. Confirming network participation helps you avoid care disruptions.
Are Your Other Healthcare Services Still Covered?
Beyond doctor visits, make sure the plan continues to support:
-
Diagnostic tests you take frequently
-
Therapies you need
-
Durable medical equipment requirements
-
Expanded preventive services
Plans sometimes adjust these benefits or place new limitations on them. Making sure they still suit you ensures smoother care throughout the year.
Reviewing Drug Coverage Before You Renew
Prescription drug coverage changes frequently from year to year. Even minor adjustments can affect how much you pay or whether certain medications remain available through your plan.
Has Your Medication Tier Changed?
Medications may move to higher tiers, which usually means higher costs. A drug that was affordable in 2025 may cost more in 2026 due to formulary adjustments.
You should:
-
Check each of your medications on the updated formulary
-
Review tier placement for brand, generic, and specialty drugs
-
Look for new rules such as prior authorization or step therapy
This step gives you a clear idea of your upcoming medication spending.
Does Your Plan Still Cover All Your Prescriptions?
Sometimes medications are removed from a plan’s formulary. If any of your prescriptions are missing, this is a sign you should compare other plan options during AEP.
Assessing Your Overall Costs For 2026
Costs change every calendar year. Reviewing them helps you predict out-of-pocket expenses more accurately.
What Are Your Updated Monthly Premiums?
Even though you cannot rely on consistent pricing from year to year, you can assess whether your new costs fit your 2026 budget. You are not comparing brands or private providers, only making sure the general cost structure works for you.
What Are Your Deductible And Cost-Sharing Changes?
Deductibles, copayments, and coinsurance amounts can shift each year.
Review the following carefully:
-
Annual deductible amount
-
Copayment amounts for primary care visits
-
Copayment amounts for specialists
-
Emergency or urgent care cost differences
-
Coinsurance amounts for lab tests, imaging, and routine procedures
This review helps you avoid unexpected cost increases midyear.
What Is Your Annual Out-Of-Pocket Limit?
Your out-of-pocket limit protects you financially by placing a ceiling on how much you may spend during the year. Because this limit can change annually, reviewing it helps ensure your plan still works for your health needs and financial comfort level.
Checking Convenience Factors That May Impact Daily Life
Sometimes a plan does not change major benefits but adjusts smaller details that affect your experience.
How Easy Will It Be To Access Care?
Verify changes such as:
-
Updated office hours
-
Changes to telehealth availability
-
Adjustments to referral rules
-
Whether your plan continues covering routine services the same way
These details influence how easily you schedule and receive care.
How Will Your Pharmacy Options Work Next Year?
Pharmacy networks may look the same at first glance but can experience structural changes.
Review:
-
Whether your current pharmacy remains in the preferred network
-
Whether new delivery or mail-order options are available
-
Whether rules around quantity limits and refill schedules have changed
These factors affect your long-term drug costs and convenience.
Reviewing Changes In Additional Services
Your plan may offer additional features designed to support your well-being. These features may shift or adjust between plan years.
What Extra Services Will Still Be Offered?
Check whether your plan maintains:
-
Wellness-related services
-
Preventive care programs
-
General support services
-
Health-related educational resources
Plans may expand, reduce, or modify these services every year. Understanding what remains available helps you make the most of your coverage.
Understanding Timeline And Duration Of Your Review
The annual review period lasts from October 15 to December 7. This eight-week window gives you enough time to explore your options in a relaxed and organized way.
A good approach is to divide your review into smaller tasks:
-
Week 1 and Week 2: Review provider networks and hospital access.
-
Week 3 and Week 4: Review prescription drug coverage and any medication tier changes.
-
Week 5 and Week 6: Compare cost structures, including deductibles, copayments, and your annual out-of-pocket limit.
-
Week 7 and Week 8: Finalize decisions, prepare questions, and consult one of the licensed agents listed on this website if needed.
This structured timeline gives you full control while ensuring you do not miss any important detail.
When Should You Consider A Change?
A change may be worth considering if:
-
Your current providers leave the network
-
Your medications change tiers or coverage
-
Your out-of-pocket limit increases significantly
-
Your plan adds multiple restrictions for your services
-
Your pharmacy access becomes more difficult
-
Your care needs have changed
Understanding these factors helps you evaluate what works best for your upcoming year.
Why Reviewing Every Year Protects Your Health And Budget
A plan that fits perfectly today may not remain the best option tomorrow. Personal health needs shift, service availability changes, and annual plan adjustments can affect your overall experience. By reviewing every year, you stay prepared and prevent surprises that could affect your care.
Keeping Your Healthcare Future Secure
Your proactive review during AEP preserves both your peace of mind and your financial stability. Staying on top of upcoming changes ensures you enjoy smooth care throughout 2026.
Strengthening Your Coverage Decisions
Use your annual review to stay informed and confident about your choices. If anything is unclear or if you want help comparing your options, reach out to any of the licensed agents listed on this website for guidance.
