What Should You Review Before Medicare Open Enrollment?

Before Medicare Open Enrollment, the short answer is this: read your plan's Annual Notice of Change, then confirm your doctors, prescriptions, and total costs still work for next year. Open Enrollment runs October 15 through December 7, 2026, and any change you make takes effect January 1, 2027.

Most people don't need to switch plans. But plans change every year, even when you do nothing, so it's worth 30 minutes to make sure your coverage still fits. Here's what we walk our Muskegon-area clients through each fall.

Start with your Annual Notice of Change

If you have a Medicare Advantage plan or a Part D drug plan, your insurance company is required to send you an Annual Notice of Change, usually called the ANOC, by September 30. It lays out everything that will be different on January 1: your premium, deductibles, copays, your drug list, and which doctors and pharmacies are in network.

It often arrives looking like junk mail, so check your mailbox and email. If you can't find it, call the member services number on your insurance card and ask for a copy, or look for it on your plan's member website.

The five things to check before Open Enrollment

1. Your doctors and hospitals. Networks change. If your plan is an HMO or PPO, confirm that your primary care doctor, specialists, and preferred hospital are still in network for 2027. This is the most common surprise we see in January.

2. Your prescriptions. Look up every medication you take on your plan's 2027 drug list (the "formulary"). A drug can be dropped, moved to a more expensive tier, or require prior authorization when it didn't before. Check your pharmacy too: a preferred pharmacy this year may not be preferred next year.

3. Your premium and out-of-pocket maximum. Compare what you'll pay each month and the most you could pay in a bad year. A lower premium doesn't help much if the out-of-pocket maximum went up by $2,000.

4. Changes to Part D drug costs. For 2027, the annual cap on out-of-pocket costs for covered Part D drugs rises to $2,400, up from $2,100 in 2026, and the standard deductible rises to $700. Once you hit the cap, you pay nothing more for covered drugs for the rest of the year. If you take several brand-name medications, it's worth knowing how quickly you'll reach it.

5. The extras you actually use. Many Medicare Advantage plans include dental, vision, hearing, or over-the-counter allowances. These change from year to year. If you counted on a dental benefit this year, make sure it's still there and still covers what you need.

What can you change during Medicare Open Enrollment?

Between October 15 and December 7, you can:

• Switch from one Medicare Advantage plan to another

• Switch from Original Medicare to a Medicare Advantage plan

• Leave a Medicare Advantage plan and go back to Original Medicare

• Join, switch, or drop a Part D prescription drug plan

If you're happy with your coverage and it still fits, you don't have to do anything. Your plan will renew automatically. You can see the full rules on Medicare.gov.

A Michigan caution about Medicare Supplement plans

If you're thinking about leaving a Medicare Advantage plan to go back to Original Medicare with a Medicare Supplement (Medigap) policy, timing matters. Open Enrollment lets you switch back to Original Medicare, but it does not guarantee you can buy a supplement. Outside of certain protected situations, supplement carriers in Michigan can ask health questions and turn you down.

If you're considering this move, talk it through before you drop your current plan. We can check whether you qualify for a guaranteed-issue right and, if not, how underwriting is likely to go. You can read more on our Medicare Supplement page.

What if you miss the December 7 deadline?

People already in a Medicare Advantage plan get a second chance. The Medicare Advantage Open Enrollment Period runs January 1 through March 31. It allows one change: switch to a different Medicare Advantage plan, or go back to Original Medicare and pick up a drug plan. It can't be used to move from Original Medicare into Medicare Advantage, or to change a standalone Part D plan.

Certain life events, like moving, losing other coverage, or qualifying for Extra Help, can also open a Special Enrollment Period at other times of the year.

When to get help with your Medicare review

A plan review makes sense if you had a big change in your health this year, started a new medication, got a letter saying your doctor is leaving your network, or just aren't sure your coverage still fits. It's also a good idea if your current plan is being discontinued. In that case you'll get a separate letter, and you'll have a Special Enrollment Period to choose a new plan.

Lakeshore Employee Benefits is an independent agency in Muskegon, and we work with several carriers. There's no cost to have us review your coverage. We'll look at your doctors, prescriptions, and budget and tell you plainly whether a change makes sense or whether you're better off staying put.

Call (231) 798-0072 | Email brendon@lebmi.com | Book a 30-minute appointment online

For more on how the pieces fit together, see our Medicare overview and Medicare Advantage pages. For free, unbiased counseling, you can also contact the Michigan Medicare/Medicaid Assistance Program (MMAP) at 1-800-803-7174.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.