Choosing the right Medicare coverage can make a big difference in your health care and your budget.
Medicare Open Enrollment runs from October 15 through December 7, 2026. During this period, you should review your current coverage and, if appropriate, make changes for 2027.
Even if you are happy with your current plan, it is important to review your options. Plans can change their costs, benefits, and participating doctors from year to year.
What Should You Review?
Before choosing a plan, take time to check three important things:
Doctors and hospitals: Make sure your preferred doctors, specialists, and hospitals participate in your plan.
Prescription medications: Check whether your medications are covered and whether your costs or pharmacy options have changed.
Costs: Compare monthly premiums, deductibles, copayments, and other out-of-pocket expenses.
My Personal Caution About Medicare Advantage Plans
Medicare Advantage plans may offer attractive benefits, such as dental coverage, vision benefits, and low monthly premiums—and sometimes a Walmart gift card! However, there are potential drawbacks that enrollees and their families should understand.
1. You may have fewer choices. Many Medicare Advantage plans use provider networks. You may have to change doctors or pay more to see providers outside your network. In the end, you could end up paying more for care than any potential savings.
2. Some care requires advance approval. Insurance companies require prior authorization for certain treatments, rehabilitation services, or skilled nursing facility care. Requests can be denied, potentially delaying or forbidding access to needed services. I have seen this happen A LOT in my 21+ years of practice.
3. Out-of-pocket costs can add up. A low monthly premium does not necessarily mean lower overall health care costs. Co-payments, deductibles, and other expenses may become significant when medical needs increase. Again, you could end up paying more for care than had you selected a traditional supplemental plan.
4. Your coverage can change. Plans may change their provider networks, benefits, and costs each year. A plan that worked well last year may not be the best choice for next year. Just like traditional supplemental Medicare plans, it is important to review the plans not just rubber stamp because it met your needs in the past.
5. Switching plans later may be difficult. If you decide to leave Medicare Advantage and return to Original Medicare, you may not be able to obtain a Medicare Supplement (Medigap) policy without medical underwriting. This is a HUGE deal and the reason I never recommend Advantage plans to my friends, family and clients if they are able to select a traditional supplemental plan.
Please don't choose a Medicare supplement or advantage plan based solely on a television advertisement, an extra (perceived) benefit, or a low monthly premium. Look at the complete picture.
Where Can You Get Help?
You can compare plans at Medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227).
You can also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare counseling.
Remember, December 7, 2026, is the deadline for making changes during the annual Open Enrollment Period. Changes generally take effect January 1, 2027.
At LMR Elder Care, LLC, we understand that navigating health insurance decisions can feel overwhelming. Taking time to understand your options today can help you make informed decisions and avoid surprises tomorrow. If you would like to learn more about LMR Elder Care, please take advantage of our complimentary discovery call opportunity. Call or text us today at 973.533.0839.