What Should You Review Before Choosing a Medicare Plan During AEP?
Choosing a Medicare plan during the Annual Enrollment Period is about more than finding the lowest monthly premium. A plan that looks affordable at first may not be the best fit if your doctors aren't in its network, your prescriptions cost more, or the benefits you actually use have changed.
The Medicare Annual Enrollment Period (AEP), also called Medicare Open Enrollment, runs from October 15 through December 7 each year. During this period, eligible beneficiaries can make certain changes to their Medicare health and prescription drug coverage, with changes generally taking effect January 1.
For a broader explanation of AEP dates, eligibility, and the types of changes you can make, read our pillar article, The Medicare Annual Enrollment Period (AEP): What You Need to Know Before October 15.
Once AEP begins, the real question becomes: How do you know whether a Medicare plan is right for you?
A thoughtful plan review should start with your actual healthcare needs and then compare how different plans handle the things that matter most to you.
Start With Your Current Medicare Coverage
Before looking at new plans, start by reviewing the coverage you already have.
If you're enrolled in Medicare Advantage or a Medicare Part D plan, your plan should send you an Annual Notice of Change (ANOC) each fall. Medicare says the ANOC explains changes in coverage, costs, and other plan details that will take effect in January.
This document is one of the most useful starting points for your AEP review.
Don't simply look for a higher or lower premium. Pay attention to changes that could affect how you actually use your healthcare.
For example, your plan may change its prescription formulary, provider network, copayments, deductibles, or supplemental benefits. A small change in one area could have a significant impact if you use that service frequently.
You should also review your plan's Evidence of Coverage (EOC). This document provides more detailed information about what your plan covers and how much you pay.
Review the Doctors and Specialists You Use
Your healthcare providers should be one of the first things you check when reviewing Medicare coverage.
Make a list of your primary care provider, specialists, preferred hospitals, and other healthcare professionals you regularly visit.
If you're considering Medicare Advantage, check whether these providers participate in the plan's network. Medicare notes that Medicare Advantage plans may require beneficiaries to use network providers for non-emergency care, depending on the plan.
This is particularly important if you have an established relationship with a specialist or receive ongoing treatment.
A plan with a lower premium may not be a good value if changing plans means losing convenient access to the doctors you trust.
Provider directories can be useful, but network information can change. Medicare recommends checking with the plan and providers when determining whether your doctors are included.
Check Your Prescription Medications
Prescription coverage deserves careful attention during AEP.
Before comparing plans, create an up-to-date list of every medication you currently take. Include the medication name, dosage, frequency, and whether you use a particular pharmacy.
Then check each plan's formulary to determine whether your prescriptions are covered.
Medicare explains that Part D plans have formularies, or lists of covered drugs, and that your actual prescription costs can vary depending on the medications you take and the plan you choose.
Don't stop at checking whether a drug is listed.
Look at its tier and cost-sharing requirements. Also check whether the plan requires prior authorization, step therapy, or other restrictions.
If you take several prescriptions every month, these details can make a meaningful difference in your total annual healthcare spending.
Compare Your Total Potential Costs
One of the easiest mistakes during AEP is focusing only on the monthly premium.
Premiums matter, but they're only one part of your potential healthcare costs.
When reviewing a Medicare Advantage plan, look at the premium alongside deductibles, copayments, coinsurance, and the plan's annual out-of-pocket maximum.
Medicare confirms that Medicare Advantage costs vary by plan and that each plan has a yearly limit on what you pay out of pocket for covered services.
Think about how you actually use healthcare.
If you rarely visit doctors and take few medications, a plan with one cost structure may work well for you. If you see multiple specialists, receive regular treatments, or take several prescriptions, another plan may provide better overall value.
The goal is not necessarily to find the plan with the lowest premium. The goal is to understand your likely total healthcare costs.
Look at the Benefits You Actually Use
Medicare Advantage plans can offer benefits beyond Original Medicare, depending on the plan.
These may include dental, vision, hearing, fitness, transportation, or other supplemental benefits.
However, a long list of benefits doesn't automatically make a plan better for you.
Ask yourself which benefits you actually use or expect to use during the upcoming year.
For example, if dental coverage is important to you, examine what the plan actually pays for, whether there are annual limits, and which providers you can use.
The same principle applies to vision, hearing, transportation, fitness programs, and other supplemental benefits.
Belle Vida's Medicare Advantage Plans resource provides additional information about how Medicare Advantage plans can differ from Original Medicare.
Consider How You Prefer to Access Healthcare
Your preferred way of receiving care should also influence your review.
Some Medicare Advantage plans use specific provider networks and may have referral requirements for certain types of care. Other plan types provide different levels of flexibility.
For example, Medicare explains that HMOs generally require members to receive care from network providers except in certain situations, while PPOs generally allow members to use out-of-network providers but often at a higher cost.
Think about whether you prefer:
- Staying within a specific local network
- Having more flexibility to see providers outside the network
- Using a particular hospital system
- Having access to specialists without certain referral requirements
- Receiving care while traveling or spending part of the year elsewhere
These preferences can be just as important as the monthly premium.
Review Prior Authorization and Referral Requirements
If you regularly receive specialized care, pay attention to the plan's rules for accessing services.
Medicare notes that Medicare Advantage plans typically require prior authorization for certain services or supplies, depending on the plan.
Some plans may also require referrals before you can see certain specialists.
This doesn't necessarily mean a plan is good or bad. These requirements are part of how different Medicare Advantage plans manage healthcare services.
The important thing is to understand how the rules could affect your care.
If you receive ongoing treatment, ask whether the services you currently use require prior authorization or referrals under a plan you're considering.
Think About Your Healthcare Needs for the Coming Year
A Medicare plan review shouldn't only look at what happened this year.
Consider what you expect your healthcare needs to look like next year.
Are you scheduled for surgery? Are you beginning treatment for a chronic condition? Do you expect to see a specialist more frequently? Are you starting a new medication?
You may not be able to predict everything, but you can consider known healthcare needs.
For example, if your doctor has recommended regular specialist visits, check how those visits are covered under each plan.
If you're expecting a major procedure, investigate the plan's cost-sharing rules and whether the relevant providers and facilities participate in its network.
Planning around expected healthcare needs can make your comparison more meaningful.
Check Whether Your Preferred Pharmacy Is Included
Your pharmacy can also affect your Medicare costs.
Part D plans have pharmacy networks, and some plans may offer preferred cost-sharing at particular pharmacies.
Medicare recommends checking pharmacies as part of the plan comparison process, along with your prescriptions and estimated drug costs.
If you've used the same local pharmacy for years, don't assume it will have the same cost-sharing arrangement under every plan.
Compare your options carefully, especially if you fill prescriptions regularly.
Compare Plans Using Medicare's Official Tools
Once you've gathered your information, Medicare's official plan comparison tools can help you evaluate available options.
Medicare's online tools allow beneficiaries to compare Medicare Advantage and Part D plans in their area, review costs and services, and enter the prescriptions they take to estimate drug costs.
This can make the comparison more personalized than simply looking at general plan advertisements.
When comparing plans, pay particular attention to:
Your doctors: Are they included?
Your medications: Are they covered and at what cost?
Your pharmacy: Is it in the network or a preferred pharmacy?
Your healthcare costs: What are the premium, deductible, copayments, coinsurance, and out-of-pocket maximum?
Your benefits: Are the supplemental benefits useful to you?
Your access to care: Are there referral or prior authorization requirements that could affect you?
Don't Assume Your Current Plan Is Automatically the Best Choice
It's easy to stay with a familiar plan because changing coverage can feel complicated.
However, familiarity isn't necessarily the same as value.
Your current plan may have worked well this year, but changes to premiums, provider networks, prescription coverage, or benefits could make another option more suitable for the upcoming year.
Medicare specifically recommends reviewing the changes described in your ANOC and deciding whether your current plan will continue to meet your needs.
At the same time, don't feel pressured to change simply because another plan advertises a lower premium or additional benefits.
If your current coverage continues to meet your needs and the costs are reasonable, staying with your current plan may be appropriate.
The important thing is to make the decision based on a review rather than automatically renewing without checking.
Consider Your Overall Healthcare Priorities
Everyone's Medicare priorities are different.
For one person, keeping a particular specialist may be the most important consideration. For another, prescription costs may be the deciding factor.
Someone else may prioritize dental benefits, predictable copayments, a particular hospital system, or flexibility when traveling.
Before comparing plans, write down your three to five most important healthcare priorities.
Then use those priorities as your comparison checklist.
This can help prevent an attractive advertised benefit from distracting you from the factors that matter most to your actual healthcare needs.
What If You're Considering a Different Type of Medicare Coverage?
AEP can also be a time to consider whether your overall approach to Medicare coverage still makes sense.
Some beneficiaries may compare Medicare Advantage with Original Medicare and potentially Medicare Supplement Insurance and Part D coverage.
These options work differently.
Original Medicare generally allows you to see any doctor or hospital that accepts Medicare, while Medicare Advantage plans may have networks and other plan-specific rules. Medicare also notes that Original Medicare generally does not have a yearly out-of-pocket maximum unless you have supplemental coverage such as Medigap, while Medicare Advantage plans have annual out-of-pocket limits.
Because these choices involve different rules, costs, and enrollment considerations, they should be evaluated based on your individual circumstances rather than one feature alone.
Give Yourself Time to Make the Decision
You don't have to make your Medicare decision on the first day of AEP.
Use the period to gather your documents, compare options, ask questions, and verify information.
Starting early also gives you time to resolve issues such as an incorrect provider listing or questions about prescription coverage.
Remember that the 2026 AEP runs through December 7, with changes generally taking effect January 1, 2027.
Waiting until the final days can make the process more stressful.
A good Medicare plan review is not about rushing to choose. It's about having enough information to make a decision you feel comfortable with.
A Simple Medicare Plan Review Checklist
Before choosing or keeping a Medicare plan during AEP, ask yourself:
Does the plan cover my doctors and preferred healthcare facilities?
Are all of my prescriptions covered, and what will they cost?
Is my preferred pharmacy included?
What will I pay in premiums, deductibles, copayments, and coinsurance?
What is the plan's annual out-of-pocket maximum?
Will I need referrals or prior authorization for services I regularly use?
Are the plan's supplemental benefits useful to me?
Does the plan fit my expected healthcare needs for 2027?
Have I reviewed my Annual Notice of Change and Evidence of Coverage?
If you can answer these questions confidently, you'll have a much clearer picture of whether a Medicare plan fits your needs.
Conclusion
Choosing a Medicare plan during AEP shouldn't be based on one number or one advertised benefit.
The best plan is the one that fits your healthcare needs, prescription medications, preferred providers, budget, and expectations for the coming year.
Before October 15, gather your current plan documents and make a list of your doctors, medications, pharmacies, and regular healthcare services. Once AEP begins, use Medicare's comparison tools to evaluate your options and pay close attention to the details that matter most to you.
And remember: you don't have to change plans simply because AEP arrives. The purpose of the annual review is to make sure your current coverage still works—or identify another option if your needs have changed.
Taking the time to review your Medicare coverage can help you enter 2027 with greater confidence and fewer surprises.
Have you reviewed your Medicare plan based on how you actually use healthcare, or have you simply renewed the same coverage each year?
Make Your Medicare Decision With Confidence
Medicare plans can change from year to year, which makes an annual review an important part of managing your healthcare coverage. If you need help understanding Medicare Advantage, Original Medicare, Part D, or your available options, schedule a consultation.
For more educational information about Medicare and health insurance, visit Belle Vida Insurance.