Understanding Medicare Advantage's Annual Enrollment Period for 2026 Coverage

Important Dates and Changes in the 2025 Enrollment

Critical Dates for Annual Enrollment Period:

• September 30: Plans mail Annual Notice of Change documents
• October 1: Complete benefit information for next year becomes available
• October 15: Annual Enrollment Period begins
• December 7: Hard enrollment deadline (last day to make changes)
• December 31: Current plan automatically terminates if you enrolled in a different plan
• January 1, 2025: New coverage begins

Major Changes for 2025:

• $2,000 prescription drug out-of-pocket cap: Down from $8,000 in 2024, estimated to save 18.7 million enrollees approximately $400 each
• Medicare Prescription Payment Plan: Option to spread out-of-pocket drug costs into monthly payments throughout the year instead of paying large amounts upfront
• Coverage gap ("donut hole") completely eliminated: Benefit structure now has just three phases instead of four
• Part D premiums: Base beneficiary premium increases to $36.78 (up $2.08), but average total premiums projected to decrease by $7.45 to $46.50
• Medicare Advantage premiums: Average premiums expected to decrease by $1.23 to $17.00, with 60% of enrollees having access to $0 premium plans
• Improved behavioral health access: New network adequacy standards for outpatient behavioral health services, with Marriage and Family Therapists and Mental Health Counselors now enrolled as Medicare providers
• Enhanced consumer protections: Agent and broker compensation standardized to prevent steering patients to specific plans; third-party marketers cannot sell personal data without written consent

Every fall, Medicare beneficiaries face a critical decision period that many overlook. Medicare's Annual Enrollment Period gives you nearly eight weeks to review your healthcare coverage and make changes for the coming year. Yet approximately 70% of Medicare beneficiaries never compare plans during this window, often missing opportunities to save money or improve their coverage.

This matters because Medicare plans change significantly from year to year. Premiums increase, drug formularies shift, provider networks narrow, and benefits evolve. What worked perfectly last year might not serve you well this year. With 2025 bringing landmark changes—including a new $2,000 cap on prescription drug costs—understanding the Annual Enrollment Period has never been more important.

What Is the Annual Enrollment Period?

The Annual Enrollment Period, also called the "Annual Election Period" or "Medicare Open Enrollment Period," runs from October 15 through December 7 every year. During these nearly eight weeks, all Medicare beneficiaries can make comprehensive changes to their health and prescription drug coverage.

The period exists because Medicare Advantage and Part D prescription drug plans change annually. Plans modify premiums, adjust drug formularies, alter provider and pharmacy networks, change copays and coinsurance amounts, and sometimes exit markets entirely. Medicare requires plans to send Annual Notice of Change documents by September 30 detailing these modifications. The Annual Enrollment Period gives you time to review these changes, compare alternatives, and select coverage that aligns with your healthcare needs and budget.

If your current plan still meets your needs and continues operating in your area, you don't need to take any action. Your coverage automatically renews for the following year—but that renewal includes whatever changes the plan announced, which may be substantial.

Who Can Enroll During This Period?

All current Medicare beneficiaries can use the Annual Enrollment Period to make coverage changes. To be eligible, you must already be enrolled in Medicare Part A or Part B, be a U.S. citizen or lawfully present in the country, and live in the service area of any plan you wish to join.

This period is specifically for existing Medicare beneficiaries making changes to current coverage, not for first-time Medicare enrollment. Individuals turning 65 or newly eligible for Medicare due to disability use their Initial Enrollment Period instead, which is a separate seven-month window.

To join a Medicare Advantage plan specifically, you must be enrolled in both Medicare Part A and Part B, continue paying the Part B premium, live in the plan's service area, and in most cases not have End-Stage Renal Disease. To join a standalone Part D prescription drug plan, you need at least Part A or Part B coverage.

The Annual Enrollment Period offers universal access—every Medicare beneficiary who meets these basic requirements can participate, whether currently in Original Medicare, Medicare Advantage, a Part D plan, or any combination. No medical underwriting applies during this period for Medicare Advantage or Part D enrollment, meaning health conditions cannot disqualify you or increase your premiums.

What Changes Can You Make?

The Annual Enrollment Period offers the broadest flexibility of any Medicare enrollment window. You can:

• Switch from Original Medicare to a Medicare Advantage plan
• Move from one Medicare Advantage plan to another
• Return to Original Medicare from Medicare Advantage
• Join, switch, or drop a Part D prescription drug plan
• Select Medicare Advantage plans with or without prescription drug coverage
• Make as many changes as you want during the enrollment window

When switching from Original Medicare to Medicare Advantage, you gain an alternative way to receive Medicare benefits through a private insurance company. Many Medicare Advantage plans include prescription drug coverage (called MAPD plans), along with supplemental benefits like dental, vision, and hearing services not covered by Original Medicare. However, you must accept the plan's network restrictions and rules, including potential requirements for referrals to see specialists or prior authorization for certain services.

Moving between different Medicare Advantage plans is completely unrestricted during the Annual Enrollment Period. You might switch to access better provider networks, lower premiums, improved prescription drug coverage, or enhanced supplemental benefits. The freedom to change plans multiple times means you can course-correct if you discover better options after initially enrolling.

Returning to Original Medicare from Medicare Advantage is allowed, and when doing so you can simultaneously enroll in a standalone Part D prescription drug plan. However, this decision carries an important caveat: obtaining a Medigap policy to fill Original Medicare's coverage gaps typically requires medical underwriting after your initial six-month Medigap Open Enrollment Period. You may face higher premiums or coverage denials based on pre-existing conditions unless you qualify for guaranteed-issue rights.

The Prescription Drug Coverage Decision

For prescription drug coverage, Original Medicare beneficiaries can enroll in a standalone Part D plan for the first time, switch between Part D plans, or drop Part D coverage entirely during the Annual Enrollment Period. Medicare Advantage enrollees can switch to plans that include or exclude drug coverage but cannot enroll in standalone Part D while in Medicare Advantage.

One critical warning: dropping Part D without maintaining other creditable prescription drug coverage triggers a permanent late enrollment penalty if you re-enroll later. This penalty, calculated as 1% of the national base beneficiary premium for each month without coverage, adds to your monthly premium permanently.

How This Period Differs from Other Enrollment Windows

Medicare has multiple enrollment periods that often confuse beneficiaries. Understanding the distinctions is essential for maximizing your options.

Medicare Advantage Open Enrollment Period (January 1 - March 31)

The Medicare Advantage Open Enrollment Period runs January 1 through March 31 and is only available to individuals already enrolled in a Medicare Advantage plan as of January 1—not to those with Original Medicare only. During this period, you can make only one change: switching to a different Medicare Advantage plan or dropping Medicare Advantage to return to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during this period, and unlike the Annual Enrollment Period's unlimited changes, you get just one modification.

Initial Enrollment Period

The Initial Enrollment Period is for first-time Medicare enrollment and runs for seven months: three months before your 65th birthday, your birth month, and three months after. This is when you initially decide between Original Medicare and Medicare Advantage, enroll in Part D, and establish your guaranteed-issue six-month window for Medigap policies. Missing this period can trigger permanent late enrollment penalties for Part B and Part D.

Special Enrollment Periods

Special Enrollment Periods are event-driven windows triggered by qualifying life changes rather than scheduled dates. Common triggers include losing employer or union coverage, moving outside your plan's service area, gaining or losing Medicaid, plan contract terminations, or qualifying for Extra Help with prescription drug costs. Most Special Enrollment Periods last two months from the qualifying event and require documentation.

Common Mistakes to Avoid

Failing to Review Coverage Annually

The most costly mistake is never comparing plans despite substantial year-over-year changes. Maximum out-of-pocket costs for Medicare Advantage plans have climbed 40% over five years, from $6,700 in 2020 to $9,350 in 2025. Yet many enrollees remain in plans that no longer serve them well simply because they assume nothing has changed.

Ignoring the Annual Notice of Change

Auto-renewal assumptions create problems when beneficiaries don't realize how significantly their plan changed. Premiums may increase, drug formularies shift (medications dropped or moved to more expensive tiers), provider networks contract, and copays rise. Auto-renewal means accepting these changes, which may substantially impact your costs and access to care.

Choosing Plans Based Only on Premium

Selecting Medicare Advantage plans based solely on zero-dollar premiums ignores total cost calculations. A plan with $0 monthly premium but high copays, restricted networks, and a $9,000 out-of-pocket maximum may cost far more than a plan with a $50 premium but comprehensive coverage and a $3,000 maximum. One hospital stay can erase a year's worth of premium savings.

Smart beneficiaries calculate estimated total annual costs including premiums, deductibles, copays for services they regularly use, and potential maximum exposure in a bad health year.

Not Verifying Provider Networks

Provider network verification failures cause major disruptions when beneficiaries assume doctors and hospitals accept new plans without confirmation. Provider directories online are notoriously outdated, and networks change annually. Call each doctor's office directly to confirm they accept the specific plan for the upcoming year, and document the call with date, representative name, and response.

Overlooking Prescription Drug Coverage

Beneficiaries must check whether their specific medications remain on the plan's formulary, at what tier level, whether quantity limits or prior authorization requirements apply, and whether preferred pharmacies remain in-network. The Medicare Plan Finder tool allows entering exact medications with dosages to calculate annual drug costs across different plans.

The "Medigap Trap"

The "Medigap trap" catches beneficiaries who switch from Original Medicare plus Medigap to Medicare Advantage, then later want to return. Medigap policies provide guaranteed-issue enrollment only during the six-month window starting when you're 65 or older and enrolled in Part B. After this period, insurers in most states can use medical underwriting—denying coverage or charging substantially higher premiums based on health conditions. Once you leave Medigap for Medicare Advantage, returning to Medigap becomes very difficult or expensive if your health has declined.

Your Step-by-Step Guide to Navigating the Annual Enrollment Period

Step 1: Review Your Current Coverage (Early October)

Begin by reviewing your current coverage thoroughly. Read the Annual Notice of Change and Evidence of Coverage documents that arrived in late September, noting what's changing for the upcoming year in premiums, deductibles, copays, drug formularies, and provider networks. Review your Medicare Summary Notices or Explanation of Benefits statements from the past year to identify which services you actually used and what they cost.

Step 2: Create Your Healthcare Inventory

Document all current medications with exact dosages, regular doctors and specialists with names and addresses, anticipated healthcare needs including upcoming procedures or ongoing treatments, chronic conditions and their progression, your healthcare budget, and preferred pharmacies. This inventory becomes the foundation for comparing plans effectively.

Step 3: Use the Medicare Plan Finder Tool

The Medicare Plan Finder tool provides comprehensive plan comparison. Enter your ZIP code, current coverage type, all medications with dosages, up to three preferred pharmacies, and doctors and hospitals you want to keep. The tool calculates estimated total annual costs including premiums plus projected deductibles and copays for your specific drugs, displays Medicare Star Ratings showing quality measures, shows formulary coverage for your drugs, and indicates network status for your providers.

Step 4: Compare Total Costs

Calculate monthly premium plus annual deductible plus estimated copays and coinsurance for services you regularly use plus the maximum out-of-pocket limit representing worst-case scenario. For Medicare Advantage plans, distinguish in-network versus out-of-network costs, prior authorization requirements, referral requirements for specialists, and geographic coverage differences between HMO and PPO plans.

Step 5: Verify Provider Participation

Call providers directly rather than trusting online directories. Contact each doctor's office asking specifically whether they accept the plan you're considering for the upcoming year, call hospitals to confirm in-network status, and document each conversation. Online provider directories are often outdated and unreliable.

Step 6: Get Expert Assistance

State Health Insurance Assistance Program (SHIP) counselors provide free, unbiased one-on-one counseling from trained volunteers not connected to insurance companies. Find your local SHIP at shiphelp.org or by calling 1-877-839-2675. SHIP counselors help with personalized plan comparisons, explain coverage options, assist with applications for Extra Help and Medicare Savings Programs, and provide enrollment assistance. Contact them in October or early November for best availability.

Alternatively, call 1-800-MEDICARE at 1-800-633-4227, available 24/7 for questions and enrollment assistance.

Step 7: Enroll Before December 7

You can enroll through Medicare.gov/plan-compare, which provides immediate documentation, by contacting plans directly by phone or website, or by calling 1-800-MEDICARE. The last plan you select by December 7 determines your coverage starting January 1.

Important Coverage Effective Dates

All enrollment changes made during the Annual Enrollment Period take effect January 1, creating a uniform transition date regardless of when you enrolled during the October 15 to December 7 window. When you enroll in a new plan, your current plan automatically terminates on December 31. You don't need to separately disenroll from your old plan.

Your new plan sends welcome materials and ID cards in December, though cards sometimes arrive in early January. Many plans provide temporary member ID numbers for immediate use if cards haven't arrived.

The December 7 deadline is absolute. Enrollment requests must reach the plan by this date, whether submitted online, by phone, or via paper forms. Given potential mail delays, beneficiaries submitting paper enrollment forms should allow several days for delivery.

How a Solace Advocate Can Help

Navigating Medicare's Annual Enrollment Period can be overwhelming, especially when plans change every year and the stakes are high. A Solace advocate can guide you through the entire process, ensuring you make informed decisions about your healthcare coverage.

Your Solace advocate will:

• Review your current plan's Annual Notice of Change with you, explaining exactly what's changing and how those changes affect your care and costs. We translate complex insurance language into clear, straightforward terms you can understand.
• Compare all available plans in your area based on your specific medications, doctors, and healthcare needs. We use the Medicare Plan Finder tool alongside our healthcare expertise to calculate your true total costs—not just premiums, but the complete picture of what you'll actually pay throughout the year.
• Verify that your doctors and hospitals participate in any plan you're considering by calling provider offices directly and documenting the responses. We know that online directories can't be trusted, so we do the legwork to confirm network participation before you enroll.
• Identify potential problems before they become issues, like medications moving to higher formulary tiers, preferred pharmacies leaving networks, or coverage gaps that could affect your care. We catch these details that are easy to miss when reviewing plans alone.
• Assist with enrollment once you've selected the right plan, walking you through the process step-by-step and ensuring all paperwork is completed correctly and submitted before the December 7 deadline.
• Coordinate with your healthcare providers about the transition, ensuring prescriptions are refilled appropriately around the January 1 coverage change and that your doctors have your new insurance information.

Most importantly,  Solace stays with you throughout your healthcare journey. We're not just here for enrollment—we're your dedicated partner in navigating the healthcare system year-round. When you have questions about coverage changes, need help with claims, or face insurance roadblocks, we're already familiar with your situation and ready to help.

You don't have to figure this out alone. Medicare's complexity shouldn't prevent you from getting the coverage you deserve.

Frequently Asked Questions

What happens if I miss the December 7 deadline?

If you miss the Annual Enrollment Period deadline and need to make changes, your options become limited. Medicare Advantage enrollees can use the Medicare Advantage Open Enrollment Period from January 1 through March 31 to make one change, but those with Original Medicare and standalone Part D coverage generally must wait until the next Annual Enrollment Period unless they qualify for a Special Enrollment Period based on a life event like losing employer coverage or moving outside their plan's service area.

Can I change my mind after enrolling in a new plan during the Annual Enrollment Period?

Yes. You can change your mind multiple times during the enrollment window. If you realize you made a mistake or find a better option, simply enroll in a different plan before December 7. The last plan you select becomes your coverage for the following year. This flexibility is unique to the Annual Enrollment Period.

Do I need to cancel my current plan before enrolling in a new one?

No. When you enroll in a new Medicare Advantage or Part D plan during the Annual Enrollment Period, your current plan automatically terminates on December 31. You should never cancel your current coverage before your new coverage begins, as this could leave you without coverage. The enrollment process handles the transition automatically.

How do I know if my medications will be covered by a new plan?

Use the Medicare Plan Finder tool at Medicare.gov to enter your specific medications with exact dosages. The tool shows which plans cover your drugs, at what tier level, what your estimated costs would be, and whether any quantity limits or prior authorization requirements apply. Always verify this information directly with the plan before enrolling, as formularies can change and the online tool may not reflect the most current information.

What's the difference between Medicare Advantage Open Enrollment Period and Annual Enrollment Period?

The Annual Enrollment Period (October 15 - December 7) is for all Medicare beneficiaries and allows unlimited changes between Original Medicare and Medicare Advantage, switching between plans, and adding or dropping Part D coverage. The Medicare Advantage Open Enrollment Period (January 1 - March 31) is only for people already enrolled in Medicare Advantage as of January 1 and allows just one change—either switching to a different Medicare Advantage plan or returning to Original Medicare. The key difference is who can use it and how many changes you can make.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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