Do these 3 things before closing this tab:
1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minuteStart with your plan’s Annual Notice of Change (ANOC), then compare your complete next-year exposure—not just the monthly premium. Check the Evidence of Coverage (EOC), service costs, annual out-of-pocket limit, doctors and hospitals, prescription coverage, pharmacies, rules such as referrals and prior authorization, and benefits you actually use. Enter your ZIP code and exact medicines in Medicare Plan Finder, verify that a switch is permitted during your enrollment period, and ask any employer, union, retiree or other benefits administrator before dropping existing coverage.
Plan details are specific to your ZIP code and coverage year. The dollar figures below for Part D apply to 2026 only and can change annually.
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Why a yearly review matters
Medicare plans can change their premiums, deductibles, copayments, coinsurance, provider networks, formularies and extra benefits for a new calendar year. A plan that worked well this year can become more expensive or less useful after January 1, even if its name looks familiar. Medicare sends an ANOC each fall so members can decide whether the plan will continue to meet their needs in the next year.
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The review is not a search for the lowest advertised premium. It is a comparison of your likely medical and drug spending, the doctors and pharmacies you can use, and the financial risk of a high-use year. A plan with a higher premium can cost less overall if it has lower cost sharing for services or medicines you use frequently. Conversely, a low-premium plan can be a poor fit if your clinicians leave its network or your prescriptions move to an expensive tier.
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Read the two notices your plan sends
Annual Notice of Change (ANOC)
The ANOC is the first document to open. Medicare says plans send it each fall, with changes effective in January. Read every section that differs from the current year, including:
- Monthly plan premium and any premium for optional benefits.
- Annual medical and drug deductibles.
- Copayments and coinsurance for primary care, specialists, hospital stays, emergency care, outpatient services, therapy, durable medical equipment and other services you use.
- The annual out-of-pocket limit for covered medical services, if your plan has one.
- Provider-network or service-area changes.
- Changes to covered services, supplemental benefits, referrals, prior authorization, step therapy or other utilization rules.
- Prescription formulary changes, drug tiers, quantity limits, utilization rules and preferred pharmacies.
If the ANOC does not arrive, contact the plan rather than assuming nothing changed. Keep the notice with your other Medicare documents; it is a year-specific record of what the plan told you.
Evidence of Coverage (EOC)
The EOC supplies the detailed terms behind the summary in the ANOC. Use it to confirm exactly what is covered, which services require approval or a referral, how costs are calculated and what exclusions apply. Look up the service codes or benefit categories that match your planned care instead of relying on a general statement such as “specialist visits covered.” The EOC is also where you can check definitions, appeal rights and procedures for obtaining services outside the normal network.
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Make a one-page inventory of your actual use and expected needs. Include your doctors, hospitals, laboratories, preferred pharmacies, recurring treatments, planned procedures, travel pattern and every prescription. Note whether you need care in more than one state or outside your plan’s service area. This list turns a generic plan comparison into a test of whether a plan fits you.
Record your current coverage
- Plan name and type (Medicare Advantage, stand-alone Part D, Original Medicare with or without supplemental coverage).
- Monthly plan premium and the Part B premium you continue to owe when enrolled in Medicare Advantage.
- Medical and drug deductibles.
- Copayments or coinsurance for the services you use most.
- Annual out-of-pocket limit for covered medical services, if applicable.
- Names of physicians, hospitals, specialists, pharmacies and other facilities you want to keep.
- All medicines, strength, dose, quantity and refill frequency.
- Benefits you actually use, such as dental, vision, hearing, transportation or fitness allowances.
- Rules that affect access, including referrals, prior authorization, step therapy and network restrictions.
Separate fixed costs from use-based costs
Fixed costs are premiums and any recurring fees. Use-based costs are deductibles, copayments and coinsurance. Estimate both a typical year and a high-use year. For the high-use estimate, apply the plan’s annual out-of-pocket limit to covered medical services and add premiums and drug spending that the limit does not cover. Do not assume the medical out-of-pocket limit includes premiums, Part D spending or services the plan excludes; read the plan’s definition.
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Compare Medicare Advantage with Original Medicare on risk, not slogans
Medicare Advantage plans set their own cost-sharing amounts and have a plan-specific annual out-of-pocket limit for covered health services. After you reach that limit, the plan pays 100% of covered services for the remainder of that calendar year. You still generally pay the Medicare Part B premium in addition to any Medicare Advantage premium.
Original Medicare generally has no yearly limit on out-of-pocket costs. A person using Original Medicare can reduce or change that exposure with supplemental coverage such as Medigap, but premiums, eligibility and underwriting rules may apply. Joining Medicare Advantage is another way to obtain a plan-defined annual limit, but it usually means using the plan’s network and authorization rules.
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| Feature | Medicare Advantage | Original Medicare |
|---|---|---|
| Medical cost sharing | Plan-specific copayments or coinsurance; amounts vary by service and plan. | Medicare cost-sharing rules apply; supplemental coverage may pay some amounts. |
| Annual medical out-of-pocket limit | Required for covered medical services; after reaching it, the plan pays 100% of covered services for the rest of the calendar year. | Generally no yearly limit unless you have supplemental coverage or enroll in Medicare Advantage. |
| Provider access | Usually tied to a plan network and service area; referrals or prior authorization may apply. | Uses providers that accept Medicare; supplemental policies do not create a Medicare Advantage-style network. |
| Part B premium | Continues in addition to any plan premium. | Continues; other premiums may apply for Medigap or prescription coverage. |
| Prescription coverage | Often included through the plan’s Part D benefit; formulary and pharmacy rules vary. | Usually added through a stand-alone Part D plan unless another qualifying source covers drugs. |
Neither arrangement is automatically cheaper. Your result depends on the services you need, the providers you use, your prescriptions, your tolerance for network rules and your ability to absorb a large bill in a high-use year.
Compare every cost that can change your annual total
Premiums and the continuing Part B premium
Record the plan premium for the new coverage year and multiply it by 12. If you are considering Medicare Advantage, include the Part B premium in both comparisons because enrolling in the plan does not generally replace that payment. A plan advertised with a $0 premium can still involve substantial service copayments, drug costs, a deductible or other out-of-pocket exposure.
Deductibles
Check whether medical and prescription deductibles are separate, whether they apply to all services or only certain categories, and whether a deductible resets each calendar year. For Part D in 2026, the maximum deductible is $615, although some plans charge less or no deductible. The $615 figure is a statutory maximum for that year, not the deductible every enrollee pays.
Copayments and coinsurance
Copayments are set dollar amounts; coinsurance is a percentage of the allowed amount. Compare the services you actually use, such as specialist visits, inpatient days, outpatient surgery, imaging, chemotherapy, dialysis, physical therapy and durable medical equipment. A percentage can create a much larger bill than a flat copayment when the allowed amount is high.
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For Medicare Advantage, write down the plan’s annual limit for covered medical services and identify what is excluded. Test a high-use scenario, such as a hospitalization followed by rehabilitation and frequent specialist care. Add premiums and any drug spending separately when estimating your total exposure, because the medical limit does not automatically cap every Medicare expense.
Prescription costs and the 2026 Part D thresholds
Use your exact medicine list in Medicare Plan Finder. Enter each drug’s name, dose, quantity and frequency, then compare the estimated annual total—not only the first month’s price. The estimate depends on whether the plan covers the medicine, its tier, utilization restrictions and the pharmacy you select.
For 2026, Medicare identifies $2,100 as the Part D out-of-pocket threshold for covered drugs. Reaching that amount moves an enrollee beyond the initial coverage phase under the year’s rules. The maximum Part D deductible for 2026 is $615. These are year-specific figures; Medicare changes cost amounts periodically, so confirm the rules for the coverage year you are evaluating.
Pharmacy choice
Enter the pharmacy you actually use and compare it with mail order and preferred in-network pharmacies shown by the tool. The same prescription can have different prices depending on the pharmacy arrangement. Confirm that a nearby pharmacy is in network and that mail order is practical for medicines requiring special handling or frequent adjustments.
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Check doctors, hospitals and access rules
Verify every important provider
Search the plan’s current directory for each doctor, hospital, laboratory, imaging center and therapy provider you use. Then call the provider’s office to confirm participation for the exact plan name and coverage year; directories can lag behind contracting changes. Ask whether the provider is accepting new patients and whether the facility bills the plan for the service you need.
Understand network types and referrals
Determine whether the plan is an HMO, PPO or another structure and what happens when you use an out-of-network provider. A PPO may cover out-of-network care at a higher cost, while an HMO may generally require network care except for emergencies or authorized exceptions. Read the EOC for referral requirements, prior authorization, step therapy and rules for planned hospital or specialist care.
Account for travel and multiple residences
If you spend part of the year in another state, verify routine-care access there, not just emergency coverage. Check the plan’s service area, visitor or travel benefits, telehealth availability and procedures for obtaining authorization while away. A plan that works near your primary home may be inconvenient or financially risky during an extended stay elsewhere.
Use Medicare Plan Finder for a like-for-like comparison
Medicare’s live Plan Finder asks for a ZIP code so it can display plans available in your area. At the time of the latest review, it also displayed an option to review 2027 plans; the screen and available plans can change. Always select the coverage year you are actually evaluating.
- Enter your ZIP code. This filters plans, premiums, networks and formularies to your location.
- Choose your coverage type. Compare Medicare Advantage plans, stand-alone Part D plans or both, depending on your current arrangement and eligibility.
- Add every prescription. Use the exact drug name, dose, quantity and refill schedule. Do not omit an occasional medicine if you expect to use it next year.
- Enter your pharmacies. Compare the pharmacy you prefer with in-network, preferred and mail-order options displayed by the tool.
- Review annual and monthly estimates. Examine premiums, deductibles, estimated drug spending and total yearly drug costs. Treat the estimate as a planning figure, not a guarantee.
- Open plan details. Check medical cost sharing, the annual out-of-pocket limit, provider network, service area, referrals, prior authorization and covered benefits.
- Confirm your doctors and facilities independently. Use the plan directory and call offices before relying on a result.
- Save the comparison. Keep the plan name, plan identification information, effective date and the assumptions used for your medication list and pharmacy.
Compare no more than a manageable shortlist in detail. A spreadsheet with one column per plan and rows for your actual services, prescriptions, providers, rules and high-use exposure makes differences visible.
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Use this decision framework before choosing a switch
| Question | What to verify | Why it can change the decision |
|---|---|---|
| What will I pay in a typical year? | Annual premiums, Part B premium, routine-service copayments and estimated drug costs. | Shows whether a lower premium is offset by frequent service or pharmacy charges. |
| What happens in a high-use year? | Medical annual out-of-pocket limit, hospital and specialist cost sharing, plus premiums and drug exposure outside that limit. | Measures financial risk when care is extensive. |
| Can I keep my care team? | Current participation of doctors, hospitals, laboratories and therapists for the exact plan and year. | Network changes can force a provider change or create higher costs. |
| Will my medicines remain affordable? | Formulary coverage, tier, restrictions, deductible, pharmacy pricing and annual estimate for every drug. | A single uncovered or restricted medicine can outweigh a premium difference. |
| Can I obtain care where I need it? | Service area, referrals, authorization rules, travel and multi-state arrangements. | Access rules matter if you travel, live in two places or need specialized care. |
| Are extra benefits useful to me? | Dental, vision, hearing, transportation or other benefits, including limits and participating providers. | An advertised benefit has little value if its allowance, network or eligibility does not match your use. |
Choose the plan that meets your access needs at an annual cost and risk level you can tolerate. Do not assign a cash value to a benefit you are unlikely to use, and do not treat a plan’s star rating or marketing summary as a substitute for checking your own providers and medicines.
Confirm that you are allowed to switch
Medicare permits joining, switching or dropping Medicare Advantage or Part D plans only during applicable enrollment periods, unless a special circumstance creates another opportunity. Check the period that applies to your situation, the effective date of a change and any restrictions on returning to prior coverage.
Before submitting an enrollment request, contact an employer, union, retiree plan, military-related administrator or other benefits administrator if that coverage is involved. Dropping or changing Medicare coverage can affect other benefits, and an administrator can explain consequences that a plan comparison tool cannot.
Keep confirmation numbers, submitted dates and effective-date notices. Do not cancel existing coverage until you know the new enrollment was accepted and when it starts, unless an authorized administrator instructs you otherwise.
Get free, independent help when the choices interact
Medicare’s State Health Insurance Assistance Program (SHIP) offers free, personalized health insurance counseling and is not connected to an insurance company or health plan. SHIP can help you interpret an ANOC, compare plans using your medicine list, check enrollment timing and think through interactions with employer or retiree coverage.
Bring your ANOC, EOC, Medicare card, medication bottles or current list, provider names, pharmacy preference and questions about travel. A counselor can explain options, but you remain responsible for confirming the final plan’s network, formulary and enrollment effective date.
Common review mistakes and how to avoid them
- Comparing premiums only: Add the Part B premium where applicable, routine cost sharing, drug spending and high-use exposure.
- Using last year’s drug list: Re-enter the exact medicines for the new coverage year because formularies and prices can change.
- Trusting an old provider directory: Confirm participation with the provider’s office for the exact plan and year.
- Ignoring authorization rules: Read the EOC for referrals, prior authorization, step therapy and quantity limits before assuming a service is readily available.
- Assuming the out-of-pocket limit covers everything: Separate covered medical services from premiums, prescription spending, excluded care and out-of-network charges that the plan treats differently.
- Forgetting travel needs: Check routine-care arrangements outside the service area, not merely emergency coverage.
- Switching before checking other coverage: Ask an employer, union, retiree or other benefits administrator what a change would do to related benefits.
- Waiting until after enrollment: Verify the enrollment period and effective date before dropping current coverage.
A practical annual checklist
- Find the ANOC and mark every changed cost, benefit, network or rule.
- Use the EOC to read the detailed terms for services and prescriptions you use.
- List your doctors, facilities, pharmacies, medicines, planned care and travel needs.
- Calculate current and alternative plans’ annual premiums, Part B premium, deductibles, cost sharing and drug estimates.
- Model a high-use year using each Medicare Advantage plan’s medical out-of-pocket limit, while keeping premiums and drug costs separate.
- Check provider participation, service area, referrals, prior authorization and formulary restrictions.
- Run the same ZIP code and medicine list through Medicare Plan Finder for the correct coverage year.
- Ask any other benefits administrator about consequences of changing coverage.
- Confirm the applicable enrollment period, submit the change through an authorized channel and retain the confirmation.
- After enrollment, verify the effective date, identification materials, provider access and prescriptions before your first appointment or refill.
What your final decision should answer
Before switching, you should be able to answer five questions in writing: What will I pay in a normal year? What is my exposure in a high-use year? Can I keep the providers and pharmacies that matter? Are every one of my prescriptions covered at an acceptable cost and with workable restrictions? Am I allowed to make this change now, and will it affect other coverage?
If any answer is uncertain, pause the switch and use the EOC, the plan’s member services, the applicable benefits administrator or SHIP to resolve it. Plan prices, benefits, networks, formularies and available plans are location- and year-specific, so make the final choice from your own ANOC and current Plan Finder results rather than an older summary.
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