Every fall, Medicare beneficiaries are given an opportunity to reconsider their health coverage. Most don’t.
A KFF analysis of federal survey data found that during the enrollment period for 2025 coverage, 69% of Medicare Advantage enrollees did not compare their coverage with other Medicare options. Even more striking, in 2022, 43% didn’t review their existing plan for changes in premiums or other out-of-pocket costs while 82% didn’t review it for changes in drug coverage.
The behavior is understandable. If you like your doctors, your prescriptions are covered and nothing went particularly wrong during the year, staying with the same plan can feel like the safe choice.
But doing nothing is still a decision.
Medicare’s Open Enrollment Period, which runs from October 15 through December 7, allows beneficiaries to change Medicare Advantage plans, switch between Medicare Advantage and Original Medicare, or change prescription drug coverage. The better question during this period isn’t, “Am I happy with my plan?” It’s “If I were choosing coverage today, knowing what I know now, would I choose this plan again?”
Neither the plan nor the person enrolled in it necessarily looks the same as they did a year ago.
Your plan may have changed
A familiar insurance card can create a false sense of continuity. Plans can change premiums, deductibles, copayments, prescription drug coverage and supplemental benefits from one year to the next. Those changes are spelled out in the Annual Notice of Change beneficiaries receive each fall, but important details can easily disappear inside pages of insurance language.
And a $0 premium doesn’t mean healthcare costs nothing. Medicare Advantage plans have an annual out-of-pocket limit for covered Medicare services, but costs for individual services vary by plan. A hospitalization, series of specialist visits or outpatient procedure can make seemingly small differences suddenly matter.
That makes one question particularly worth asking: What could this plan cost me if I actually have to use it?
CMS projects the weighted average Medicare Advantage premium will decline 16.5%, from $14.37 a month in 2026 to $12 in 2027. But averages don’t tell you whether your specialist copay increased, hospital costs changed or a benefit you use was reduced.
There is also no shortage of alternatives. CMS says 97% of Medicare beneficiaries will have access to at least 10 Medicare Advantage plans in 2027. Staying may still be the right choice. But having that much choice makes it worth knowing what you’re choosing not to consider.
Your provider network may have changed
People don’t experience healthcare through an insurance company. They experience it through doctors, hospitals, pharmacies and other providers. That’s why reviewing coverage should include checking whether the physicians and healthcare systems that matter most are still participating.
The issue has become increasingly visible. Major health systems including Mayo Clinic, Johns Hopkins and UNC Health were among those that had eliminated or reduced relationships with some Medicare Advantage plans in 2026.
Then there is prior authorization. In 2024, Medicare Advantage insurers made nearly 53 million prior-authorization determinations. They denied 7.7% of requests in whole or in part. Only 11.5% of those denials were appealed, but 80.7% of the denials that were appealed were ultimately overturned in whole or in part.
That doesn’t mean every initial denial was inappropriate. It does show why the mechanics behind an insurance plan can matter as much as the benefits advertised during enrollment.
Someone who rarely sees a doctor may barely notice these distinctions. Someone who develops cancer, needs surgery or begins seeing several specialists may experience them very differently. Don’t just check whether your primary care physician is in network. Think about the healthcare system you would want access to if something serious happened.
Your medications may have changed
The third review should happen at the medicine cabinet. Prescription drug coverage can change from year to year, and so can the medications a beneficiary takes. A drug can move to a different tier, cost-sharing can change, and a medication may require prior authorization or other restrictions.
For 2027, the Part D out-of-pocket threshold rises to $2,400, up from $2,100 in 2026. Once the applicable threshold is reached, beneficiaries generally pay $0 for covered Part D drugs for the remainder of the year.
That’s important protection, but it doesn’t make formularies irrelevant. What matters for most people is what they spend before reaching that threshold — and whether their drugs are covered under favorable terms.
Before renewing, enter every medication you currently take into Medicare’s Plan Compare tool and compare estimated annual costs. The plan that worked when you took two inexpensive medications may not be the plan you would choose now that you take six.
Your health may have changed
This may be the most overlooked part of Medicare Open Enrollment. People naturally evaluate insurance based on their experience during the previous year. But insurance is designed primarily to protect against what happens next.
Maybe the last year brought a new diabetes diagnosis, a knee that will probably need replacing, early memory problems or cancer. Perhaps a spouse can no longer drive you to appointments. Or it may simply be the reality that at 78, your healthcare needs aren’t what they were at 72.
Those changes should alter how you evaluate coverage. Someone managing several chronic illnesses may place more value on access to particular specialists. Someone expecting surgery should understand inpatient and outpatient cost sharing. Someone beginning to need more help at home may look more closely at supplemental benefits and care coordination.
The question isn’t simply whether your plan worked last year. It’s whether it fits the healthcare you’re increasingly likely to need next year.
Your financial life may have changed, too
Healthcare and financial planning are often treated as separate subjects. Retirement has a way of proving otherwise. Income changes. A spouse dies. Long-term care expenses appear. Someone who previously focused on premiums may suddenly care much more about predictable out-of-pocket exposure.
So don’t compare plans solely on what you pay every month. Look at specialist copays, hospital costs, outpatient surgery, imaging, prescription drugs and the maximum out-of-pocket limit. Then ask a different financial question: What happens if this is the year I get sick?
A plan with a slightly higher monthly cost may provide better financial protection for the way you actually use healthcare. The reverse can also be true.
For higher-income beneficiaries, Medicare can also cost more than expected. Income-related adjustments increase Part B and Part D premiums, often based on tax returns from two years earlier. A Roth conversion, capital gain or required minimum distribution can push someone into a higher premium bracket.
But even affluent beneficiaries who can afford to pay privately shouldn’t assume their financial resources eliminate the complications of a poorly matched Medicare Advantage plan. Self-pay may provide alternatives, but it doesn’t necessarily eliminate delays in securing appointments, coordinating specialists or navigating treatment decisions. Wealth can buy more options, but it doesn’t automatically buy easier access to care.
Make your current plan compete for your business
None of this means beneficiaries should switch Medicare Advantage plans every year. For someone whose physicians, medications, costs and health needs remain well served, staying put may be exactly the right choice.
But there is an important difference between choosing to stay and simply failing to reconsider.
Medicare beneficiaries can already compare 2027 coverage using Medicare’s Plan Compare tool. Changes made during the October 15 through December 7 Open Enrollment Period generally take effect January 1. Open Enrollment isn’t necessarily an invitation to change plans. It’s an invitation to make the plan you already have earn another year of your business.
Pull out the Annual Notice of Change. Make a list of your physicians, hospitals and medications. Think honestly about what has changed in your health and finances. Then compare your existing coverage with what’s available.
You may end up exactly where you started. But this time, doing nothing will have been a decision.