Every autumn, Medicare beneficiaries get a crucial window that far too many people overlook. It is a chance to review their health coverage, cut unnecessary costs and ensure access to the doctors they need.
Medicare’s annual open enrollment runs from Oct. 15 to Dec. 7. During these weeks, you can switch Medicare Advantage plans, adjust your Part D drug coverage, or return to Original Medicare if that works better for your health and budget. Yet year after year, most older adults do nothing — costing them money and frustration.
It’s easy to see why. Navigating Medicare options in the first place is exhausting, full of complex jargon and endless plan variations. Once you’ve picked a plan and gotten used to it, sticking with the status quo feels like the easiest, safest move. But staying on autopilot can silently drain your retirement savings.
Health plans rarely stay the same from year to year. Insurers regularly tweak premiums, deductibles, copays, network directories and drug lists to manage their own costs. A primary care doctor or specialist you’ve relied on for years might suddenly drop out of network without much warning. A routine daily medication could jump to a more expensive pricing tier or require new prior authorization rules. Even extra perks that attracted you initially — like dental, hearing or vision allowances — can quietly shrink or disappear altogether.
Checking your coverage starts with a piece of mail many people toss directly into the recycling bin, the annual notice of change. Insurers send this essential document in late September. While it isn’t thrilling reading, it details every major operational shift taking effect on Jan. 1. Reading it carefully is your best defense against unexpected medical bills in the new year.
As you look over your options, keep a few practical questions in mind:
— Your doctors: Are your primary care physicians, preferred specialists, physical therapists and local hospitals still fully in the network?
— Your prescriptions: Are your current medications still on the plan’s formulary list, and will your copays go up?
— Upcoming care: Has your health changed over the last year? If you know you’ll need a major procedure in 2027 — like a hip replacement, cataract surgery or specialized rehabilitation — will your plan leave you with heavy hospital bills or restrictive prior authorizations?
— The full picture: Are you looking at total out-of-pocket limits and potential deductibles, rather than just choosing the plan with the lowest monthly premium?
A sudden bump in medical costs can hit especially hard when you’re living on a fixed income. To make matters worse, open enrollment brings a fresh wave of deceptive mailers, high-pressure sales pitches and outright scams targeting older adults.
Aggressive brokers often push plans that benefit their commissions rather than your health needs. If someone calls or texts claiming you’ll lose your benefits unless you act immediately, hang up. Official Medicare representatives will never call out of the blue asking for your Social Security number or financial details. When in doubt, check Medicare.gov or call 1-800-MEDICARE directly.
If you live in San Diego County, you don’t have to figure this complex system out on your own. You can get free, confidential, unbiased guidance through the Health Insurance Counseling and Advocacy Program (HICAP), run locally by Elder Law and Advocacy. State-certified counselors there help you compare options without trying to sell you a thing. You can also connect with San Diego County’s Aging and Independence Services for local support and resources.
Don’t wait until the frantic final days before the December deadline to start looking. The right Medicare plan isn’t the one with the flashiest TV commercials or the one your neighbor picked. It’s the one that covers your specific doctors, covers your exact prescriptions and fits your actual budget. Taking a couple of hours to review your options now can save you hundreds of dollars and endless frustration in the year ahead.
Downey is the chief advocacy officer for the San Diego Seniors Community Foundation. He has over 30 years’ experience as a national leader on aging policy and program services, including serving as the chair of the California Commission on Aging.