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9 Reasons to Change Your Medicare Coverage During Open Enrollment

Reviewing your plan every year can save you money and avoid headaches

9-minute read

Article 2 out of 8 in Changing Medicare Plans

Tony Pugh and Tamara Lytle,

Updated October 13, 2026

AARP

Reviewed by

Jane Sung, J.D.

En español

Updated October 13, 2026

Illustration of doctors, a prescription bottle, exercise bike and health care symbols representing reasons to change Medicare coverage.

KOTRYNA ZUKAUSKAITE

Key takeaways

Use the Medicare sign-up period to keep your meds covered.
Coverage changes can help with travel plans or respond to a new illness.
Change plans to access a specialist or reflect infrequent doctor visits.
Lower income, retiree benefit changes may spur new coverage search.
Consider a change if a key doctor exits your plan or you need dental work.

Each fall, Medicare beneficiaries get a chance to switch or update their coverage for the upcoming year during Medicare open enrollment, which runs from Oct. 15 to Dec. 7.

It’s an opportunity to make important coverage changes — or comparison shop for cheaper options — but nearly 70 percent of Medicare’s 70.6 million beneficiaries don’t take advantage of it, according to KFF, a nonprofit, nonpartisan health care research organization.

During open enrollment in 2024, fewer than 1 in 5 beneficiaries changed their coverage for 2025, according to a poll of 931 older Medicare enrollees by SeniorLiving, an online publication.

By forgoing the chance to review and potentially change their Medicare coverage, people could miss out on improved care or significant savings. Or they could face potential surprises down the road about their benefits or health care choices.

“For most people, it’s a good idea to compare,” says Alex Cottrill, a senior policy analyst with KFF’s Program on Medicare Policy. “Even if they’re happy in their plan or they think their situation is fairly stable, it’s always a good idea to at least take a look.”

However, “we’ve generally seen that, most of the time, few people take advantage of that opportunity.”

Many feel confused and overwhelmed by the choices they face and simply opt to stick with their current coverage, Cottrill said.

But here are nine situations that might cause you to consider a change during the annual open enrollment. The information is based on interviews with several Medicare experts and guidance from Medicare itself.

First, a warning: Switching from a Medicare Advantage plan to original Medicare carries a big risk if you intend to supplement that coverage with a Medigap policy, which helps cover out-of-pocket expenses.

In most states, Medigap insurers can turn you down because of a preexisting health condition or charge you more based on your health or age if you’ve had Medicare Part B for more than six months or you’ve had Medicare Advantage for more than 12 months. Factor that into your decision-making.

You should consider changing your Medicare coverage during open enrollment if:

1. My prescription costs have jumped

That usually happens when:

Your Part D policy’s monthly premiums and required cost sharing have increased.
You’ve been prescribed a new drug your Part D policy doesn’t cover or covers with expensive cost-sharing.
Your current medicines have fallen off your Part D plan’s list of covered medicines.
Your health status has changed and new medications are required.

Each September, Part D prescription drug plans send out a list of modifications to their drug coverage, called the Annual Notice of Change (ANOC). That gives you time to make sure your medicines are still covered.

If they aren’t, you can shop around for another plan, ask your doctor to apply for an exception in covering your preferred medicine, or contact the plan yourself and have the doctor provide a written statement explaining why alternatives aren’t as effective or could cause problems. Remember, too, that your Part D annual out-of-pocket spending limit for prescriptions will increase to $2,400 in 2027. That’s up from $2,100 in 2026. To help you budget for your medication costs, consider joining the Medicare Prescription Payment Plan, which spreads your Part D out-of-pocket costs throughout the calendar year.

But if some of your medications aren’t covered in your present plan, your out-of-pocket costs won’t count toward the $2,400 maximum or your deductible. And they won’t be able to be added to the prescription payment plan.

2. I’m spending extended time in a different state

Medicare Advantage plans typically charge more for visitsto doctors outside of their networks. In some cases, they won’t cover any charges if it’s not an emergency.

So a Midwestern snowbird might have to pay more to see out-of-network doctors while in Florida. Read the details of your MA plan or talk with a representative to find out where you stand.

If you’ll be living a dual-residence existence for years to come, you might consider a switch to original Medicare.

3. I’ve been diagnosed with a chronic condition

A serious medical change such as a diabetes or even a prediabetes diagnosis should trigger a full review of your Medicare coverage. Consider the care you’ll need.

If you have a Medicare Advantage plan and want a gym membership or disease-specific programs, find a plan that offers them. If you anticipate needing a lot of specialists, check to see if your preferred ones are in your plan’s network. If you need new medications, make sure your plan covers them.

If you have original Medicare, make sure your Part D policy pays for any new prescriptions, or find one that does. And if you want to work out regularly, some Medigap plans that pair with original Medicare also offer free memberships or discounts. If you anticipate needing lots of specialists, 98 percent of all doctors who aren’t pediatricians accept Medicare, KFF points out.

Making critical changes early can “really affect your pocketbook and save you money,” says Gretchen Jacobson, a vice president with the Commonwealth Fund foundation.

4. I need surgery and prefer a specific doctor

Original Medicare allows patients to choose any doctor or hospital that accepts Medicare. And since that’s all but 2 percent of physicians who don’t specialize in treating children, chances are good that you’ll be covered.

But if you’re in a Medicare Advantage plan and its surgeons don’t meet your needs, you may need a different Medicare Advantage plan. Or you might need to switch to original Medicare — if you can be accepted into a Medigap plan. The Medicare Plan Finder began listing providers that participate in some MA plans during open enrollment for 2026 coverage.

Beneficiaries who’ve suffered major problems like cancer and heart attacks are the ones who really need to focus on which doctors are in their network, says Joseph Antos, senior fellow emeritus at the American Enterprise Institute, a public policy think tank.

“A specialist may be key to their treatment,” he says.

5. I’m super healthy and rarely need a doctor

If you’re in original Medicare, not seeing the doctor isn’t costing you anything extra beyond your mandatory Part B and Part D insurance premiums. If you’re in a Medicare Advantage plan that charges a monthly premium and offers lots of extra supplemental benefits, like gym memberships — on top of your mandatory Part B premium — a less-expensive monthly option might be to consider a lower-cost plan without services you don’t plan to use in the coming year.

6. My income has dropped sharply

If you are in original Medicare, your Part B monthly premium is locked in, but your Part D prescription drug plan costs are not. You may be able to find a lower-cost stand-alone Part D plan that covers the medicines you take. But remember to consider both premiums and cost sharing when shopping around. Plans with low premiums are often less generous and can lead to higher overall costs.

If you’re in a Medicare Advantage plan, consider a switch to a plan with no extra payment on top of the mandatory Part B premium.

If your Part B or Part D premiums include an income-related monthly adjustment amount (IRMAA), you can fill out Form SSA-44 to request a review of those additional fees.

And you might qualify for help. Ask your state Medicaid office — links to state offices are on the federal Medicaid website — or State Health Insurance Assistance Program (SHIP) about Medicare Savings Programs. Or call 800-MEDICARE (800-633-4227) or the SHIP helpline at 877-839-2675. And don’t forget the Part D Extra Help program that provides financial assistance with premiums and out-of-pocket costs for people with limited resources.

7. My former employer is changing its retiree benefits

Some companies provide retirees with supplemental insurance, which covers many health costs that original Medicare doesn’t.

If you have changes to your retiree benefit coverage, or if that coverage is no longer offered, contact Medicare’s Coordination of Benefits & Recovery Call Center at 855-798-2627. Someone can tell you whether you fall in the window in which Medigap insurers cannot deny you coverage based on preexisting conditions.

8. My regular doctor is no longer in network for my plan

If you want to stay with a doctor, ask directly whether he or she is moving to a different Medicare Advantage plan, accepting original Medicare patients or dropping out of Medicare completely.

If you decide to make a change, make sure a short-term decision won’t affect your long-term coverage. For example, you wouldn’t want to switch to original Medicare to keep one doctor if it turns out you can’t qualify for Medigap coverage. It might be safer to ask your doctor to recommend a colleague in your current plan.

9. I’m looking for dental coverage

Original Medicare doesn’t cover routine dental care costs, but many Medicare Advantage plans do.

If you don’t have your own dental insurance and can’t afford dentistry costs out of pocket, you can buy a stand-alone dental policy. Some Medigap insurers also offer discounts on dental services if you choose from their list of in-network dentists.

If you have Medicare Advantage, you can consider finding a plan that will cover a portion of the costs of your needed work. But Antos warns that figuring out what portion of your dental bills a Medicare Advantage plan will cover is complicated — some plans cover little more than routine cleanings — so it helps to know what services you will use in the coming year.

People considering leaving original Medicare just to get dental coverage offered in Medicare Advantage should first discuss the broader coverage implications with a counselor from their State Health Insurance Assistance Program.

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This story, originally published Oct. 12, 2021, has been updated with information for the 2027 Medicare plan year.

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About the authors

Tony Pugh is an award-winning writer and editor covering Medicare for AARP. He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.

Tamara Lytle is a veteran political reporter whose work has been published in The Washington Post, the Orlando Sentinel and many other news outlets.

About the reviewer

Jane Sung, director of health care costs and access at the AARP Public Policy Institute, previously worked as health policy counsel at the National Association of Insurance Commissioners, senior policy adviser to a leader in the House of Representatives and federal legislative analyst in the Maryland governor’s office. She earned her law degree from American University’s Washington College of Law.