Understanding Medicare Open Enrollment: What You Need to Know

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Every year, Medicare’s open enrollment period offers a short window of opportunity to make changes that can have a lasting impact on your healthcare—and your wallet. Yet many people approach it unsure of where to begin, what to look for, or how to make decisions that truly work for them.

The independent health insurance agents at Stith & Associates Health Insurance Agency, Inc.  talk to individuals and families all the time who feel overwhelmed by the process. This guide is here to help simplify what can feel like a complex task. Whether you’re enrolling for the first time or reviewing your current plan, here’s what you should know to make the most of this crucial period.

What Is Medicare Open Enrollment?

Medicare Open Enrollment runs from October 15 to December 7 each year. This is the time when individuals already enrolled in Medicare can:

• Switch from Original Medicare (Part A and B) to a Medicare Advantage (Part C) plan—or vice versa
  
  

• Change from one Medicare Advantage plan to another
  
  

• Join, switch, or drop a Part D prescription drug plan
  
  

These changes take effect on January 1 of the following year.

Why This Period Matters

Life changes—and so do healthcare needs. Maybe your prescription list has grown. Perhaps your doctor is no longer in-network. Or, maybe a better plan option is available for the upcoming year with lower premiums, better coverage or fewer restrictions.

Open enrollment allows you to reevaluate your current situation and adjust your coverage accordingly. But the window is brief, and decisions made during this time can shape your healthcare for the next 12 months.

What You Should Review

Before making any changes, take a close look at your current plan. Consider:

• Monthly costs: Are your premiums and out-of-pocket costs manageable?
  
  

• Prescription coverage: Are your medications still covered under your current plan’s formulary?
  
  

• Provider network: Are your doctors and preferred hospitals still in-network?
  
  

• New benefits: Are there any added perks (like dental, hearing, vision, or gym memberships) you’d like to take advantage of?
  
  

Even if you're happy with your plan, it's a good idea to confirm nothing has changed in the plan’s structure for the upcoming year. Carriers adjust coverage all the time—and it's up to you to catch those changes before they affect your care or your budget.

Common Mistakes to Avoid

One of the biggest mistakes people make is simply doing nothing. Assuming your current plan is “good enough” without reviewing the updates for the next year can be costly. Drug plans, in particular, tend to update their formularies, and a drug you rely on this year might cost significantly more in the next.

Another common issue is choosing a plan based solely on premium costs. While low premiums might seem appealing, they can sometimes mean higher deductibles, narrower networks, or fewer prescription options. It’s essential to look at the total picture.

How to Get Help Making the Right Choice

You don’t have to figure this all out on your own. Medicare’s official website offers plan comparison tools, but navigating them can still be a bit tricky. Speaking with a licensed independent agent—someone who understands both the national options and local provider networks—can give you a clearer sense of what makes the most sense for your personal health situation.

Agents can also help you:

• Compare Part D drug plans based on your current prescriptions
  
  

• Find Medicare Advantage plans that include dental, vision or other added benefits
  
  

• Understand the differences between Medigap (supplemental) coverage and Advantage plans
  
  

• Make sure your preferred doctors are covered under any new plan you consider

Don’t Wait Until the Last Minute

Although Medicare Open Enrollment stretches over several weeks, it’s best not to wait until the final days. Reviewing your plan, gathering necessary information, and asking questions takes time. And with deadlines set in stone, procrastination can leave you stuck with a plan that no longer fits your needs.

How to Make the Most of Medicare Open Enrollment

Although the open enrollment period runs through early December, acting early is strongly recommended. Reviewing plan changes, comparing coverage options, and verifying provider networks can take time—especially when prescription coverage or out-of-pocket costs are involved.

Waiting until the last minute increases the risk of missing important plan changes or overlooking better alternatives. Early preparation allows for a smoother transition into the new year with confidence in the selected coverage.

Choosing the right Medicare plan is not just about minimizing costs—it's about finding a balance between comprehensive benefits, access to preferred providers, and long-term peace of mind.

For those who need guidance, working with a licensed independent insurance agent can provide clarity during the decision-making process. With support from someone familiar with both national and local plan options, enrollees can avoid guesswork and move forward knowing they’ve made an informed choice.