Medicare Annual Enrollment Period: Everything You Need to Do

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Medicare Annual Enrollment Period: Everything You Need to Do

Key Takeaways

AEP runs October 15–December 7 each year — your main chance to change Medicare coverage
Plans change annually — even if you were happy last year, your doctor might be dropped from the network or your medication costs could spike
Use the Medicare Plan Finder tool at medicare.gov/plan-compare to compare total estimated annual costs, not just premiums
Free help is available — contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling
Changes take effect January 1 — so you must act during the October 15–December 7 window
Missing the deadline locks you in — you’ll be stuck with your current plan until next year’s AEP unless you qualify for a Special Enrollment Period

What Is the Medicare Annual Enrollment Period?

Every fall, Medicare beneficiaries face a critical decision window. The Medicare Annual Enrollment Period (AEP) runs from October 15 to December 7 each year — and it’s your main opportunity to review, change, or switch your coverage. Missing this window or ignoring it can mean paying hundreds or even thousands of dollars more than necessary, or staying locked in a plan that no longer serves your healthcare needs.

Think of AEP as your annual Medicare “refresh” button. During this seven-week window, you can make significant changes to your coverage that take effect on January 1 of the following year. However, once December 7 passes, you’re generally locked into whatever coverage you have — barring a qualifying life event — until the next October.

What Changes Can You Make During AEP?

The AEP allows you to make four major types of changes:

Switch from Original Medicare (Parts A & B) to a Medicare Advantage (Part C) plan — moving from fee-for-service coverage to a managed care plan
Switch from Medicare Advantage back to Original Medicare — returning to the government’s traditional plan
Change from one Medicare Advantage plan to another — switching between different MA insurers or plan types
Join, switch, or drop a Medicare Part D prescription drug plan — changing how your medications are covered

All changes made during AEP take effect on January 1 of the following year. This is why timing matters — you need to complete your enrollment by December 7 to ensure your new coverage starts on the first day of the new year.

Why You Should Review Your Coverage Every Single Year

Many Medicare beneficiaries assume that if they’re satisfied with their current plan, there’s no need to revisit it during AEP. This is one of the costliest mistakes you can make. Medicare plans are not static — they change dramatically from year to year.

How Plans Change Year to Year

Even if you love your current Medicare plan, significant changes can occur that make it less suitable for your needs. Here’s what commonly happens:

Your doctor gets dropped from the network. Insurance companies frequently negotiate new networks, and your trusted cardiologist, primary care physician, or specialist may no longer be included. This is especially common with Medicare Advantage plans, which have narrower networks than Original Medicare.
A medication you depend on is removed from the formulary. Insurers regularly update their drug lists, and a medication that was covered at a low copay might be removed entirely or moved to a higher tier, increasing your out-of-pocket costs from $10 per month to $50 or more.
Premiums and out-of-pocket maximums increase. The monthly premium you paid last year might jump 10-20% or higher. Even worse, the plan’s maximum out-of-pocket limit could increase, meaning you’d pay more if you have expensive medical needs.
New benefits become available. Your plan might add dental, vision, hearing, or even transportation benefits that could save you significant money if you take advantage of them.
Copays and coinsurance change. Your $30 doctor visit copay might increase to $35 or $40. Specialist copays, hospital stays, and emergency room visits all have different cost structures that plans adjust annually.

The Annual Notice of Change (ANOC)

Every September, Medicare requires all insurers to send you an “Annual Notice of Change” (ANOC) letter. This document outlines every modification to your plan for the upcoming year — premium changes, new copay amounts, formulary updates, and network modifications. This letter is your roadmap, and reading it carefully is essential. Don’t throw it away or ignore it. Set aside 30 minutes to review it before AEP opens on October 15.

Step-by-Step Guide: What to Do During AEP

Step 1: Gather All Your Important Information

Before you start comparing plans, collect the following documents and information:

A complete list of all your prescription medications — include the drug name, dosage, and how often you take it (e.g., metformin 1000mg twice daily)
A list of your preferred healthcare providers — your primary care physician’s name, any specialists you see regularly (cardiologist, endocrinologist, orthopedist), and the hospitals or surgical centers you prefer
Your current plan’s Annual Notice of Change (ANOC) letter — this shows what’s changing in your existing plan
Your Medicare card — you’ll need this information when comparing plans
Your current insurance card if you have supplemental coverage (Medigap) or any other health insurance
Recent medical bills or statements — this helps you estimate your total healthcare costs for the year

Taking 15-20 minutes to organize this information upfront will make the entire comparison process much faster and more accurate.

Step 2: Use the Medicare Plan Finder Tool

Medicare’s official Plan Finder tool is your most powerful resource. Located at medicare.gov/plan-compare, this free tool allows you to:

Enter your ZIP code to see all available plans in your area
Enter your current medications to see how they’re covered under each plan
View your specific healthcare providers and confirm they’re in-network
See a total estimated annual cost for each plan — this is far more useful than just comparing monthly premiums

Example: Let’s say Plan A costs $45/month but has a $1,500 deductible and $50 copays for doctor visits. Plan B costs $89/month but has no deductible and $20 copays. The Plan Finder shows you that Plan A’s total estimated annual cost is $3,240, while Plan B is $2,890. Most people would choose based on monthly premium alone, but the Plan Finder reveals Plan B saves you $350 per year.

Spend 30-45 minutes in the Plan Finder. Compare at least 3-5 different plans, noting which options include your doctors, cover your medications, and offer the lowest total estimated annual cost.

Step 3: Verify Your Doctors Are In-Network

This step is critical if you’re considering switching to a Medicare Advantage plan. Unlike Original Medicare, which accepts all Medicare providers nationwide, MA plans have limited networks. Being out-of-network can mean paying 40-50% more for services, or even no coverage at all in HMO plans.

For each plan you’re considering:

Verify your primary care physician is in-network
Check each specialist you see regularly (cardiologist, dermatologist, oncologist, etc.)
Confirm your preferred hospital and surgical centers are included
If you see a therapist or mental health provider, make sure they’re covered

You can do this through the Plan Finder tool or by calling the insurance company directly. If your doctor isn’t in-network and you want to keep seeing them, choose a different plan. Switching doctors mid-year for cost reasons is a major stressor.

Step 4: Check How Your Medications Are Covered

Prescription drug coverage is one of the biggest cost variables between plans. Medicare Part D plans use a “tiered formulary” system:

Tier 1 (Generic drugs) — lowest copay, usually $5-15 per prescription
Tier 2 (Preferred brand-name drugs) — moderate copay, usually $25-50
Tier 3 (Non-preferred drugs) — higher copay, usually $50-100+
Tier 4 & 5 (Specialty drugs) — highest copay or coinsurance, often $100+

Example: Suppose you take atorvastatin (for cholesterol) and lisinopril (for blood pressure). In Plan A, both are Tier 1 generics at $10 each per month — $240 per year. In Plan B, atorvastatin is Tier 1 but lisinopril is Tier 3 at $75 per month — totaling $900 per year for the same medications. The Plan Finder will show these differences, making the choice obvious.

For each medication you take, check:

Is it covered on the plan’s formulary?
What tier is it on?
What’s the copay or coinsurance amount?
Are there quantity limits or prior authorization requirements?

Sometimes switching to a generic alternative can save enormous amounts. If your current medication is expensive, ask your doctor if a generic option exists. Many doctors are happy to switch you if it reduces your costs.

Step 5: Enroll or Make Changes

Once you’ve decided which plan works best for you, it’s time to enroll. You have several convenient options:

Online at medicare.gov — the fastest option if you’re comfortable with computers
By phone at 1-800-MEDICARE (1-800-633-4227) — toll-free, available 24/7, with representatives who can answer questions
By contacting the insurance company directly — each plan has its own enrollment phone number, usually found on their website or in their marketing materials
Through a licensed insurance broker — brokers are paid by insurance companies, so their help is free to you, and they can walk you through the entire process
Through a SHIP counselor — unbiased, free help available in every state

Whichever method you choose, you’ll need your Medicare card and personal information handy. Enrollment typically takes 10-15 minutes online or 20-30 minutes by phone.

Understanding Other Medicare Enrollment Periods

While AEP is the primary enrollment period, other windows exist for special circumstances:

Medicare Advantage Open Enrollment Period (MA OEP): January 1–March 31 — If you’re already enrolled in a Medicare Advantage plan, this gives you one additional chance to switch to a different MA plan or return to Original Medicare. You can only make one change during this period.
Initial Enrollment Period (IEP): 7-month window around your 65th birthday — This is for first-time Medicare enrollment. It spans three months before your birth month, your birth month itself, and three months after.
Special Enrollment Period (SEP): Various dates throughout the year — Available if you have a qualifying life event such as moving to a new state, losing coverage from an employer, getting married, or experiencing other major changes. You typically have 60 days to enroll after a qualifying event.

If you miss AEP and don’t qualify for a Special Enrollment Period, you’ll be locked into your current plan until the next October. This is why marking October 15 on your calendar is so important.

Free Help and Resources

State Health Insurance Assistance Program (SHIP)

Every state has a SHIP office staffed with trained counselors who provide free, unbiased Medicare guidance. These volunteers and employees have no financial incentive to steer you toward any particular insurance company or plan — they’re simply there to help you understand your options and make informed decisions.

SHIP counselors can:

Help you navigate the Plan Finder tool
Explain the differences between Original Medicare and Medicare Advantage
Answer questions about prescription drug coverage
Help you understand your rights and benefits
Assist with enrollment if you need guidance

Find your local SHIP at shiphelp.org or by calling 1-800-MEDICARE.

Medicare.gov Resources

The official Medicare website has extensive information:

Plan Finder (medicare.gov/plan-compare) — the core tool for comparing plans
Medicare Coverage Database — search for specific drugs, procedures, and services
Provider Directory — check if your doctors are included in specific plans
Educational materials and videos — learn about different plan types and coverage options

Insurance Brokers

Licensed insurance brokers can be helpful resources during AEP. However, understand their limitations:

Brokers can only sell plans they’re contracted with — they may not represent every insurance company or plan option in your area
They’re paid by insurance companies — so their advice is free to you, but they have a financial interest in directing you toward certain plans
They’re not unbiased — unlike SHIP counselors, brokers have a financial stake in which plan you choose

Using both a broker AND the Medicare Plan Finder tool gives you the most complete picture. The Plan Finder shows all available options, while a broker can provide personalized guidance.

Common Mistakes to Avoid During AEP

Seniors frequently make costly errors during enrollment:

Comparing only monthly premiums — a $30/month plan might cost $500+ more per year than a $50/month plan when you factor in deductibles and copays
Not checking if their doctor is in-network — discovering your cardiologist isn’t covered after enrollment is stressful and expensive
Assuming their medications are covered — many beneficiaries don’t verify formulary coverage until they try to fill a prescription in January
Waiting until December to compare plans — you’ll have less time to