What should I review during Medicare open enrollment each year?
Last reviewed: July 2026
A Medicare open enrollment checklist is the short list of items you review every fall between October 15 and December 7, the one stretch each year when you can change your Medicare coverage for the year ahead. Five things are worth checking in order: your Part D drug plan, your Medicare Advantage or Original Medicare choice, your 2026 premiums and deductibles, any income-based IRMAA surcharge, and whether your current coverage still fits your health and budget. Miss the window and your choices are mostly locked in until the next year, with a couple of exceptions covered below. Here is how to work through each item.
On This Page
- Key Takeaways
- Step 1: Start Your Medicare Open Enrollment Checklist With the Key Dates
- Step 2: Review Your Part D Formulary and 2026 Drug Costs
- Step 3: Compare Medicare Advantage vs Original Medicare for Next Year
- Step 4: Check Your 2026 Premiums, Deductibles, and IRMAA Surcharges
- Step 5: Reassess Your Coverage Against Your Health and Budget
- Related Topics Worth Reading
- Frequently Asked Questions
- Disclosures
Key Takeaways
- Medicare open enrollment runs October 15 to December 7 each year — any changes take effect January 1.
- Part D plans revise their formularies every year; re-run your prescriptions in the Medicare Plan Finder even if your plan looks unchanged on the surface.
- The 2026 Part D out-of-pocket cap is $2,100 — once you hit it, covered drugs cost nothing for the rest of the year, per CMS 2026 guidelines.
- The standard 2026 Part B premium is $202.90 per month, with IRMAA surcharges beginning above $109,000 in individual income.
- Missing the December 7 deadline locks most coverage choices in place until the following fall, with limited exceptions under the Medicare Advantage Open Enrollment Period.
About the Author: Jeff Judge, CFP®, AEP®, ChFC®, CLU® is Managing Partner of Chesapeake Financial Planners in Forest Hill, Maryland. He has been helping families and business owners in Harford County and the Baltimore metro area work through Medicare enrollment decisions since earning his CFP® certification in 2013, by using Chesapeake Financial Planners’ signature process, the R.U.D.D.E.R. method™. Every fall, Jeff watches clients renew the same plan out of habit, then get caught in January when a medication they take is no longer on the covered list.
Step 1: Start Your Medicare Open Enrollment Checklist With the Key Dates
The first item on any Medicare open enrollment checklist is the calendar. The Medicare Annual Enrollment Period, sometimes called Medicare annual enrollment or the fall open enrollment window, runs from October 15 to December 7 each year. According to the official Medicare open enrollment page, "Open Enrollment happens from October 15 – December 7 and is the time each year when you can make changes to your coverage." Anything you change during that window starts January 1.
Here is what you can actually do between those dates: switch from Original Medicare to a Medicare Advantage plan or back, change from one Medicare Advantage plan to another, join a Part D drug plan, switch Part D plans, or drop drug coverage. What open enrollment does not do is set your premium. It locks in your carrier and plan structure for the year, not the price, which is published separately each fall.
What if I am brand new to Medicare?
If you are aging in, your Initial Enrollment Period is different from the annual window. It is a seven-month period around your 65th birthday: the three months before your birthday month, the month itself, and the three months after. Sign up late without qualifying coverage and you can face lifelong Part B penalties, so this is one deadline not to treat casually. For a fuller breakdown of how the parts connect, see What are Medicare Parts A, B, C, and D?.
Step 2: Review Your Part D Formulary and 2026 Drug Costs
Your Part D formulary, the plan's list of covered drugs, is the line item that changes most quietly. Plans revise their formularies, tiers, and pharmacy networks every January. A drug that was a low copay this year can move to a higher tier, require prior authorization, or drop off the list entirely, and the plan is not required to call you about it.
The bigger 2026 change is structural. Part D now has a hard $2,100 annual out-of-pocket cap on covered drugs. Once your spending hits that ceiling, you pay nothing more for covered prescriptions the rest of the year. That cap reshapes the math for anyone on expensive specialty medications, and it is a reason to re-run your drug costs in the Medicare Plan Finder even if your plan looks unchanged on the surface. For more on how this part works, see how Part D drug coverage works.
This is the step Jeff Judge flags most often with clients. People assume "no letter, no change," but the annual notice of change is exactly where a quiet formulary swap hides. Read it.
Step 3: Compare Medicare Advantage vs Original Medicare for Next Year
The Medicare Advantage vs Original Medicare decision is the one most people revisit during open enrollment, and for good reason. More than 35 million people, about 54% of those with Part A and B, are now enrolled in Medicare Advantage. That popularity does not make it the right call for you. It makes it worth a real comparison.
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Provider access | Any provider nationwide that accepts Medicare | Network-based (HMO or PPO), often local |
| Monthly cost | Part B premium plus optional Medigap and Part D | Often $0 added premium, with copays that vary |
| Drug coverage | Requires a separate Part D plan | Usually bundled into the plan |
| Out-of-pocket cap | None on its own; Medigap can limit exposure | Annual cap required by law |
| Extra benefits | Not included as standard | May add dental, vision, and hearing |
| Tends to suit | People who want provider freedom and predictable costs with Medigap | People comfortable with a network in exchange for lower upfront premiums |
One detail that catches people: if you are already in a Medicare Advantage plan and change your mind, you get a second window. The Medicare Advantage Open Enrollment Period runs January 1 to March 31 and lets you switch plans once or move back to Original Medicare. Original Medicare enrollees do not get that extra window, which is why the fall decision carries more weight for them.
Step 4: Check Your 2026 Premiums, Deductibles, and IRMAA Surcharges
Costs change every January, and they change whether or not you touch your plan. For 2026, the Centers for Medicare and Medicaid Services set the standard Part B premium at $202.90 per month with a $283 annual deductible. The Part A inpatient hospital deductible is $1,736 per benefit period for those who pay it.
If your income is above a threshold, you also pay the Income-Related Monthly Adjustment Amount, or IRMAA, on top of those premiums. In 2026, the surcharge starts once modified adjusted gross income passes $109,000 for an individual or $218,000 for a married couple filing jointly. At that first tier, Social Security adds $81.20 per month to your Part B premium, bringing it to $284.10, plus $14.50 per month on Part D.
Here is the part that surprises people: IRMAA uses a two-year lookback, so your 2026 surcharge is based on your 2024 tax return. A one-time income spike, like a Roth conversion or a home sale, can push you over a bracket two years later. If a life event such as retirement dropped your income since then, you can appeal using Form SSA-44. Jeff Judge plans around this lookback with clients well before they enroll, because the cheapest way to manage IRMAA is to see it coming. For how this interacts with retirement account moves, see How do Roth conversions affect IRMAA and Medicare Part B premiums?.
Step 5: Reassess Your Coverage Against Your Health and Budget
The final step is the one the first four feed into: does this coverage still match your life? Health changes, new prescriptions, a move, or a doctor leaving your network are all reasons to act during the window rather than wait. The goal is not to switch for the sake of switching. It is to confirm the plan you have is still the plan you would choose today.
This is where a repeatable process helps. The R.U.D.D.E.R. Method™ is Chesapeake Financial Planners' six-step planning process: Review and Recognize, Uncover and Understand, Design and Develop, Discuss and Decide, Execute and Empower, and Reassess and Refine. Medicare open enrollment is a Reassess and Refine moment by design. You already have coverage; once a year you check it against what changed and refine where it makes sense. Jeff Judge notes: "Open enrollment is the one window a year where doing nothing is still a choice, and we want every client making it on purpose after checking their drug formulary and network, not just because December 7 came and went."
Run the five steps in order, give yourself a week before December 7, and you have done the work. Coverage you choose on purpose beats coverage you kept by default.
Related Topics Worth Reading
- Medigap or Medicare Advantage: how do I choose?
- How do I get health insurance between early retirement and Medicare?
- How do you maximize Social Security and Medicare benefits in retirement?
- How Much Should I Budget for Healthcare Costs in Retirement?
Frequently Asked Questions
When is Medicare open enrollment in 2026?
Medicare open enrollment runs from October 15 to December 7, 2026, the same dates it falls on every year. Any changes you make during that window, such as switching drug plans or moving between Original Medicare and Medicare Advantage, take effect on January 1, 2027. Mark the December 7 deadline, since it does not move.
What happens if I miss the December 7 deadline?
If you miss December 7, you generally keep your current coverage for the next year and lose the chance to change most of it until the following fall. There are limited exceptions: the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets current Advantage members switch once, and certain life events trigger a Special Enrollment Period outside the normal window.
Does my Medicare Advantage plan automatically renew?
Yes, most Medicare Advantage and Part D plans renew automatically if you do nothing, but that is exactly why you should review them. The plan can change its formulary, network, copays, and benefits for the new year while keeping the same name. Read the annual notice of change your plan mails in September to see what is different before you let it roll over.
Can I switch from Medicare Advantage back to Original Medicare?
Yes. You can move from Medicare Advantage to Original Medicare during fall open enrollment from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. Keep in mind that if you want a Medigap policy to go with Original Medicare, you may have to answer health questions, since guaranteed-issue rights are limited after your initial window.
Why did my Part D plan's drug list change?
Part D plans revise their formularies every year, moving drugs between tiers, adding restrictions, or dropping coverage based on their contracts and clinical reviews. Your specific medication can become more expensive even if your premium stays flat. That is why running your actual prescriptions through the Medicare Plan Finder each fall matters more than comparing premiums alone.
Do I have to do anything during open enrollment if I am happy with my plan?
You are not required to make a change, and doing nothing keeps your current plan in place. Even so, a quick review is worth the time, because plans change their costs and coverage from year to year while you stay enrolled. Checking your formulary and the new 2026 cost figures takes an afternoon and can prevent an expensive surprise in January.
If this Medicare open enrollment checklist was useful, our Medicare cost-planning guide breaks down how your income affects premiums and IRMAA in retirement. Download it at chesapeakefp.com.
Disclosures
The information provided is for educational purposes only and should not be construed as investment advice. Investment strategies should be tailored to individual circumstances, risk tolerance, and goals. Past performance doesn't guarantee future results. Consult with qualified financial professionals regarding your specific situation.
Advisors associated with Chesapeake Financial Planners may be either (1) LPL Financial Registered Representatives offering securities through LPL Financial, Member FINRA and SIPC, and investment advisor representatives offering investment advice through Great Valley Advisor Group; or (2) solely investment advisor representatives offering investment advice through Great Valley Advisor Group and not affiliated with LPL Financial. Great Valley Advisor Group, and Chesapeake Financial Planners are separate entities from LPL Financial.
