Choosing or changing your Medicare coverage isn’t something to rush. Each year, your health needs, prescriptions, and budget can shift—and plans change too. Use this simple checklist so you can feel confident in your decision.
1) Confirm your doctors and hospitals are in-network
Provider networks can change. Before you commit to a plan, verify that your primary care doctor, specialists, preferred hospital, and clinics participate in the plan’s network. Out-of-network care can mean higher costs or no coverage.
2) Re-check your prescriptions
Make a fresh list of every medication you take (dosage and frequency). Compare it to each plan’s formulary:
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Is each drug covered?
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What tier is it on?
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Are there quantity limits or prior authorization?
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What will you pay at your preferred pharmacy vs. mail order?
3) Estimate total annual cost—not just the premium
Look at the full picture:
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Monthly premiums
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Deductibles
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Copays/coinsurance
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Maximum out-of-pocket (for Medicare Advantage)
Sometimes a slightly higher premium can save you more across the year if you see doctors regularly or take multiple prescriptions.
4) Review extra benefits (and what they require)
Some plans include dental, vision, hearing, fitness, transportation, or OTC allowances. Check the fine print:
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Coverage limits and frequencies
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Approved providers
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Any referrals or authorizations needed
5) Check travel and snowbird needs
If you spend time in another state, ask how the plan works away from home. Original Medicare + Medigap typically offers broader flexibility, while Medicare Advantage plans vary by network and emergency coverage rules.
6) Consider your preferred doctors vs. lowest cost
There’s often a trade-off between maximum choice (Original Medicare + Medigap) and potentially lower premiums with limited networks (Medicare Advantage). Decide which matters more for your situation, then compare accordingly.
7) Understand enrollment windows
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AEP (Annual Enrollment Period): Oct 15–Dec 7 — review or change Medicare Advantage/Part D for the next year.
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OEP (Open Enrollment Period): Jan 1–Mar 31 — if you’re already on Medicare Advantage, you can make a one-time switch to another Advantage plan or go back to Original Medicare (with the option to enroll in a Part D plan).
8) Avoid late-enrollment penalties
If you’re delaying Part B or Part D because you’re still working, make sure your employer coverage is creditable and that you enroll within the special enrollment window when you retire or your coverage ends.
9) Get a no-pressure plan review
Plans update annually. A quick review can help ensure your coverage still fits your needs and budget. Bring:
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Your Medicare card (and any plan cards)
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List of prescriptions
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Preferred pharmacies
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List of doctors/specialists
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Any planned procedures
FAQs
Is Original Medicare enough by itself?
Original Medicare (Parts A & B) doesn’t include most prescriptions and doesn’t cap your out-of-pocket costs. Many people add a Part D plan and consider a Medigap plan for predictable costs.
What’s the difference between Medicare Advantage and Medigap?
Medicare Advantage (Part C) replaces Original Medicare with a private plan, usually with networks and an out-of-pocket max. Medigap is supplemental insurance that works with Original Medicare to help pay remaining costs; you’ll pair it with a separate Part D plan for prescriptions.
Can I keep my doctor?
It depends on the plan. Always check the network (for Advantage) or confirm a provider accepts Medicare (for Original Medicare/Medigap).
