Key takeaways
- October 1 is when next year's Medicare Advantage and Part D plan information becomes available to review. The Annual Enrollment Period runs October 15 – December 7.
- Plans change every year — premiums, copays, drug formularies, pharmacy and provider networks, out-of-pocket limits, prior authorization rules, and extra benefits can all shift.
- Don't assume this year's plan is automatically right for next year — and don't assume you need to switch because an advertisement shows a bigger benefit.
- A bigger advertised benefit doesn't make a better plan. A larger dental allowance means little if your doctor, hospital, or medication is treated worse.
- If someone calls about "additional Medicare benefits," don't assume they're from Medicare, your insurer, or your agent — and never feel obligated to decide while they have you on the phone.
- Sometimes the right recommendation is to switch. Sometimes it's to stay exactly where you are. Good guidance is willing to say both.
If you have Medicare, get ready. Your mailbox is about to get fuller. Your phone may ring more often. Your television will fill with Medicare commercials. Emails, postcards, flyers, and advertisements will promise better benefits, lower costs, more extras, or a plan you simply have to hear about.
And beginning October 1, you’ll be able to see Medicare Advantage and Part D plan information for the upcoming year. Which means one thing: Medicare marketing season is about to get very loud.
Before all of that begins, we want our clients — and anyone trying to make sense of Medicare — to understand two things:
The plan with the flashiest benefits is not necessarily the best Medicare plan for you. And a Medicare advertisement is not the same thing as personalized Medicare advice.
What happens with Medicare plans every fall?
Medicare Advantage and Part D prescription drug plans can change from one year to the next — sometimes substantially.
| What can change | Why it matters to you |
|---|---|
| Monthly premium | The most visible change, and often the least important one |
| Medical copays and coinsurance | What you actually pay at each visit |
| Prescription drug costs | Frequently the largest real-world difference between plans |
| Drug formulary | A medication can move tiers, gain restrictions, or drop off entirely |
| Pharmacy network | Your pharmacy may no longer be “preferred” |
| Provider network | Your doctor or hospital may no longer be in network |
| Maximum out-of-pocket limit | Your worst-case exposure in a bad health year |
| Prior authorization requirements | How easily you can actually get care approved |
| Dental, vision, and hearing benefits | The extras most often featured in advertising |
| Over-the-counter allowances | Nice to have, rarely the deciding factor |
Some plans may also leave a service area entirely, while new plans become available.
That’s why you shouldn’t assume the plan that worked well this year is automatically the best choice next year. But the opposite is equally true: you shouldn’t assume you need to change plans simply because another plan advertises a benefit that looks better.
October 1 is an important date
Medicare’s Annual Enrollment Period runs from October 15 through December 7 each year. But October 1 matters because that’s when information about next year’s Medicare Advantage and Part D plans becomes available for you to review. It gives you a window to understand your options before enrollment opens.
It’s also when the marketing intensifies. You may suddenly find yourself wondering:
- Is there something better than what I have?
- Am I missing benefits?
- Should I switch plans?
- Why does this plan have a bigger dental benefit than mine?
- This commercial says I could get more benefits — do I qualify?
Those are all reasonable questions. They just can’t be answered by looking at one benefit on a postcard or in a thirty-second commercial.
A bigger benefit doesn’t automatically mean a better plan
Suppose you see a Medicare Advantage plan advertising a larger dental benefit than your current plan. Sounds better, right?
Maybe. But consider what the advertisement doesn’t tell you:
- What if your doctors aren’t in that plan’s network?
- What if one of your important medications is covered differently?
- What if your preferred hospital is out of network?
- What if the plan has different prior authorization requirements?
- What if your specialist copay increases?
- What if the pharmacy you use isn’t preferred?
- What if you’re giving up another benefit that matters far more to you?
Medicare plans have to be evaluated as an entire package — not one benefit at a time. That’s one of the biggest mistakes we see people make during the Annual Enrollment Period.
Before you change plans, ask these questions
Before switching a Medicare Advantage or prescription drug plan, look past the headline benefits. Here’s what we work through when reviewing options.
Are your doctors and specialists in the network?
Don’t assume that because a doctor accepts Medicare, they accept every Medicare Advantage plan. Those are different things.
What about your hospitals and health systems?
If there’s a particular hospital, cancer center, specialist group, or health system you want access to, this can matter more than every extra benefit combined.
How are your prescriptions covered?
We look at the actual medications you take — including dosages and your pharmacy — rather than simply comparing drug plan premiums.
Are there prior authorization or referral requirements?
A plan can look wonderful on paper and operate very differently when you actually need care.
What will your healthcare realistically cost?
A $0 premium doesn’t mean $0 healthcare costs. Copays, coinsurance, deductibles, drug costs, and your maximum out-of-pocket exposure all belong in the math.
What are you gaining — and what are you giving up?
This may be the most important question of all. Switching shouldn’t be about finding something new. It should be about determining whether the new option is genuinely better for you.
Be careful about phone calls this fall
Medicare beneficiaries are bombarded with marketing in the fall. If someone calls and starts talking about additional Medicare benefits, don’t assume they’re calling from Medicare, from your insurance company, or from your current agent.
And don’t feel you need to make an insurance decision simply because someone has you on the phone.
Your Annual Notice of Change matters
If you’re currently enrolled in a Medicare Advantage or Part D plan, pay attention to your Annual Notice of Change — the ANOC. This document explains how your current plan is changing for the upcoming year.
Don’t throw it away. Changes to premiums, copays, drug coverage, benefits, and other features all affect whether your current coverage still makes sense. Our walkthrough of how to read your ANOC covers the five sections worth fifteen minutes of your time.
For our clients, this annual review is why we work so hard each fall. We aren’t simply looking for something new — we’re looking for whether something needs to change.
Sometimes the best recommendation is to change plans. Sometimes the best recommendation is to stay exactly where you are. Good Medicare guidance should be willing to tell you both.
Don’t choose a plan based on the brand name
A recognizable insurance company isn’t automatically the best choice. Neither is the company running the most television commercials. And neither is the plan advertising the biggest extra benefit.
Major insurers can offer excellent plans in one county and far less competitive options somewhere else. Medicare Advantage and Part D coverage depends heavily on where you live, your providers, your prescriptions, and your circumstances.
That’s why “what is the best Medicare plan?” isn’t really the right question. A better one:
“What is the best Medicare option for me, based on my doctors, medications, healthcare needs, finances, and priorities?”
That’s a very different conversation.
Frequently asked questions
When can I actually make a change? The Annual Enrollment Period runs October 15 through December 7, with changes effective January 1. October 1 is simply when you can start reviewing next year’s plan information.
What happens if I do nothing? Your current plan generally renews into its next-year version, with every change described in your ANOC. That’s fine when it’s a verified decision, and expensive when it’s a shrug.
Is a $0-premium plan really free? No. A $0 premium refers only to the plan’s monthly cost. You can still owe copays, coinsurance, deductibles, and drug costs, and you continue paying your Part B premium.
Should I switch if my friend loves their plan? Not necessarily. Their doctors, medications, and county may be entirely different from yours. The same plan can be an excellent fit for one person and a poor one for their neighbor.
Does a plan leaving my area mean I lose Medicare? No. If a plan is discontinued you keep Medicare and get a window to choose new coverage — as we covered when Humana cut plans for 2027.
Is there any reason to enroll early rather than wait until December 7? Possibly. Beyond simply having more time to check doctors and drugs, some 2027 Medicare Advantage plans can carry an enrollment capacity limit and close once it’s reached.
The bottom line: don’t let the advertising decide for you
October is coming. So are the commercials, the mailers, the phone calls, and the promises of bigger benefits.
Some of those plans may genuinely be worth considering. Others will look much better in an advertisement than they do once you examine the details. Don’t make a Medicare decision based on the loudest advertisement.
If you’d like help before the noise starts, our September prep checklist walks through the homework that makes an October decision easy — and the 2027 Medicare & You handbook covers what’s changing across Medicare next year.
Already a Mere Benefits client? You don’t have to navigate this season alone. You’re going to see advertisements, hear about friends’ plans, and get calls about something you’re supposedly missing. Before you make a change, talk to us. There may be a good reason your current plan still makes sense — and there may be a good reason we recommend changing it. Our job isn’t to keep you in any particular insurance company’s plan. It’s to help you make an informed decision about your circumstances.
Not a client yet? If you’ve been trying to figure Medicare out by yourself, you don’t have to. Mere Benefits is an independent agency — we are not Medicare, and we are not employed by one insurance company. Reach out for a free, no-obligation review or call 904-654-5450. Kate Spilsbury (RSSA®, CMIP®) is an independent, licensed agent based in Jacksonville, serving Northeast Florida and Camden County, GA.
Because Medicare shouldn’t be a contest to see which advertisement gets your attention first. It should be a thoughtful decision about your healthcare — and you deserve someone who can explain what all of it actually means for you.
Mere Benefits is an independent insurance agency and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits, provider networks, formularies and costs vary by plan and service area. Enrollment is subject to applicable Medicare enrollment periods and eligibility requirements. This article is educational and not medical, tax, or legal advice.
Founder & Licensed Insurance Agent at Mere Benefits — RSSA®, CMIP®. Independent, no-pressure guidance across Northeast Florida & Camden County, GA. This article is educational and not medical, tax, or legal advice.
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