Every October, I start getting calls from clients and their adult children asking some version of the same question: "Do I need to do anything about Medicare?" The honest answer is that most people do nothing — and most years, that is probably fine. But some years it is a very expensive mistake. The problem is that you rarely know which kind of year it is until it is too late.
Medicare Open Enrollment runs from October 15 through December 7. Whatever changes you make take effect on January 1. It is the one window each year when you can review your coverage, compare your options, and make changes without penalty. After December 7, that window closes — and you are generally locked into whatever plan you have for the rest of the year.
In my years working with elderly clients and their families, I have seen the consequences of ignoring this period. A client who stayed in a Part D prescription drug plan that no longer covered her medications. A gentleman who kept his Medicare Advantage plan because switching seemed complicated — only to discover that his preferred specialist no longer accepted it. A widow who did not realize her husband's plan choices did not automatically carry over to her own coverage after he passed. These are not unusual stories. They are very common ones.
What Medicare Open Enrollment Actually Covers
There is a great deal of confusion about what you can and cannot change during Medicare Open Enrollment. Let me be direct about it.
- Switch from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C)
- Switch from Medicare Advantage back to Original Medicare
- Switch from one Medicare Advantage plan to a different one
- Enroll in a Part D prescription drug plan if you don't have one
- Switch from one Part D drug plan to another
- Drop Part D drug coverage entirely (though this is rarely wise)
- Add or switch Medicare Supplement (Medigap) plans without medical underwriting — Medigap has its own enrollment rules separate from this window
- Enroll in Medicare Parts A or B for the first time — that requires a different enrollment period
- Make retroactive changes for the current year
- Change coverage mid-year outside of special enrollment events
That last point about Medigap deserves emphasis. I see it cause real confusion. Medicare Supplement plans — the policies that pay the gaps left by Original Medicare — are not governed by the annual Open Enrollment period in the same way. Outside of your initial Medigap enrollment window when you first get Medicare, insurers can generally reject you or charge more based on your health status. This is one of the most important reasons to think carefully about your coverage choices when you first become eligible — because changing later is much harder.
The Part D Trap
Of all the areas where I see families make costly errors, Part D prescription drug coverage is at the top of the list. Drug plan formularies — the lists of covered medications and their cost tiers — change every year. A drug that was in Tier 2 this year may move to Tier 4 next year. A medication your plan covered in full may require prior authorization in January. Your plan may have added a new preferred pharmacy network that does not include your pharmacy.
"The plan that was right for you last year may not be right for you this year. Drug formularies change annually. Premiums change. Networks change. The only way to know is to look."
Each fall, Medicare beneficiaries receive an "Annual Notice of Change" from their plan. Most go unopened. That letter tells you exactly what is changing about your coverage in the coming year — premium changes, formulary changes, network changes. I encourage every client and every adult child who helps manage a parent's affairs to open that letter and read it.
The Medicare Plan Finder tool at Medicare.gov allows you to enter your current medications and compare the total annual cost — premiums plus out-of-pocket drug costs — across every plan available in your area. In many cases, switching plans can save hundreds of dollars per year. In others, staying put is the right call. But you cannot make that decision without looking.
Medicare Advantage: Network and Coverage Changes
If you are in a Medicare Advantage plan, the same principle applies. These plans — sometimes called Part C — are offered by private insurers and bundle hospital, medical, and often drug coverage together. They frequently have networks: lists of doctors, hospitals, and specialists who participate. Those networks can change from year to year.
Before renewing automatically in a Medicare Advantage plan, I would encourage you to confirm that your primary care physician, any specialists you see regularly, and your preferred hospital are still in the plan's network for the coming year. If your cardiologist left the network, or if your plan has added prior authorization requirements for procedures you rely on, that matters — and you will not find out unless you check.
What This Has to Do with Long-Term Care Planning
As an elder law attorney, I think about Medicare in a specific context: what happens when a client needs nursing home care or significant long-term services. And here the distinction between Medicare and Medicaid becomes critical.
Medicare covers skilled nursing facility care — but only for a limited time, and only following a qualifying hospital stay of at least three days. It does not pay for long-term custodial care: the help with bathing, dressing, eating, and daily activities that most nursing home residents actually need. That is Medicaid's role, and Medicaid has strict financial eligibility requirements.
I raise this because I see families assume that Medicare will "cover the nursing home." It will not — at least not beyond a defined short-term skilled period. Understanding that distinction now, before a crisis, is one of the most valuable things a family can do. And if a long-term care event is on the horizon, getting the right Medicare coverage in place during Open Enrollment — particularly around prescription coverage and specialist access — can meaningfully affect quality of life and out-of-pocket costs during what may be a very difficult period.
A Practical Checklist for Open Enrollment
Open Enrollment is not a complicated process if you approach it systematically. The difficulty is that most people are busy, the information is dense, and the consequences of doing nothing are invisible until they are not. My advice is simple: set aside an hour in October, gather your medication list, and check your plan. It is the kind of due diligence that quietly pays for itself.