Key Takeaways
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You should reevaluate certain parts of your Medicare coverage every single year because plans, costs, and rules change regularly.
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Reviewing your coverage during AEP helps you avoid surprises and stay aligned with your current health needs and budget.
Looking Ahead At Medicare’s Changing Landscape
Medicare changes from one year to the next, and these adjustments can influence how well your current plan fits your needs. Even if your health has stayed the same, your plan benefits, costs, covered medications, and provider networks may not. The Annual Enrollment Period (AEP), running from October 15 to December 7 each year, gives you the chance to make changes for the upcoming year. When you review certain areas consistently, you stay in control of your coverage and can make adjustments before they turn into problems.
This article outlines what you should reevaluate every single year so you can stay ahead of Medicare’s annual adjustments for 2026.
Reviewing Your Health Needs
How Have Your Medical Needs Changed This Year?
Your healthcare needs often shift more than you expect. Routine checkups, new diagnoses, and changes in prescribed medications all influence the type of coverage you require. Ask yourself:
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Did your doctor recommend new treatments?
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Do you expect more frequent visits next year?
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Are your current benefits enough to support your needs?
Evaluating these details early helps you understand whether your existing plan still meets your medical requirements.
Evaluating Prescription Drug Coverage
Are Your Medications Covered The Same Way?
Plans adjust their drug lists every year. These formularies affect what medications are covered, the tiers those drugs fall under, and what you pay for them.
You should review:
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Whether your medications remain on the formulary
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Any tier changes that affect your out-of-pocket costs
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Whether your preferred pharmacy is still included
These changes directly influence your total prescription spending for the year. Reviewing them during AEP ensures that you protect yourself from unexpected cost increases.
Checking Provider Networks
Is Your Doctor Still In Your Plan’s Network?
Doctor networks can shift annually. If your primary care physician or specialist is no longer in your plan’s network for 2026, you may experience higher costs or lose access altogether.
Confirm the following each year:
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Your doctor’s network status for the upcoming year
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Available specialists in your area
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Network restrictions related to travel or seasonal residence
This step helps you avoid surprise bills and ensures that your care stays uninterrupted.
Understanding Annual Cost Adjustments
What Costs Are Changing For 2026?
Every year, Medicare updates cost-related items such as deductibles, premiums, and out-of-pocket limits. These changes impact how much you may need to budget. For 2026, you should review:
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Adjustments to Medicare Part A and Part B costs
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Updated deductible amounts
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Out-of-pocket maximums
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Changes to copayments and coinsurance amounts
General cost changes happen on a predictable yearly cycle. Evaluating them now helps you prepare your budget for the next calendar year.
Reviewing Supplemental Benefits
Are Extra Benefits Still Included?
Some plans include additional benefits, and these may change from year to year. Even if you rely on these benefits only occasionally, it is important to confirm:
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Whether the benefits are still offered
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Whether the rules around eligibility or usage have changed
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Whether limits or coverage caps were updated
Small adjustments to supplemental benefits can significantly influence your overall satisfaction with your plan.
Examining Prior Authorization Rules
Have Authorization Requirements Changed?
Many services require prior authorization. These rules can shift annually, and if you do not review them, you may accidentally schedule appointments or procedures without knowing they need approval.
Carefully review your plan’s latest authorization requirements, especially if you anticipate tests, imaging, physical therapy, or specialist visits in 2026.
Comparing Available Plan Options
Are There Better Options For Your Needs This Year?
AEP allows you to switch coverage if your current plan no longer fits your needs. Even if you choose to stay with your existing plan, it is beneficial to compare:
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Costs for similar plans in your area
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Differences in drug coverage across options
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Availability of providers within each network
A comparison once per year helps ensure you are not overlooking a plan that better aligns with your medical needs.
Evaluating Your Total Annual Spending
What Did You Spend Last Year?
Your expenses from the previous year create a clear picture of how well your plan served you. Review:
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Total prescription spending
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Copayments and coinsurance amounts
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Out-of-pocket maximums you reached
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Costs related to doctor visits and diagnostics
If these costs were higher than expected, it may be time to consider a new plan.
Making Sense Of The Annual Notice Of Change
What Is Your ANOC Telling You?
Your Annual Notice of Change (ANOC) explains everything changing in your plan for the following year. This document arrives each September. Look for:
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Cost updates for the upcoming year
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Changes to drug coverage
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Network and benefit updates
Reviewing this document helps you understand whether your plan still supports your needs for 2026.
Staying Proactive For The Year Ahead
Why Should You Reevaluate Every Year?
Medicare changes regularly, and small adjustments can gradually affect your coverage. Reevaluating each year ensures your plan stays aligned with your:
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Health status
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Prescription needs
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Budget
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Doctor preferences
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Travel habits
A yearly review during AEP keeps your coverage in the strongest possible position.
Moving Forward With Confidence
You have several moving parts to review each year, and understanding them helps you avoid surprises and stay ahead of Medicare’s annual adjustments. When you take the time to reevaluate your coverage, you protect yourself from unexpected costs and ensure you are ready for the year ahead. If you need help reviewing your options or want personalized guidance, reach out to any of the licensed agents listed on this website for clear and reliable assistance.
