What to Review Every Year Before Keeping Your Medicare Plan

Every fall, Medicare plans release their details for the upcoming year. Premiums can change. Drug formularies can shift. Provider networks can expand or contract. Benefits can be added or removed.

Many people assume their current plan will stay the same, but that is not always the case. The Annual Enrollment Period (October 15 to December 7) is your opportunity to review your coverage and make changes if needed.

Here is a practical checklist of what to review.

When to Do the Review

• Late September / early October — your Annual Notice of Change (ANOC) arrives. This is the starting gun.
• October 15 – December 7 — the Annual Enrollment Period, when most changes are made for a January 1 start.
• January 1 – March 31 — Medicare Advantage members get one additional opportunity to change plans through the MA Open Enrollment Period.

Before working through the checklist, make a fresh list of your care: every doctor, every hospital you would actually use, every medication with its dosage, your pharmacy, and any procedures you expect in the coming year. The review is only as good as that list.

1. Check for Premium Changes

Your plan's monthly premium can increase, decrease, or stay the same from year to year. If you are on a Medicare Advantage plan, check whether the premium has changed. If you have a Part D plan, compare its premium to alternatives.

A premium increase does not automatically mean you should switch — but it is worth knowing about so you can factor it into your total costs.

2. Review Your Drug Formulary

This is one of the most important steps. Plans can change which drugs are covered, what tier they are on, and what restrictions apply (prior authorization, step therapy, quantity limits).

For each medication you take:

• Confirm it is still on the plan's formulary
• Check whether the tier has changed
• Note any new restrictions

A drug that moved from Tier 1 to Tier 3 could cost you significantly more. A drug removed from the formulary entirely would leave you paying full price.

3. Verify Your Doctor and Hospital Networks

Provider networks can change annually. Doctors may leave a plan's network, new providers may be added, and hospital affiliations can shift.

Confirm that your primary care provider, specialists, and preferred hospitals are still in-network for the coming year.

4. Review Copays and Coinsurance

Even if your premium stays the same, your out-of-pocket costs for specific services can change:

• Doctor visit copays
• Specialist visit copays
• Hospital stay coinsurance
• Emergency room copays

Check the plan's Annual Notice of Change (ANOC) document — your plan is required to send this to you each September.

5. Check the Out-of-Pocket Maximum

If you are on a Medicare Advantage plan, the out-of-pocket maximum may change. A higher max means more financial exposure if you need significant care during the year.

• Plans change every year — never assume your current coverage will remain the same.
• Drug formulary changes are the most common source of unexpected cost increases — check your medications first.
• The Annual Enrollment Period is the time to act — October 15 to December 7 each year.

6. Evaluate Extra Benefits

If your plan includes dental, vision, hearing, or wellness benefits, check whether those have changed. Benefit allowances, covered services, and participating providers can all shift.

7. Review Your Annual Notice of Change

Every Medicare plan must send you an Annual Notice of Change (ANOC) by September 30. This document outlines exactly what is changing for the next plan year. Read it carefully — it is the most reliable source of information about your specific plan's changes.

8. Compare Available Alternatives

Even if your current plan has not changed much, new plans may have entered your area, and existing alternatives may have improved. It is worth comparing at least two or three options to make sure you are still getting the best value.

Summit Benefits Group does annual plan reviews for Kentucky clients each fall. We compare your current plan against available alternatives based on your medications, doctors, and budget.

9. Add Up Your Expected Total Annual Cost

Premium alone will not tell you what a year costs. A rough estimate is more useful: monthly premium × 12, plus any deductible, plus the copays you realistically expect based on how often you saw providers last year, plus any separate premium you pay for Medigap or a standalone Part D plan. Compare that figure between your current plan and the alternatives — not the headline premium.

10. Every Few Years, Re-check Your Path

Most years, the review is about the plan. Every two or three years it is worth asking the larger question: does the Medicare path itself still fit — Advantage, or Original Medicare with Medigap and a drug plan? Health changes, travel patterns, and budget changes can all shift that answer. Our Advantage vs Medigap comparison walks through both paths.

Common Review Mistakes

• Skipping the review because "it worked last year."
• Ignoring the ANOC when it arrives.
• Switching plans because of an advertisement rather than a comparison.
• Choosing a new plan without checking formulary fit for every single medication.
• Comparing premiums only, and discovering the cost-sharing later.

What Happens If You Do Nothing?

If you do not make any changes during the Annual Enrollment Period, you stay on your current plan with its updated terms for the next year. This is fine if your plan still meets your needs. But if costs have increased or coverage has changed in ways that affect you, doing nothing can mean paying more than you need to.

Related Reading

For the enrollment window itself, our Kentucky Medicare AEP guide covers what can be changed between October 15 and December 7. If you are not sure a review is due, 5 signs it may be time to review your Medicare coverage is the quicker read.

Annual plan reviews are one of the most valuable services we provide. At Summit Benefits Group, we compare your current plan with available options each year to make sure your coverage, costs, and provider access still align with your needs.