Running from October 15 through December 7, Open Enrollment is a great time to review your Medicare Advantage plan and healthcare requirements for the upcoming year. This check-in helps ensure you take advantage of all your benefits and prevents you from being caught off guard by any network or coverage changes. 

Here are five questions to ask during open enrollment to ensure your plan continues to meet your needs (and your budget). 

1. Will your doctors and hospitals still be in-network? 

If you’re keeping your current Medicare plan, you may be wondering, “Do I even need to check my doctor network this year?” The answer is: yes. Health networks can change from year to year, so it’s crucial to make sure your preferred healthcare providers and facilities are still in the network. Losing network coverage could result in unexpectedly higher out-of-network costs or leave you looking for new doctors. 

There are several ways to confirm your doctor and hospital are covered and in-network, such as reviewing your Annual Notice of Change, contacting your healthcare providers, or checking with your specific Medicare plan.

If contacting your doctor’s office, make sure that:

• They accept your specific Medicare Advantage plan for the following year
• Both your provider and the office are still in-network

You can also go online to confirm your health plan’s coverage. With Medicare’s compare tool, you can find and learn more about Medicare-approved providers in your area, but you’ll need to double-check that they’re in your plan’s network. You can also use the provider directory on your Medicare Advantage company’s website. These tools allow you to look up specific healthcare providers, hospitals, services, and more to ensure you’ll have continued care. 

2. Will my healthcare expenses change next year?

As you prepare for Medicare Open Enrollment, consider how your healthcare costs may change next year and how it will impact your budget. Compare prices between your current and future plans to note changes in your:

• Monthly premium
• Deductible
• Co-pays for office visits or prescription medications
• Co-insurance 
• Out-of-pocket max

By estimating your cost changes for next year, you can make informed choices and avoid surprise expenses or financial strain.

3. Is my prescription drug coverage affected by plan changes?

Prescription drug coverage under Part D is also subject to change annually. Medications may move tiers (for example, a Tier 2 drug may become a Tier 3 drug), which can raise your drug prices. Or specific medications may be removed from the formulary altogether. Additionally, significant changes are coming to Part D in 2026 that could impact prices.

That’s why it’s important to check your Medicare prescription formulary every year, especially during your Medicare Open Enrollment plan review. The formulary includes all covered generic and name-brand prescription drugs, their available dosages, and tier classifications. Taking this step helps guarantee uninterrupted access to your medications and allows you to estimate future prescription costs.

4. Did my health change significantly this year?

If you received a new diagnosis this year or have a procedure or surgery scheduled for the new year, you’ll want to complete a Medicare Advantage plan check. Though your current policy may have met your needs so far, it may not be as well-suited as your health requirements evolve. 

Consider reviewing your plan if you are:

• Managing a chronic condition
• Visiting more specialists
• Taking new medication(s)
• Planning an outpatient diagnostic procedure or surgery
• In need of in-home medical care
• Expecting an inpatient hospital stay or rehabilitation costs (like physical therapy or skilled nursing care)

Make sure that next year’s plan covers all your expected healthcare needs. Consider your expenses to ensure it’s still a cost-effective solution. 

5. Have I taken advantage of all my plan’s benefits?

A key part of your Medicare Open Enrollment plan review is evaluating how you used your plan’s benefits this past year. To do so, first take note of which benefits you accessed, including routine doctor visits, specific therapies, and prescription benefits. Be sure to consider any vision, dental, or hearing aid care if your Medicare Advantage plan offers these benefits. 

Then, compare your actual usage to the total benefits offered. Did you have any surprises this year or changes you’ll need to account for next year? Did you end up paying for benefits you didn’t use or need? Understanding your actual use and anticipated needs for next year will help you make the most out of your available benefits.

Get support and answers this Medicare Advantage enrollment period

Medicare Open Enrollment can feel overwhelming, leaving you unsure if you need to make changes or stick with your current plan. Asking yourself a few simple questions can simplify the process — but you don’t have to navigate it alone. SmartMatch insurance agents are ready to help answer your Medicare questions and provide personalized recommendations aligned with your health goals.

*Disclaimer:

The information provided in this blog post is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical consultation or treatment. Always consult with a qualified healthcare provider for any questions you may have regarding a medical condition.

SmartMatch does not endorse or recommend any specific products, treatments, or procedures mentioned in this article. Reliance on any information provided in this blog post is solely at your own risk. We encourage you to discuss any health concerns or questions with your doctor before making any decisions about your health or treatment.