If navigating the indecipherable world of Medicare feels like getting tangled in a web of endless choices, costs, and deadlines, you’re not alone. In fact, tens of millions of older adults and eligible individuals across the United States go through the exact same struggle each fall, when the United States’ Medicare Annual Enrollment Period (AEP) opens. During this critical window, Medicare beneficiaries can reevaluate their coverage, adjust plans, and lock in benefits for the upcoming year. We hope you find this breakdown of open enrollment helpful whether you’re a first-time enrollee or a long-term Medicare veteran looking to make plan changes.

As a reminder, Medicare is a federal health insurance program in the United States that primarily covers medical expenses for people aged 65 and older, as well as younger individuals with qualifying disabilities or specific chronic conditions.

Understanding the Different Parts of Medicare

You will hear terms like Part A and Part B thrown around a lot in the Medicare conversation, so here’s a quick refresher on what they mean:

Medicare Part A: Hospital Insurance

Part A covers hospital insurance, covering inpatient hospital stays, skilled nursing facility care, hospice, and limited home healthcare.

Medicare Part B: Medical Insurance

Part B covers medical insurance, covering outpatient medical care, doctor visits, preventive services, lab tests, durable medical equipment, and mental health care.

Medicare Part C: Medicare Advantage

Part C covers Medicare Advantage, an all-in-one alternative offered by private insurance companies and approved by Medicare and usually offering extra perks.

Medicare Part D: Prescription Drug Coverage

Medigap: Medicare Supplement Insurance, working alongside Original Medicare to pay for gaps in coverage like coinsurance, copayments, deductibles, and more (does not work with Medicare Advantage).

Medicare Supplement (Medigap)

Medigap policies work alongside Original Medicare to help cover expenses like deductibles, coinsurance, and copayments. These plans cannot be used with Medicare Advantage.

Important Medicare Enrollment Dates for 2026 

Missing a Medicare enrollment deadline could mean a financial penalty or unexpected gap in healthcare coverage, so make sure you’re aware of this year’s key dates and timing windows:

• October 15-December 7, 2026: Fall Open Enrollment Period, coverage changes take effect January 1
• January 1-March 31, 2027: Medicare Advantage Open Enrollment Period, for those already enrolled in Medicare Advantage
• 7-month window: Initial Enrollment Period, taking place 3 months before, the month of, and 3 months after turning 65

During the Fall Open Enrollment Period, you can switch from Original Medicare (Parts A and B) to Medicare Advantage (Part C), switch from Medicare Advantage back to Original Medicare, switch from one Medicare Advantage plan to another, enroll in a standalone prescription drug plan (Part D), and more.

Medicare Advantage Open Enrollment serves as a secondary window during which those enrolled in Advantage can make a one-time switch to another Advantage plan or return to Original Medicare.

If you are turning 65, your Initial Enrollment Period is an individualized 7-month span that takes precedence over the other time periods – but only if you are newly eligible.

What’s New for Medicare in 2026? 

Healthcare costs, policy rules, and more change each year. You should stay on top of these changes so you aren’t taken by surprise when it comes time to pay for a plan, but here are this year’s numbers according to the Centers for Medicare & Medicaid Services (CMS):

• Part B Standard Monthly Premium: $202.90 per month (up from $185.00 in 2025)
• Part B Annual Deductible: $283 per year before Part B coinsurance (typically 20%) kicks in
• Part A Hospital Deductible: $1,736 per benefit period for inpatient hospital stays
• Part D Out-of-Pocket Prescription Cap: $2,100 maximum out-of-pocket spending limit for covered drugs under Part D
• Part D Maximum Deductible: Capped at $615 annually

One item of note is the Inflation Reduction Act’s hard cap on covered prescription drugs: the current maximum annual out-of-pocket cap is $2,100. Once you spend that out of pocket on covered medications during the calendar year, your plan will cover 100% of your medicine costs for the remainder of your coverage window. Medicare users can also use open enrollment to opt in to the Medicare Prescription Payment Plan, a monthly payment installment system for those who can’t afford to pay up front for uncovered prescription drugs.

Understanding Medicare IRMAA Surcharges 

Income-Related Monthly Adjustments

High income earners are typically subject to additional surcharges on Part B and Part D premiums known as Income-Related Monthly Adjustments (IRMAA). According to the latest CMS IRMAA determinations, the surcharges will kick in based on Modified Adjusted Gross Income (MAGI) from your last two filed tax returns. Please consult that website to calculate your own specific IRMAA if you are a high income earner, but here’s an example: under the latest calculations, A single earner tax return MAGI of under $109,000 would owe a standard Medicare premium of $202.90, while a single earner tax return MAGI of over $500,000 would owe a higher Medicare premium of $689.90. A First Light advisor can help you determine what category you fall in based on your tax bracket, and what to expect from your own Medicare premium.

Original Medicare vs. Medicare Advantage

According to data from the Kaiser Family Foundation, over 35 million people (51%+ of all eligible beneficiaries) are enrolled in Medicare Advantage plans, and choosing between original Medicare and Medicare Advantage is one of the most important decisions you’ll make during open enrollment. Here’s a quick comparison of the two on some important points:

• Original Medicare’s provider network is nationwide, while Medicare Advantage is restricted to local HMO and PPO networks. Out of network care costs are typically higher or not covered at all.
• Prior authorization is rarely required with Original, but frequently required for specialists, procedures, and scans under Advantage.
• Original beneficiaries pay the standard Part B premium plus optional Medigap and Part D premiums, while Advantage beneficiaries pay the standard Part B premium plus a plan premium (although many are $0 extra).
• There is no annual out-of-pocket cap under Original, while Advantage is capped annually in-network at $8,850.
• Dental, vision, and hearing insurance are not covered by Original, but are often included (and sometimes extended to extras like fitness perks) under Advantage.
• On the topic of prescription drugs, Original requires separate purchasing of a standalone Part D plan, while Advantage bundles prescription drug plans directly into the main plan.

A First Light advisor can help you determine which Medicare plan makes the most sense for you and your family!

Medicare Open Enrollment Checklist 

1. Review your Annual Notice of Change (ANOC), which was sent to you by your current plan in late September and details changes in premiums, copays, drug formularies, and provider networks for the coming year.
2. Audit your current prescription drugs including exact dosages.
3. Verify physician and hospital networks to ensure that your preferred providers will still be in-network.
4. Calculate the total estimated cost of your plan, not just premiums – a First Light advisor would be helpful with this one!
5. Assess travel and geographic needs if you frequently split time between states, as Medicare Advantage typically restricts routine coverage to local regional networks while Original Medicare with Medigap offers nationwide flexibility.

Common Medicare Open Enrollment Mistakes to Avoid 

Don’t assume your plan remains unchanged. Don’t incur late enrollment penalties by missing the deadlines listed above. And don’t wait until the final days of open enrollment when high call volumes and website traffic often lead to delays.

Follow these tips and complete your Medicare evaluation by mid-November to ensure seamless processing, and you’ll be wondering why you ever thought the process was overwhelming!

Final Thoughts on Medicare Open Enrollment

If you still have questions or concerns after reading open enrollment, don’t hesitate to visit our website and set up a call or meeting with an experienced, trusted First Light Financial advisor today! As always, a First Light advisor can help review your specific, individual situation and determine what enrollment options best align with your long-term financial goals and current budget. See you next time.