Annual Medicare Review: Checking Whether Your Parts Still Fit Your Needs

Why This Review Matters More Than Most People Realize

Medicare isn't a set-it-and-forget-it system. Every year, the plans that deliver your Part C (Medicare Advantage) and Part D (prescription drug) benefits are allowed to change their premiums, cost-sharing structures, covered drug lists, and provider networks. They do this — every single year — often with minimal fanfare. If you don't review your coverage each fall, you may head into January carrying costs or coverage gaps you didn't see coming.

This checklist is designed to walk you through a complete annual Medicare review in 30 to 60 minutes. It covers everything from pulling together your paperwork to evaluating your drug coverage to making a final enrollment decision before the December 7 deadline. Think of it as an annual checkup — not for your health, but for your health coverage.

If you're new to the structure of Medicare and want a refresher on what Parts A, B, C, and D each actually do before diving in, start with our overview of all four Medicare parts. And if you're weighing whether Original Medicare or Medicare Advantage is the right framework for you, our Original Medicare vs. Medicare Advantage comparison lays out the trade-offs clearly.

The Annual Enrollment Period (AEP) — October 15 through December 7 — is the one time each year when anyone on Medicare can switch Medicare Advantage plans, switch Part D drug plans, move from Medicare Advantage back to Original Medicare, or move from Original Medicare into a Medicare Advantage plan. Outside of that window, your options are limited to Special Enrollment Periods triggered by specific life events.

Tools You'll Need Before You Start

Before you sit down with the checklist, gather a short stack of materials. This isn't bureaucratic busywork — each document answers a specific question the checklist will ask you.

If you don't have your ANOC yet and it's after September 30, call your plan directly or log into your plan's member portal to download it. If you've misplaced your Medicare Summary Notices, you can view them at MyMedicare.gov under your account. Your plan's provider directory should always be pulled fresh from the plan's website — don't rely on a printed copy from last year.

One underused resource worth highlighting: your State Health Insurance Assistance Program (SHIP). Every state has one, and the counselors are trained, free, and have no financial stake in which plan you choose. If you find the plan comparison process overwhelming, a SHIP counselor is the most trustworthy help available.

The Full Annual Review Checklist

Work through these groups in order. The first group sets the foundation; everything else builds on it. Check off each item as you go — if you find a red flag (a dropped doctor, a drug moved to a higher tier, a premium spike), note it rather than stopping. Finish the full review first, then assess whether a plan change makes sense.

On drug coverage specifically: Medicare Plan Finder at medicare.gov has a drug cost estimator that is genuinely useful. Enter your drugs and it will show you the estimated annual cost for each plan available in your ZIP code. This tool alone can surface savings of hundreds of dollars per year that you'd never find by comparing premium sheets.

For anyone who relies on durable medical equipment — a CPAP machine, a wheelchair, a walker — coverage rules deserve a separate look. Medicare Advantage plans may have different prior authorization requirements for DME than Original Medicare. Our article on what plans cover for DME like wheelchairs and CPAP machines walks through what documentation you'll need and where plans tend to draw the line.

How to Evaluate Whether You Should Switch Plans

Completing the checklist isn't the same as deciding to switch. Here's a simple framework for making that call:

1. If nothing changed for you and nothing changed in your plan — your doctors are in-network, your drugs are at the same tiers, your premium is the same or lower — staying put is perfectly reasonable.
2. If one or two things changed but you can absorb the cost — maybe your premium went up $15/month but everything else held steady — run the numbers and decide whether the disruption of switching outweighs the extra cost.
3. If a key doctor dropped out of network, a critical drug moved to a high tier, or your out-of-pocket maximum jumped significantly — those are serious flags that justify shopping for alternatives. Use Medicare Plan Finder to compare at least two or three options before deciding.
4. If you've repeatedly dealt with prior authorization headaches or claim denials — consider whether a different plan type (switching from HMO to PPO, or back to Original Medicare with a Medigap policy) would give you more flexibility.

If you're seriously considering moving from Original Medicare to Medicare Advantage for the first time — or the reverse — our step-by-step walkthrough on switching between Medicare structures covers the timing, the paperwork, and what to watch out for. And if you're trying to evaluate which combination of parts (Original Medicare + Medigap + Part D versus Medicare Advantage) makes financial sense for your specific situation, our guide to choosing the right bundle of Medicare parts is the right next read.

One thing I want to be direct about: there is no universally "best" Medicare plan. The right plan is the one that covers your doctors, covers your drugs at reasonable cost, and keeps your total annual out-of-pocket spending predictable given your income. That equation is personal, and it changes as your health changes. That's exactly why this review belongs on your calendar every fall — not as a chore, but as a habit that protects your budget and your access to care.

What to Do If You Miss the Annual Enrollment Period

If December 7 passes and you didn't make changes, you're not entirely without options — but they are narrower. Here's what's still available:

• Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31. During this window, if you're already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or drop Medicare Advantage and return to Original Medicare. You cannot, however, use this period to enroll in Medicare Advantage for the first time from Original Medicare.
• Special Enrollment Periods (SEPs): Triggered by specific events — moving out of your plan's service area, losing other coverage, qualifying for Extra Help, or your plan being discontinued. SEPs are narrow and time-limited, so act quickly if you experience a qualifying event.
• Five-Star Special Enrollment Period: If a Medicare Advantage or Part D plan in your area earns a 5-star quality rating, you can switch into it once per year outside of the AEP window.

If you realize you should have made changes but missed your window, contact your State Health Insurance Assistance Program (SHIP) or call 1-800-MEDICARE to explain your situation. In some cases, extenuating circumstances can be addressed. Otherwise, document what to change next October so you're ready before the AEP opens.

For anyone approaching Medicare for the first time and not yet enrolled, our checklist of questions to ask before enrolling in Medicare is a useful pre-enrollment companion to this annual review. Many of the same evaluation criteria apply — the difference is that new enrollees have Initial Enrollment Period windows that operate on different rules than the AEP.

The bottom line: Medicare gives you one reliable, wide-open window each fall to get your coverage right. Use it. Thirty to sixty minutes of focused review can prevent months of coverage frustration and, in some cases, save you a significant amount of money. Put the AEP dates on your calendar right now — October 15 and December 7 — and treat them as non-negotiable.