9 Reasons to Change Your Medicare Coverage Now

You should consider changing your Medicare coverage during open enrollment if:

1. My prescription costs have jumped ​

That usually happens when:

• Your Part D policy’s monthly premiums and required cost sharing have increased.
• You’ve been prescribed a new drug your Part D policy doesn’t cover or covers with expensive cost-sharing.
• Your current medicines have fallen off your Part D plan’s list of covered medicines.
• Your health status has changed and new medications are required.

Each September, Part D prescription drug plans send out a list of modifications to their drug coverage, called the Annual Notice of Change (ANOC). That gives you time to make sure your medicines are still covered.

If they aren’t, you can shop around for another plan, ask your doctor to apply for an exception in covering your preferred medicine, or contact the plan yourself and have the doctor provide a written statement explaining why alternatives aren’t as effective or could cause problems.​​ Remember, too, that your Part D annual out-of-pocket spending limit for prescriptions will increase to $2,400 in 2027. That’s up from $2,100 in 2026. To help you budget for your medication costs, consider joining the Medicare Prescription Payment Plan, which spreads your Part D out-of-pocket costs throughout the calendar year.

But if some of your medications aren’t covered in your present plan, your out-of-pocket costs won’t count toward the $2,400 maximum or your deductible. And they won’t be able to be added to the prescription payment plan.

2. I’m spending extended time in a different state​

Medicare Advantage plans typically charge more for visitsto doctors outside of their networks. In some cases, they won’t cover any charges if it’s not an emergency.

So a Midwestern snowbird might have to pay more to see out-of-network doctors while in Florida. Read the details of your MA plan or talk with a representative to find out where you stand.

If you’ll be living a dual-residence existence for years to come, you might consider a switch to original Medicare.

3. I’ve been diagnosed with a chronic condition ​

A serious medical change such as a diabetes or even a prediabetes diagnosis should trigger a full review of your Medicare coverage. Consider the care you’ll need.

If you have a Medicare Advantage plan and want a gym membership or disease-specific programs, find a plan that offers them. If you anticipate needing a lot of specialists, check to see if your preferred ones are in your plan’s network. If you need new medications, make sure your plan covers them.

If you have original Medicare, make sure your Part D policy pays for any new prescriptions, or find one that does. And if you want to work out regularly, some Medigap plans that pair with original Medicare also offer free memberships or discounts. If you anticipate needing lots of specialists, 98 percent of all doctors who aren’t pediatricians accept Medicare, KFF points out.

Making critical changes early can “really affect your pocketbook and save you money,” says Gretchen Jacobson, a vice president with the Commonwealth Fund foundation.

4. ​​I need surgery and prefer a specific doctor

​Original Medicare allows patients to choose any doctor or hospital that accepts Medicare. And since that’s all but 2 percent of physicians who don’t specialize in treating children, chances are good that you’ll be covered.

But if you’re in a Medicare Advantage plan and its surgeons don’t meet your needs, you may need a different Medicare Advantage plan. Or you might need to switch to original Medicare — if you can be accepted into a Medigap plan. The Medicare Plan Finder began listing providers that participate in some MA plans during open enrollment for 2026 coverage.

Beneficiaries who’ve suffered major problems like cancer and heart attacks are the ones who really need to focus on which doctors are in their network, says Joseph Antos, senior fellow emeritus at the American Enterprise Institute, a public policy think tank.

“A specialist may be key to their treatment,” he says.

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