Medicare open enrollment runs from October 15th through December 7th, and the earlier you begin the planning process, the better positioned you’ll be to make the right choices for 2026.
The Landscape in 2025:
In 2025, 34.1 million people are enrolled in Medicare Advantage plans, representing approximately 54% of the eligible Medicare population (Source: KFF). The average Medicare beneficiary has access to 43 different Medicare Advantage plans—a number that can make the selection process feel overwhelming.
New Payment Flexibility for Prescriptions
A helpful change was implemented in 2025, which allows Medicare beneficiaries to spread their Part D drug costs over 12 months instead of paying larger lump sums. This can significantly improve cash flow management for those with expensive prescription needs.
Rising Costs Ahead
Medicare Part B premiums will increase 11.6% in 2026 to $206.50 per month (before Income-Related Monthly Adjustment Amounts). This significant increase makes it even more critical to review your coverage options during this enrollment period to ensure you’re getting the best value.
Three Essential Questions to Start With
Before diving into plan comparisons, you and your spouse should answer these fundamental questions:
- Have my health needs changed?
- Are my current providers still in-network?
- Am I taking advantage of available resources
Understanding Your Evolving Health Needs
Life happens quickly, and health needs can change in an instant. This is why evaluating your coverage annually is essential. While medications, specialized care, and new diagnoses are obvious triggers for plan review, don’t overlook changes in your mobility, daily living needs, and cognitive abilities. Each of these factors should inform your coverage decisions.
Confirming Provider Networks
Continuity of care matters. The doctors and facilities you trust can shift between networks on an annual basis, making it crucial to verify that your current providers will remain in-network for 2026. If they won’t be covered, you’ll need to decide whether to:
- Pay the difference in out-of-network costs
- Find a new plan that includes your preferred providers
- Identify new providers within your current network
Don’t forget the convenience factor: if your doctor moves to a different office location, consider whether the additional travel time is worth maintaining that relationship or if finding a closer provider makes more sense.
Your Plan Is Personal
Remember: what works for your friends or family members may not be the best fit for you. Medicare planning can feel like navigating alphabet soup, but you don’t have to do it alone.
Your health and financial wellbeing for the coming year depends on the choices you make during this brief enrollment window.
Contact a Sunpointe advisor today if you’d like to talk more about your Medicare plan options.
