Should I Switch Medicare Plans? 7 Questions to Ask This Fall

Medicare open enrollment runs October 15 through December 7 this year, and any change you make takes effect January 1, 2027. That gives you about eight weeks to answer one question: keep your current plan, or switch?

Plenty of people switch for good reasons. Plenty of others switch for a lower premium and end up paying more once copays, networks, and drug tiers shake out. And many people who should switch never look at all. A little homework in October can save you real money all year.

Before you decide, work through these seven questions. Each one comes with a way to check the answer yourself, for free.

1. Are my doctors still in the network?

Provider networks change every year, even inside the plan you already have. The doctor who was in network in 2026 is not guaranteed to be in network in 2027, and the same goes for your hospital and your preferred pharmacy.

How to check: Call each doctor’s office and ask if they will accept the specific plan in 2027. Name the exact plan, not just the insurance company, since one insurer can offer several plans in your area. Then confirm with the plan itself, because provider directories can lag behind reality. If you use a plan with pharmacy tiers, ask whether your pharmacy is a preferred pharmacy or just a standard one. The difference shows up in your copays.

2. Are my drugs still covered, and at what tier?

Every Medicare drug plan has a formulary, which is the list of drugs it covers. Formularies change each January. A medication can move to a higher tier, pick up new rules like prior authorization, or drop off the list entirely. A drug that cost you $10 a month this year could cost far more next year on the same plan.

There is some good news on the cost side. For 2027, once your out-of-pocket spending on covered drugs reaches $2,400, you pay nothing more for covered prescriptions the rest of the year. That cap is up from $2,100 in 2026. The standard Part D deductible also rises, to $700 in 2027 from $615.

How to check: Use the Medicare Plan Finder at medicare.gov/plan-compare. Enter your ZIP code, your exact drugs and doses, and your pharmacies. The tool estimates your total yearly drug cost under each plan, which matters far more than the premium alone. Your plan’s Annual Notice of Change letter also lists formulary and tier changes.

3. What is the true out-of-pocket maximum?

Premium is the number plans advertise. The out-of-pocket maximum is the number that protects you in a bad year. Every Medicare Advantage plan sets an annual limit on what you pay for covered in-network medical care, and those limits vary widely from plan to plan. Federal rules cap how high the limit can go, and that ceiling has been rising, so do not assume your plan’s limit stayed put.

Keep in mind the medical limit and the $2,400 drug cap are separate buckets. Original Medicare, by contrast, has no out-of-pocket maximum at all unless you pair it with a Medigap policy.

How to check: The out-of-pocket maximum appears on each plan’s page in the Medicare Plan Finder and in your plan documents. Compare your current plan’s 2027 limit against the alternatives, and ask yourself what a hospital stay would actually cost you under each.

4. What does my Annual Notice of Change letter say?

If you have a Medicare Advantage or Part D plan, your plan must send you an Annual Notice of Change, usually called the ANOC, by September 30. It lists exactly what changes on January 1: premium, deductible, copays, the drug formulary, the provider network, and extra benefits.

This letter is the single most useful document in the whole decision, and it is the one most people never open.

How to check: Watch your mail in September. Read the ANOC side by side with what you pay now. If your premium is flat but your specialist copay doubled and your maintenance drug moved up a tier, the plan got more expensive even though the headline number did not move. If you never received an ANOC, call your plan and ask for it.

5. How does the plan’s star rating look?

Medicare rates plans from 1 to 5 stars based on dozens of quality measures, including member complaints, customer service, and how well the plan manages care. New ratings come out each October on the Plan Finder, shortly before open enrollment begins, so the ratings you see this fall are fresh.

Stars are not everything, but a pattern is worth noticing. A plan sitting at 2.5 stars year after year is telling you something. And 5-star plans come with a bonus: if one is offered in your area, you can switch into it once outside the normal enrollment window, using a special enrollment period that runs December 8 through November 30 of the following year.

How to check: Star ratings appear on each plan’s listing at medicare.gov/plan-compare. Look at the overall rating and the trend, not just one year.

6. Which extra benefits do I actually use?

Dental, vision, hearing, gym memberships, over-the-counter allowances. Extra benefits are the shiniest part of any plan ad, and they are also the benefits plans trim first when money gets tight. Industry analysts expect some plans to reduce supplemental benefits for 2027 as costs rise.

Be honest about your own record. A $2,000 dental allowance you used is real money. A gym benefit you have not touched since 2024 is not a reason to stay, and a new plan’s flashy perk is not a reason to switch unless you will genuinely use it and the core coverage holds up.

How to check: Your ANOC lists benefit changes. For any benefit you count on, verify the 2027 details with the plan directly: the dollar limits, the network of dentists or providers, and any restrictions.

7. What will switching cost me in disruption?

Switching has a price tag that never shows up in the premium. New ID cards, new pharmacy setup, possibly new doctors, new prior authorization approvals for treatments already underway, and a learning curve on new rules.

One caution deserves special attention. If you are thinking about leaving Medicare Advantage for Original Medicare, know that buying a Medigap policy is not guaranteed in most states once your initial enrollment window has passed. Insurers may review your health history and can charge more or decline coverage, with limited exceptions. Ask a SHIP counselor about your state’s rules before you make that move.

Also worth knowing: if you switch Medicare Advantage plans and regret it, the Medicare Advantage open enrollment period runs January 1 through March 31, when you can make one change or return to Original Medicare.

How to check: List everything that would have to move with you, then weigh it against the savings. Real savings beat inertia. Small savings rarely beat a care team you trust.

When keeping your plan is the right call

Switching is not the goal. The goal is the right coverage at the right price. If your doctors are staying in network, your drugs are still on reasonable tiers, your ANOC shows only modest changes, and the Plan Finder does not surface a clearly better total cost, keeping your plan is a perfectly good decision. You did the review, and the review said stay. That is a win too.

One note for this year: many standalone Part D premiums are rising for 2027 as a temporary federal subsidy winds down, so drug plan shoppers especially should compare totals rather than assume this year’s bargain is still one.

Free help, no sales pitch

Two resources give unbiased answers at no cost. Your State Health Insurance Assistance Program (SHIP) offers free one-on-one counseling from trained counselors who do not sell insurance; find yours at shiphelp.org. And 1-800-MEDICARE (1-800-633-4227) is available around the clock during open enrollment. Whatever you decide, confirm the final details with the plan itself before you enroll.

While you are reviewing your coverage, take a minute to browse the insurance section of our perks page, where we round up offers worth a look for readers 55 and up.

This is part two of our open enrollment series. Subscribe to Retired Perks and the next installment will land in your inbox before decision day.

Sources

• Medicare.gov: Open Enrollment
• Medicare.gov: Special Enrollment Periods
• UnitedHealthcare: How Medicare Part D is changing in 2027
• UnitedHealthcare: Medicare Part D deductibles in 2027
• KFF: Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits
• KFF: How can I compare my Medicare coverage options?
• CMS: Medicare Open Enrollment Partner Resources
• Forbes: An Early Look at Medicare’s 2027 Annual Enrollment Period
• NCOA: A 7-Point Checklist for Choosing a Medicare Advantage Plan
• SHIP TA Center: Get Medicare Help from Your Local SHIP