Picking the Right Medicare Plan

A Caregiver's Guide to Enrollment

If you're a caregiver navigating Medicare, whether for yourself or helping a loved one, you're managing a lot. Insurance decisions on top of everything else can feel overwhelming.

Here's the truth: picking the right Medicare plan doesn't have to be complicated. It just requires understanding what's available and knowing which questions to ask.

Why This Matters Right Now

Medicare Open Enrollment happens once a year. It's your window to review your current coverage, compare options, and make changes if something isn't working for you.

For 2026 coverage, that window is now: October 15 – December 7, 2025.

If you miss this deadline, you're locked into your current plan for another year unless you qualify for a special circumstance. So paying attention right now could literally save you thousands of dollars and keep your healthcare exactly where you need it.

Key Medicare Enrollment Dates (2025-2026)

Medicare Open Enrollment Period (Annual Election Period)

• Dates: October 15 – December 7, 2025

• Changes take effect: January 1, 2026

• Who can use it: Anyone on Medicare

• What you can do: Make any changes to your coverage, switch plans, drop coverage

Medicare Advantage Open Enrollment Period (for people already in Medicare Advantage)

• Dates: January 1 – March 31, 2026

• Changes take effect: The month after you enroll

• Who can use it: People currently enrolled in a Medicare Advantage plan

• What you can do: Switch to a different Medicare Advantage plan OR return to Original Medicare (only ONE change allowed)

• Note: This is just for people already in Medicare Advantage

5-Star Special Enrollment Period

• Dates: December 8, 2025 – November 30, 2026

• Who can use it: Anyone who lives in an area with a 5-star Medicare plan

• What you can do: Switch to or stay with a highly-rated 5-star plan (one enrollment per window)

If Your Plan Is Terminating

• Dates: December 8, 2025 – February 28, 2026

• Who this applies to: People whose Medicare Advantage plan is ending

• Action: You need to switch to a new plan; aim for changes by December 31 to avoid coverage gaps

The Medicare Parts: What You're Actually Choosing

Before you can pick a plan, you need to understand what Medicare is offering. Think of it this way: Medicare has different "parts," and your job is figuring out which combination makes sense for your situation.

Medicare Part A (Hospital Insurance) Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. Most people don't pay a premium if they or their spouse paid Medicare taxes for 10+ years.

Medicare Part B (Medical Insurance) Covers doctor visits, preventive services, outpatient care, and medical equipment. You pay a premium (2025: $185/month minimum, though it can be higher based on income). You also pay copays and deductibles.

Original Medicare = Parts A + B combined. It's the federal government option. It covers a lot, but it doesn't cover prescription drugs, dental, vision, or hearing care.

Medicare Part D (Prescription Drug Coverage) If you choose Original Medicare (Parts A & B), you need to add Part D separately for prescription drug coverage. You pick this alongside Original Medicare.

Medicare Part C (Medicare Advantage) This is a private insurance alternative to Original Medicare. It combines Parts A, B, and usually D into one plan. It often includes extras like dental, vision, and hearing that Original Medicare doesn't cover. But it comes with network restrictions—you can only see doctors in the plan's network (with exceptions).

Original Medicare vs. Medicare Advantage:
Which Is Right?

This is the biggest decision you'll make, and it depends entirely on your situation.

Choose Original Medicare + Part D if:

• You want flexibility to see any doctor anywhere (no networks)

• You have specific doctors or hospitals you don't want to change

• You want to add a Medigap plan (supplemental insurance) to reduce out-of-pocket costs

• You prefer the simplicity of federally-managed healthcare

Choose Medicare Advantage if:

• You want all-in-one coverage (no separate prescription drug plan)

• You want extra benefits like dental, vision, hearing that Original Medicare doesn't offer

• You don't mind using doctors within a specific network

• Your main doctors and hospitals are in the plan's network

• You want lower or zero premiums (though you may pay more in copays)

Important: If you're currently in Original Medicare and want to switch to Medicare Advantage, you can do that during Open Enrollment (October 15 – December 7). But if you're already in Medicare Advantage and want to go back to Original Medicare, you'll also want to consider getting a Medigap policy during your initial enrollment period for Medicare, otherwise you may face higher premiums or denials due to pre-existing conditions later.

The Decision-Making Process: Step by Step

Step 1: Gather Your Information (Before December 7) Collect your current Medicare documents; your Medicare card, your Annual Notice of Change from your current plan, any prescription drug lists, your list of current doctors and hospitals you use.

Step 2: Review What's Changed Plans change every year. Premiums, copays, deductibles, covered drugs, and in-network doctors all shift. You received an Annual Notice of Change (ANOC) in the mail in September. Read it. Seriously. It tells you exactly what's different for 2026.

Step 3: Use Medicare's Plan Finder Go to Medicare.gov and use their Plan Finder tool. Enter your zip code, your medications, and your preferred doctors/pharmacies. It will show you all available plans, their costs, and coverage details.

You can also call 1-800-MEDICARE (1-800-633-4227) to compare plans with a live person.
This is free and often helpful, especially if you're feeling lost.

Step 4: Compare Costs Across the Year Don't just look at premiums. Calculate the total out-of-pocket costs: premiums + deductibles + copays for the drugs and doctor visits you actually use. A plan with a $0 premium might cost you $3,000 more in copays. Do the math.

Step 5: Verify Network Coverage If you're considering a Medicare Advantage plan, call the plan directly and verify that your doctors and preferred hospitals are in-network. Don't rely only on the website; plans change networks, and you want confirmation.

Step 6: Make Your Decision and Enroll Enroll through Medicare.gov, by calling 1-800-MEDICARE, or by calling the plan directly. Make sure your enrollment request arrives before December 7 for 2026 coverage.

Document everything: date, time, who you spoke with, what they said. If there are problems later, you'll have a record.

For Caregivers Helping Loved Ones

If you're helping an elderly parent or relative navigate this, your job is to be their advocate, not their decision-maker (unless they genuinely can't decide).

Get them involved in the process. Ask what doctors they want to keep seeing. Ask what medications they take. Ask if they want dental or vision coverage. Their answers should guide the choice, not yours.

If they're struggling with this decision due to cognitive changes, you may need to be more directive. But the goal is still to honor their preferences whenever possible - just like the Medicare system is designed to do.

What Actually Happens After You Enroll

Once you've made your changes during Open Enrollment, your new coverage starts January 1, 2026.

You'll receive new insurance cards by December 31. Keep your old cards until you're sure the new ones work. Start using your new plan on January 1.

If something goes wrong, your plan doesn't work, your doctor isn't actually in-network, you're unhappy with it, remember: Medicare Advantage enrollees get another enrollment window from January 1 – March 31 when they can make one change.

But for Original Medicare enrollees, you're locked in until next October.

The Bottom Line

Medicare is complex, but breaking it down into pieces makes it manageable. Your job is to understand the options, gather real information, do the math, and decide what works best for your situation.

You don't need to be an insurance expert. You just need to ask the right questions and not ignore this deadline.

Open Enrollment ends December 7, 2025. That's your window. Use it.

Need Help?

• Medicare.gov Plan Finder tool

• Call 1-800-MEDICARE (1-800-633-4227) for free plan comparison assistance

• Visit your local State Health Insurance Assistance Program (SHIP) for free, personalized help

• Ask your doctor's office if they can verify in-network status for plans you're considering

This is complex work. But it's doable work. And getting it right matters.