Medicare & Insurance

Medicare Open Enrollment Starts October 15: Look Beyond the Premium

By Maren Hale / October 16, 2026 / Updated November 8, 2026

Older couple laughing together at a desk, with the woman facing the viewer

Medicare’s yearly open enrollment period runs from October 15 to December 7, 2026. As of November 8, about four weeks are left. Changes you make start on January 1, 2027, but only if your plan receives your request by December 7.

A plan with a low monthly premium can still cost more over a year if it leaves out your medicines, your doctors or the extras you count on. This article explains what to look at besides the premium. It is general information, not advice for your own situation. Free, trained counselors can help with that, and we explain how to reach them below.

Key takeaways

The window is October 15 to December 7, 2026. New coverage starts January 1, 2027.
If your plan still suits you and is still offered, you generally do not need to do anything.
Look past the premium at five things: your drug list, your doctors, the yearly out-of-pocket limit, extra benefits and star ratings.
Free, independent counseling is available through your state’s SHIP program and by phone at 1-800-MEDICARE.

What the open enrollment window lets you do

Depending on what you have now, you can join, drop or switch a Medicare Advantage plan, with or without drug coverage. You can add or drop drug coverage. You can also move between Original Medicare and Medicare Advantage.

Two quick terms. Original Medicare is the government program that works with any doctor or hospital that accepts Medicare. Medicare Advantage is offered by private insurance companies. Its plans must cover everything Original Medicare covers, and many add extras. Medicare’s name for drug coverage is Part D.

If your current plan still meets your needs and is still available, the Medicare agency, CMS, says you do not need to change it. Looking at other plans does not commit you to switching.

If you miss the deadline

From January 1 to March 31, people who already have a Medicare Advantage plan can make one change. They can switch to another Medicare Advantage plan, or return to Original Medicare and join a drug plan. People in Original Medicare cannot use that window to join Medicare Advantage.

Some life events, such as moving or losing other coverage, open a Special Enrollment Period. Ask a counselor if that might apply to you.

Why the premium tells only part of the story

A premium is the monthly amount you pay just to have the plan. You may also pay when you see a doctor or fill a prescription, and those costs differ from plan to plan.

In a September 28, 2026 announcement, CMS projected that the average monthly premium for Medicare Advantage plans would fall from $14.37 in 2026 to $12.00 in 2027. It projected stand-alone drug plans would edge up from $35.09 to $36. These are national averages, not what any plan in your area will charge.

Five things to compare beyond the premium

1. Your drug list and pharmacy

Each drug plan has a list of covered medicines, called a formulary. Plans often sort medicines into tiers, and a lower tier generally costs less. Each plan sets up its tiers differently.

Medicare says plans can change their drug lists during the year, and a plan must tell you about changes that affect medicines you take. Plans also have pharmacy networks, and some include “preferred” pharmacies that charge less. Check both the medicine and the pharmacy you use.

Two 2027 limits apply, according to Medicare.gov. No drug plan may have a deductible above $700. A deductible is what you pay before the plan starts sharing costs. And once your own spending on covered drugs reaches $2,400 in 2027, you pay nothing more for covered drugs for the rest of the year.

2. Your doctors and hospitals

Medicare Advantage plans generally expect you to use doctors and hospitals in their network for care that is not an emergency. Some plans also require approval before certain services, called prior authorization, or a referral to see a specialist. Original Medicare usually does not.

Medicare’s online Plan Finder, at Medicare.gov, lets you compare plans and find and save your doctors, so you can check them against each plan. Plans can change their networks each year, so check even if you did last year.

3. The yearly out-of-pocket limit

Medicare Advantage plans cap what you pay in a year for covered services. After that, you pay nothing more for them that year. Original Medicare has no such cap unless you have extra coverage, such as a Medigap policy. Medigap is private insurance that helps pay costs Original Medicare leaves to you.

The cap differs by plan. KFF, a health policy research group, reported that the average in-network limit in 2026 was $5,421, and about 9 percent of enrollees were in plans at the federal maximum of $9,250. We could not confirm the 2027 federal maximum from a government page, so look up each plan’s own 2027 figure.

4. Extra benefits

Original Medicare does not cover routine dental care or eye exams. Many Medicare Advantage plans add vision, hearing and dental, and CMS expects those offerings to stay stable in 2027. Still, ask what each benefit pays for, how much, and who provides it.

5. Star ratings

Each year CMS rates plans from one to five stars on quality and performance. The 2027 ratings were published October 8, 2026. CMS reported that 15 Medicare Advantage contracts with drug coverage earned five stars, and the average was 3.99, compared with 4.01 in 2026.

Use stars as one clue, not a verdict. CMS says changes from year to year are normal, partly because the scoring cut-offs are reset each year. A rating also cannot tell you whether your own doctor is in the network.

At a glance: what to check and where to find it

What to check	Where to look	A question to ask
Drug list and tier	The plan’s formulary, linked from Plan Finder	Are my medicines covered, and at what cost?
Pharmacy	The plan’s pharmacy network	Is my pharmacy in the network?
Doctors and hospitals	Plan Finder provider search	Are my doctors in the network for 2027?
Out-of-pocket limit	Plan Finder and the plan’s documents	What is the most I could pay for covered care?
Extra benefits	The plan’s Summary of Benefits	What do dental, vision and hearing really pay?
Star rating	Plan Finder	Has it changed since last year?

A checklist for the next four weeks

Find what your current plan sent about next year, and read what is changing.
Write down every medicine, its dose and the pharmacy you use.
List your doctors, specialists and preferred hospital.
Compare your current plan with one or two others on Medicare.gov.
If you might leave Medicare Advantage, ask a counselor about Medigap rules first.
If you switch, keep your confirmation and check the start date and plan name.

Where to get free, one-on-one help

Every state has a State Health Insurance Assistance Program, known as SHIP, part of a national program funded by federal grants. Medicare.gov describes it as free, personalized counseling, and says SHIPs are not connected to any insurance company or health plan. Staff and trained volunteers can help you compare plans and find help paying for care.

To find your local program, visit shiphelp.org and choose your state. You can also call 1-800-MEDICARE (1-800-633-4227), open every day at all hours except some federal holidays. The TTY number is 1-877-486-2048.

Frequently asked questions

Do I have to do anything if I like my current plan?

Generally no. CMS says people who want to keep their coverage usually do not need to enroll again. But plans can change costs, coverage and networks every year, so it is worth reading what your plan sends.

Can I change my plan after December 7?

Sometimes. If you are in Medicare Advantage, you can make one change between January 1 and March 31. A Special Enrollment Period may also apply after certain life events.

If I go back to Original Medicare, can I buy Medigap?

Medicare.gov notes that there are limits on when you can add a Medigap policy, so do not assume you can buy one later. Medigap cannot be bought together with a Medicare Advantage plan. Speak with a SHIP counselor before you drop a plan.

Who can I trust to help me choose?

Start with Medicare.gov, 1-800-MEDICARE and your local SHIP.

Before you decide

You do not need the perfect choice, only an informed one. Gather your medicines and doctors, compare two or three plans on Medicare.gov, and ask a counselor to look over your choice. You have until December 7, 2026.