The Medicare Annual Enrollment Period runs October 15 through December 7, and it’s easy to let it slip by without a second look at your coverage. If you want the bigger picture of what’s changing this AEP, we’ve covered that separately. This Medicare enrollment checklist breaks the actual review process into six simple steps, including two that are easy to skip: comparing your prescription drug costs and checking your specialist referral rules. Work through it at your own pace, and bring it with you if you’d like help along the way.
Helping a parent with this? This checklist works well as something to go through together. Sitting down with a parent’s Annual Notice of Change letter and working through each step side by side often catches things a quick skim would miss.
Before You Start: Gather These Documents
Before you dive into the steps below, gather a few things:
- Your plan’s Annual Notice of Change (ANOC) letter
- A current list of your medications
- A list of your doctors and specialists
Having these on hand will make every step below faster.
Step 1: Review Your Current Coverage and Costs
Start with the basics: what are you actually paying right now?
- Premium: what you pay each month
- Deductible: what you pay before your plan starts covering costs . It’s important to note that in some situations like seeing your PCP or with some prescriptions, your deductible doesn’t apply.
- Copays: what you pay per visit or service
- Annual out-of-pocket maximum: the most you’d pay in a year before your plan covers the rest
Your Annual Notice of Change letter will show whether any of these will change next year.
Step 2: Compare Your Prescription Drug Costs
Drug formularies (the list of medications a plan covers) and cost tiers can change every year, even if you don’t switch plans. And this can go either way: some people end up paying more for the same medication, while others find they’d actually pay less on a different plan or tier.
That’s the real reason this step is worth doing. It’s not just about avoiding a surprise increase. It’s a chance to see if you could be paying less for the medications you already take.
To check: look at your plan’s formulary, or use Medicare’s Plan Finder at Medicare.gov to compare drug costs across plans side by side.
Step 3: Check Specialist Referral Rules
Original Medicare generally doesn’t require a referral to see a specialist. Many Medicare Advantage HMO plans do, and seeing a specialist without one can mean the visit isn’t covered.
If you see a specialist regularly, like a cardiologist or endocrinologist, it’s worth confirming your plan’s referral rules before AEP ends on December 7. Referral requirements vary by plan and even by plan type (HMO vs. PPO), so check with your plan directly or ask your care team.
Step 4: Confirm Your Doctors Are Still In-Network
If you’re considering a new plan, check whether your current doctors are in its network before you switch. See our list of accepted Medicare Advantage plans to check whether Palm Primary Care is included. And if staying with your care team matters to you, we’ve written more about why continuity of care matters and how it works.
Step 5: Look at Extra Benefits and Star Ratings
Many Medicare Advantage plans include extras like dental, vision, hearing, or fitness benefits. It’s worth checking whether you’re using the ones you already have, like an annual eye exam or a gym membership, or whether a different plan offers something you’d actually use.
Star Ratings are Medicare’s way of scoring plan quality on a 1-to-5 scale, and they’re worth a look. But they’re one input, not the only factor. A 5-star plan that doesn’t cover your medications or include your doctor isn’t automatically the better choice for you.
Step 6: Mark Your Calendar and Decide by December 7
AEP runs October 15 through December 7. Any changes you make take effect January 1.
If you don’t make any changes, your current plan generally continues into next year, as long as it’s still offered in your area. If your plan is discontinued, you’ll be notified directly and will need to choose a new one.
Frequently Asked Questions
What happens if my Medicare Advantage plan requires a referral I don’t have?
This depends on your specific plan. Many HMO plans won’t cover a specialist visit without a referral from your primary care provider first. If you’re not sure whether your plan requires one, check your plan documents or call your plan directly before your appointment.
Do I need to do anything to keep my current plan?
Not necessarily. We’d recommend reaching out to your insurance broker or a Palm outreach representative to discuss any upcoming changes to your plan and taking a quick look at your Annual Notice of Change letter. Your plan’s costs or covered drugs may have changed even if you plan to keep it. If you’re happy with your coverage, you don’t have to make any changes during AEP.
Where can I get free, unbiased help comparing plans?
Medicare’s Plan Finder at Medicare.gov, 1-800-MEDICARE, and your local State Health Insurance Assistance Program, or SHIP, all offer free, unbiased help. None of them are trying to sell you anything.
We can’t tell you which plan is right for you. That depends on your specific needs, and it’s not our role as your care provider. But if you’d like to talk through your health needs for the year ahead, schedule a wellness visit with your care team. And if you have questions about whether we’re in your network, give us a call.
Want to work through this checklist on paper? Download a printable version to keep with your Medicare mail this AEP season.
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