Estimated read: 7 minutes
This post is part of the Community Education series on the Connection path at The Gracewell Studio. For more plain language guides like this one, visit the Connection path here.
Medicare plans change every year. Many people on Medicare are not aware of what changes will take place, or how those changes will affect them.
Medication coverage changes. What you take today, and what was covered this year, may not be covered in the coming year. The doctor you have seen all year may not take your plan next year. Rules about rehab may change.
And the part that stinks? Nobody is going to call you to tell you what changes will impact your healthcare.
The changes come in a letter. A letter that may sit unopened on your kitchen counter until it is too late to make changes.
The Letter on Your Counter
That letter is called the Annual Notice of Change. If you have a Medicare Advantage plan or a drug plan, your plan mails it to you each fall. It tells you what is changing next year: your costs, which medicines are covered, and which doctors and hospitals are in your network.
This is what to look for. Open it. Do not let it sit.
If you cannot find it, call the number on the back of your card and ask them to send it again.
Here Is the Good News
Open enrollment starts today. And if you are reading this, I can help outline some questions for you to ask while the window to choose is open.
I work in an emergency department as an RN case manager. Every shift, I meet families and patients who are unaware of the rules of their coverage. Too often, they are left scrambling for solutions once the emergency has arrived.
This article is for you. I am writing it to help you understand your coverage, prepare, plan, or at least understand what is covered and what you may need to supplement.
This is also for my fellow Gen Xers who have parents on Medicare, who find themselves in the sandwich of caring for our budding adult children and our aging parents. So listen up. You can help your parents understand and plan. And this is good for us to know as we step into our own Medicare time.
What Is Medicare Open Enrollment?
Every year, from October 15 to December 7, people with Medicare can review their coverage and make changes for the coming year. Any change starts on January 1. Your new plan must receive your enrollment request by December 7 (Medicare.gov, n.d.-b).
During open enrollment, you can (Medicare.gov, n.d.-b):
- Switch from Original Medicare to a Medicare Advantage plan
- Switch from a Medicare Advantage plan back to Original Medicare
- Switch from one Medicare Advantage plan to another
- Join, switch, or drop a Medicare drug plan
If your plan still fits and is still offered next year, you do not have to do anything. But you have to look to know.
Your Options, in Plain Words
Original Medicare. Run by the federal government. Part A covers hospital care. Part B covers medical care, like doctor visits. You can see any doctor or hospital in the country that accepts Medicare.
Medigap. A supplement plan sold by private companies. It helps pay some of the costs Original Medicare leaves behind, like copays and deductibles. It works alongside Original Medicare.
Medicare Advantage (Part C). Offered by private companies approved by Medicare. It bundles your coverage into one plan and often includes extras. It usually has a network of doctors and hospitals, and its own rules for what needs approval first.
Part D. Drug coverage. You can add it as a separate plan with Original Medicare, or it may come built into a Medicare Advantage plan.
A note for New Yorkers: New York is one of three states where you can buy a Medigap plan at any time of year, even with preexisting conditions, and insurers must charge everyone in an area the same rate regardless of age (AARP, n.d.). That matters if you are in Medicare Advantage and thinking about switching back to Original Medicare.
There are more plan types than I am listing here, like Special Needs Plans. Each plan varies and asks for your due diligence to understand its details. But please do not worry about this being too complicated. This is a starting point, and these questions will help you begin your understanding.
Five Questions, and Who to Call
Bring a notebook. Bring someone you trust. Write down every answer, the date, and the name of the person you spoke with.
- Are my doctors in the network next year?
Call your plan, using the number on the back of your card. Then call each doctor’s office and ask, “Will you take my plan next year?” - Is my hospital in the network?
Call your plan. You can also call the hospital’s billing office. - Are all of my medicines covered?
Bring your full list, with doses. Call your plan, and compare plans at Medicare.gov/plan-compare. Your pharmacist can help, too. - What needs approval first?
This is called prior authorization. Call your plan and ask about rehab, home care, and medical equipment. - What would I pay for a hospital stay, rehab, and home care?
Call your plan, and check your Annual Notice of Change.
For a free, unbiased second set of eyes, call your State Health Insurance Assistance Program. They offer free counseling and sell nothing. In New York, it is called HIICAP.
What If a Change Affects Me?
This is about more than knowing what is coming. You can act.
- Switch plans before December 7. If your doctors, hospital, or medicines are leaving your plan, open enrollment is your chance to choose one that fits.
- If a medicine is dropped, ask your doctor about a covered medicine that would work for you. If none will, you or your doctor can ask your plan for an exception. Your doctor will need to explain the medical reason (Medicare.gov, n.d.-a).
- Already in Medicare Advantage? From January 1 to March 31, you can switch to a different Medicare Advantage plan, or go back to Original Medicare and join a drug plan (Medicare.gov, n.d.-b).
- Get help deciding. Call 1-800-MEDICARE (1-800-633-4227), any time, day or night, or sit down with a free HIICAP counselor.
Protect Yourself From Scams
This time of year, the mailbox fills up and the phone rings. Some of it is helpful. Some of it is selling. Some of it is a scam.
There are a lot of scammers making moves this time of year, and the calls, letters, and ads can be confusing. I got you. Follow these simple guidelines for avoiding scams and misinformation (Federal Trade Commission [FTC], 2025):
- Keep your numbers private. Hang up on any unexpected call asking for your Medicare, bank, or credit card number.
- Know that caller ID can be faked. A call showing “Medicare” may still be a scammer.
- Your Medicare card is free. Real cards arrive in the mail automatically. Anyone asking you to pay for one, or saying you need a “new” card, is a scammer.
- Medicare stays out of sales. Medicare only asks you to verify information when you contact them first, and it never tries to sell you anything.
- Go to the source. Hang up and call 1-800-MEDICARE yourself. Look things up at Medicare.gov, since paid ads can appear at the top of search results.
- Report it. Tell 1-800-MEDICARE, then report it to the FTC at ReportFraud.ftc.gov.
Your Free One Page Worksheet
I made a free printable worksheet with all five questions and room for your answers, plus a quick guide on page two, to help lessen the overwhelm.
Print one for yourself. Print one for your parents. Fill it out together over coffee. It is a gentle way for adult children to understand their parents’ coverage before anyone needs it.
Free printable
Your Medicare Check In worksheet
Two pages: five questions with who to call and room for notes, plus key dates, your options in plain words, and scam tips. Enter your email below and it will arrive in your inbox.
You will also receive the Gracewell Letter. You can leave anytime. No hard feelings, only love.
Before the Window Closes
Here is what I see in the emergency department. The families who looked early have more choices later. There is more peace in that room.
So this week, find the letter. Open it. Make the calls. It is a small act of love, for yourself or for someone you love.
This post is for education only. Medicare rules and costs change, and every situation is different. Always confirm your coverage with Medicare, your plan, and a free counselor.
A Blessing for the Ones Who Look Ahead
May the letters make sense. May the answers come clearly. May you meet these choices with a calm heart and good company. And may every small thing you do now become a kindness that waits for you later.
Go gracefully. 🤍
References
AARP. (n.d.). When is the best time to buy Medigap? https://www.aarp.org/health/medicare-qa-tool/best-time-to-buy-a-medigap-policy/
Federal Trade Commission. (2025, September). This Medicare Open Enrollment season, learn how to protect yourself from scams. https://consumer.ftc.gov/consumer-alerts/2025/09/medicare-open-enrollment-season-learn-how-protect-yourself-scams
Medicare.gov. (n.d.-a). How do drug plans work? U.S. Centers for Medicare & Medicaid Services. https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover/how-drug-plans-work
Medicare.gov. (n.d.-b). Joining a plan. U.S. Centers for Medicare & Medicaid Services. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
