Understanding Medicare Open Enrollment: A Simple, Honest Guide for Older Adults
As the seasons shift, so does something else important for many older adults: Medicare Open Enrollment, which runs from October 15 to December 7 each year.
This annual period is when people enrolled in Medicare can make changes to their coverage — whether that means reviewing existing plans, adjusting prescription drug coverage, or considering supplemental options. While there are many advertisements this time of year, not all Medicare plans are created equal, and it’s important to understand how they really work — especially plans that might seem too good to be true.
In this post, we’ll break down what you can do during Open Enrollment, what to look out for, and how to protect your health and finances with the right coverage.
✅ What You Can Do During Medicare Open Enrollment
Between October 15 and December 7, you can:
Switch from Original Medicare (Parts A & B) to Medicare Advantage (Part C) — or vice versa
Change from one Medicare Advantage plan to another
Join, switch, or drop a Medicare Part D prescription drug plan
Sign up for a Medigap (Medicare Supplement) plan if eligible
Any changes made during this period will take effect January 1 of the following year.
🧠 Understanding Your Options (And What to Watch For)
🔹 Original Medicare (Parts A & B)
Run by the federal government
Covers hospital care (Part A) and doctor/medical services (Part B)
Offers flexibility — you can see any provider who accepts Medicare
Doesn’t include prescription drugs — but you can add Part D
Allows you to add a Medigap plan to help cover out-of-pocket costs (like deductibles and coinsurance)
🔸 Medicare Advantage (Part C) — What You Should Know
Medicare Advantage plans are run by private insurance companies. Many advertise low or $0 premiums, dental, vision, gym memberships, and more — but these perks come with tradeoffs.
According to recent findings from Kaiser Family Foundation (KFF) and U.S. Government Accountability Office (GAO):
Restricted networks: You may be limited to certain doctors or hospitals. Seeing specialists or getting care out-of-network can be costly — or denied entirely.
Prior authorizations: Many Advantage plans require pre-approval for tests, surgeries, or treatments — which can delay or block care.
Denied services: GAO reports found that some insurers wrongly denied care that should have been covered under Medicare rules.
Out-of-pocket costs can add up: While premiums may seem low, copays, coinsurance, and non-covered services can be expensive.
Switching out can be hard: If you try a Medicare Advantage plan and later want to go back to Original Medicare, you may not be able to get a Medigap plan (or may have to pay more for one).
Bottom line: Medicare Advantage may work well for some, but it’s not a great fit for everyone — especially if you have complex medical needs or value flexibility in choosing providers. Be sure to read the fine print and know what you're trading off.
📋 A Checklist to Help You Review Your Coverage
Review your current plan
Are your doctors still in-network?
Are your medications covered?
Have your health needs changed?
Compare your prescription drug coverage (Part D)
Check for changes in your formulary (list of covered drugs)
Make sure your pharmacy is still included
Understand costs
Review your premiums, copays, and deductibles
Don’t assume that $0 premium plans mean $0 care
Ask: Do I need supplemental coverage?
A Medigap plan can help cover costs that Original Medicare doesn’t, like hospital stays and specialist visits
These plans allow you to see any Medicare provider without referral requirements
📞 How Warmly Nursing Concierge Can Support You
At Warmly Nursing Concierge, we understand that reviewing Medicare options can be overwhelming — especially with so many sales calls, flyers, and confusing offers this time of year.
Our team is here to:
Walk you through plan comparisons without pressure
Help you identify what coverage works best for your unique health needs
Support caregivers navigating the Medicare system on behalf of loved ones
Whether you just want to talk through your questions or need help reviewing multiple options, we’re happy to assist — even if it’s just a friendly voice to guide you through.
🗓️ Final Thoughts: Take Your Time, Ask Questions, and Protect Your Coverage
Don’t rush. Don’t feel pressured by ads or sales agents. This is your opportunity to make sure your healthcare coverage works for you — not against you.
Remember, Open Enrollment runs from October 15 to December 7. Set aside a little time this month to review your options — or reach out for support if you need it. The choices you make now will shape your health access for all of 2026.
Warmly Nursing Concierge is just a phone call away if you’d like help navigating the process. You don’t have to go it alone.
