Medicare Open Enrollment: How Beneficiaries Can Compare Plans, Use SHIP Help and Avoid Surprise Costs
Medicare Open Enrollment guidance: how beneficiaries can compare plans, use Plan Compare, get free SHIP counseling, and access low‑income assistance for 2026.
The Medicare Open Enrollment period requires action by many beneficiaries, with a December 7, 2025 deadline to lock in coverage beginning January 1, 2026. University of Michigan researchers warn that large numbers of Medicare enrollees do not use available tools or independent counseling, potentially missing savings and better coverage. This report explains practical steps beneficiaries and their families can take to compare options, evaluate total costs and identify assistance programs.
Who must act by December 7, 2025
More than 68 million Americans on Medicare faced the December 7, 2025 deadline to select or change plans for coverage starting January 1, 2026. That population includes people over 65 and those with significant disabilities who rely on Medicare Advantage, standalone Part D drug plans, or traditional Medicare with Medigap. Missing the enrollment window can leave beneficiaries with plans that no longer match their medical needs or budgets.
Many beneficiaries confront dozens of choices, with nearly every county offering multiple Medicare Advantage options and a range of Part D and Medigap supplements. Insurers routinely alter plan networks, formularies and cost-sharing from year to year, making a fresh review during Open Enrollment essential to avoid unexpected out-of-pocket spending.
Use Plan Compare to compare costs and coverage
Medicare’s Plan Compare and related online tools let users see which Medicare Advantage and Part D plans are available in a specific ZIP code and what they cover. Entering prescription names and dosages produces estimated yearly costs on different Part D or Medicare Advantage formularies, and identifies in-network pharmacies. Those estimates can reveal large differences in annual drug spending that a simple premium comparison misses.
Plan Compare also shows plan star ratings and whether a current Medicare Advantage plan will continue next year, information that can be decisive for people who rely on particular hospitals or specialists. Beneficiaries who find the site confusing are encouraged to seek hands-on help so they don’t overlook cheaper or better-suited options.
Seek independent counseling through SHIP
Commercial marketing from insurers and brokers increases sharply during Open Enrollment, and many sales pitches include incentives such as free meals or local events. University of Michigan analysts emphasize that these sources are not independent; agents and brokers may be compensated for enrollments. Beneficiaries who want unbiased guidance should contact their state’s State Health Insurance Assistance Program, or SHIP, which offers free, non‑commercial counseling.
SHIPS are staffed by paid employees and trained volunteers who do not have a financial interest in an enrollee’s plan choice. Despite their availability, surveys show most older adults are unaware of SHIP services. Counselors can provide one-on-one sessions, walk clients through Plan Compare results, and help identify programs for low‑income beneficiaries or those dually eligible for Medicaid.
Evaluate total costs, not only monthly premiums
A headline premium can be misleading. Some Medicare Advantage plans advertise $0 additional premiums beyond Part B, but that does not eliminate Part B payments or guarantee low out‑of‑pocket costs for care. Beneficiaries should review copayments, coinsurance, deductibles and the plan’s annual out‑of‑pocket maximum to understand likely annual spending based on anticipated care needs.
Traditional Medicare paired with Part D and Medigap may have higher monthly premiums but lower per-visit or per-prescription costs, and Medigap plans can protect against large unexpected bills. Conversely, Medicare Advantage plans may have narrower provider networks or prior authorization rules that affect access to care. Comparing both coverage details and costs for the specific drugs and providers a person uses will produce the clearest picture of total financial risk.
Resources for low‑income and dually eligible people
Beneficiaries with limited incomes have additional programs that can reduce premiums and drug costs, but some supports require applications while others are automatic. People who qualify for both Medicare and Medicaid — often called “dually eligible” — may receive Medicaid help with Medicare cost-sharing and should check state Medicaid rules and recertification requirements. There are also Medicare Savings Programs that can help pay Part B or Part A premiums for eligible individuals.
The Extra Help program can greatly reduce or eliminate Part D premiums and deductibles for qualifying beneficiaries, and some people are enrolled automatically while others must apply. Other options include Medicare Prescription Payment Plans that smooth annual drug costs, the PACE program for those who qualify for nursing‑home‑level care, and Special Needs Plans tailored to people with specific chronic conditions or dual eligibility. SHIP counselors can assist people in identifying and enrolling in these supports.
Different plans may better serve spouses or partners
Households often assume a single plan will suit both partners, but individual health needs and prior coverage can make separate choices wiser. Care requirements, prescription lists, travel patterns and prior employer or military benefits can differ dramatically between spouses. University of Michigan researchers note that couples frequently choose identical plans out of convenience, yet this can leave one partner with suboptimal access to specialists or higher drug costs.
Medicare tools do not have a “couples” mode, so each person should run their own plan comparison and, if needed, schedule separate counseling appointments. Making independent choices helps ensure each person’s coverage aligns with their personal care needs and financial circumstances.
Beneficiaries who enroll in a Medicare Advantage plan and later decide it is unsuitable have a limited opportunity to change coverage; they can typically switch plans during the Medicare Advantage open period through March 31, 2026. Major life changes such as a move, change in income, or loss of other coverage can also trigger Special Enrollment Periods that permit plan changes outside the regular window.
For most people on Medicare, taking time during Open Enrollment to compare options, consult an independent SHIP counselor, and focus on total annual costs rather than monthly premiums can prevent surprise bills and ensure access to needed providers and medications.
