If you're helping a parent or aging loved one manage their healthcare, the Medicare Open Enrollment period is a critical time of year. From October 15 through December 7, 2025, Medicare beneficiaries can change their plans for the upcoming year. This window allows enrollees to evaluate their current coverage, compare costs, and make changes to better suit their evolving medical and financial needs.
Even if your loved one seems satisfied with their current Medicare plan, it’s worth reviewing everything—especially if they’ve had new diagnoses, changes in prescriptions, or shifts in provider availability. What worked well last year may no longer be the best option for 2026.
Below are essential tips to guide you through the decision-making process with clarity and confidence.
1. Understand the Two Primary Paths: Original Medicare vs. Medicare Advantage
Choosing between Original Medicare and a Medicare Advantage Plan is the first—and often most important—step.
Original Medicare (Parts A and B)
- Coverage: Hospital (Part A) and outpatient/medical (Part B) services.
- Flexibility: Patients can see any provider nationwide who accepts Medicare.
- Costs: Medicare typically covers 80% of approved services. The remaining 20% is out-of-pocket unless covered by supplemental insurance.
- Drug Coverage: Not included; must be added separately via a Part D plan.
- Premiums: Usually deducted from Social Security benefits.
Medicare Advantage (Part C)
- All-in-One Plans: Combines hospital, medical, and often drug coverage in one plan.
- Lower Costs: Monthly premiums are often lower than Original Medicare with supplemental insurance.
- Provider Networks: Requires choosing from a specific group of doctors, hospitals, and pharmacies—so make sure preferred providers are "in-network."
- Extras: Some plans include dental, vision, or wellness perks not available through Original Medicare.
Tip: Medicare Advantage may be more cost-effective, but it limits provider flexibility. If your loved one needs access to a wider range of specialists or frequently travels, Original Medicare with Medigap might be better.
2. Review Prescription Drug Coverage (Part D)
If your loved one takes medications regularly, reviewing Part D drug plans is a must—even if they’re happy with their current plan.
- Formulary Changes: Insurance companies often adjust which drugs they cover and at what dosage levels.
- Pharmacy Pricing: Prices can vary significantly between pharmacies even within the same plan.
- Preferred Pharmacies: Look for plans that offer better pricing at your loved one’s pharmacy of choice.
Tip: Use Medicare’s Plan Finder tool at medicare.gov to enter current medications and compare coverage, pricing, and pharmacy networks.
3. Evaluate the Need for Supplemental Insurance (Medigap)
If sticking with Original Medicare, consider whether to purchase a Medigap plan to cover the remaining 20% of healthcare costs.
- Plan Variety: Medigap plans vary in coverage, provider flexibility, and monthly cost.
- Premiums vs. Copays: Plans with higher premiums typically offer lower copays and broader provider networks.
- Underwriting Requirements: Changing Medigap plans may involve a physical exam or lead to denial due to pre-existing conditions—unless you qualify for guaranteed issue rights.
Tip: Medigap open enrollment is only automatic during the 6-month window when someone first signs up for Medicare Part B. After that, switching can be tricky—so read the fine print carefully.
How Geriatric Care Managers Can Help
Navigating Medicare can be overwhelming—especially when coordinating care for an aging loved one with complex health needs. Geriatric Care Managers (GCMs) are invaluable allies during Open Enrollment. Here’s how they support families:
- Personalized Medicare Reviews: Assess current health status, medication needs, and preferred providers to recommend the most cost-effective and appropriate plan.
- Plan Comparison Support: Help interpret benefits, networks, and formularies so you can make apples-to-apples comparisons.
- Advocacy: Communicate directly with insurance companies and healthcare providers to resolve billing issues or network concerns.
- Long-Term Planning: Offer guidance on future care needs, ensuring that today’s Medicare choices align with tomorrow’s challenges.
Whether you're unsure which plan to choose or simply want a second opinion, a GCM can give you peace of mind.
Make the Most of Open Enrollment: Get Expert Medicare Help Today
Don't leave your loved one’s healthcare to chance. The decisions you make during Medicare Open Enrollment can impact coverage, access to care, and financial stability for the entire year.
📞 Contact LiveWell today to schedule a free initial consultation and discover how our experienced care managers can support you and your loved ones—during the holidays and beyond.
