The Annual Enrollment Period (AEP) is your opportunity to evaluate your coverage and ensure your healthcare plan continues to fit your needs and budget for the upcoming year.

If you are satisfied with your current coverage, you do not need to take any action; your plan will automatically renew. However, insurance plans frequently adjust their costs, doctor networks, and prescription coverage each year. Use this simple checklist to review your options before the enrollment window closes.

1. Review Your Annual Notice of Change (ANOC) & Doctor Networks

• By September 30, your insurance provider should have sent you an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC).
• Review plan modifications: Carefully examine changes to your monthly premium, copays, deductibles, and covered benefits.
• Verify your care team: Physician and hospital networks change annually. Confirm that your primary care physician, key specialists, and preferred hospitals remain in-network for 2027 to avoid unexpected out-of-pocket costs.

2. Confirm Prescription Drug Coverage

• Drug coverage rules and costs are updated every year. Check the drug list (formulary): Ensure all your current medications remain on your plan’s covered list.
• Watch for tier shifts: If a drug moves to a higher tier, your copay or coinsurance will increase.
• Review coverage rules: Look for newly added requirements, such as prior authorization or step therapy, before your prescriptions can be filled.

3. Evaluate Out-of-Pocket Safeguards

• Pay close attention to your plan’s Maximum Out-of-Pocket (MOOP) cap, the safety net that protects you financially during major health events.
• A plan featuring a $0 monthly premium may carry a high MOOP cap, leaving you responsible for substantial expenses in the event of a hospital stay or serious illness.
• Always evaluate both in-network and out-of-network MOOP limits when comparing HMO and PPO options.

4. Calculate True Costs & Check Pharmacy Networks

• Look beyond the headline monthly premium to understand your total expected healthcare costs.
• Calculate total expenses: Combine the monthly premium with deductibles, specialist copays, hospital stay rates, and prescription costs.
• Use preferred pharmacies: Filling prescriptions at a standard or out-of-network pharmacy can significantly increase your co-pays. Verify that your local pharmacy is designated as a “preferred” network partner.

5. Check Your Supplemental Perks

• Secondary benefits, such as dental, vision, hearing aid allowances, over-the-counter (OTC) stipends, and gym memberships frequently change their rules and allowance limits annually.
• Review the exact quarterly or annual limits to ensure these extra perks continue to align with your personal health and wellness needs.

6. Consider Original Medicare Alternatives

• During AEP, you have the option to leave Medicare Advantage and return to Original Medicare (Parts A & B) combined with a standalone Part D prescription drug plan.
• Important Note on Medigap: While returning to Original Medicare is straightforward, securing a Medicare Supplement (Medigap) policy may require medical underwriting in most states. Depending on your health history, this could result in higher rates or denial of coverage.