Medicare’s annual open enrollment period runs from October 15 to December 7 each year, giving beneficiaries nearly eight weeks to adjust their coverage. During this window, people can switch between traditional Medicare and Medicare Advantage plans, alter prescription drug coverage, or make other changes that take effect on January 1. The program covers over 70 million Americans aged 65 and older or younger adults with disabilities, offering services ranging from hospital stays to preventive care.
Changes available during open enrollment include switching from traditional Medicare to a Medicare Advantage plan or vice versa, changing Part D prescription drug plans, and enrolling in a new Part D plan if one wasn’t previously held. Traditional Medicare beneficiaries who missed their initial enrollment window for prescription drugs may face penalties but can still add Part D coverage during the open period. Those in Medicare Advantage can opt to switch plans or return to traditional Medicare, though they’ll need a separate Part D plan if they choose traditional coverage.
Special Enrollment Periods for Life Changes
Outside the annual enrollment period, Special Enrollment Periods (SEPs) allow changes under specific circumstances. For example, relocating across counties, losing employer-sponsored coverage, or exiting Medicaid eligibility grants immediate access to modify Medicare plans. As of 2025, dual-eligible beneficiaries and those receiving Part D Low-Income Subsidies can make changes once per month. Nursing home residents and certain facility dwellers also qualify for monthly adjustments. Additionally, Medicare Advantage enrollees can switch plans between January 1 and March 31 via the Medicare Advantage Open Enrollment Period, and those in plans with lower quality ratings can move to 5-star plans between December 8 and November 30 of the following year.
Supplemental coverage options like Medigap policies and retiree health benefits factor significantly into Medicare decisions. Medigap policies, which help cover deductibles and cost-sharing, can be purchased at any time by traditional Medicare beneficiaries. However, those applying after their initial six-month enrollment period may face higher premiums or denial of coverage due to pre-existing conditions. Employer-sponsored retiree benefits, held by over 14 million Medicare beneficiaries, may be tied exclusively to either traditional Medicare or Medicare Advantage, limiting flexibility if beneficiaries switch coverage types during open enrollment.
Low-Income Beneficiaries and Subsidies
Low-income beneficiaries accessing Medicaid, Medicare Saving Programs (MSP), or Part D Low-Income Subsidies (LIS) gain additional support for premiums and out-of-pocket costs. Those eligible for full Medicaid benefits can coordinate coverage through dual-eligible plans, with changes allowed monthly under certain conditions. Automatically qualifying for LIS due to full Medicaid coverage or Supplemental Security Income payments, beneficiaries are enrolled in a benchmark Part D plan at no cost unless they opt for a different plan.
Traditional Medicare vs. Medicare Advantage Plans
Traditional Medicare offers broad provider access, with no referrals or prior authorizations required for most services, while Medicare Advantage plans often include extra benefits like dental, vision, and hearing coverage. Most Medicare Advantage plans cap out-of-pocket spending at $9,250 for in-network services, with average limits lower than that. These plans typically bundle Part D coverage and may require referrals or prior authorizations for certain treatments.
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In 2027, the average Medicare beneficiary can choose from 35 Medicare Advantage plans, including 28 with Part D coverage, though options vary significantly by state. Premiums for these plans averaged $15 monthly in 2026, with three-quarters of enrollees paying no additional premium beyond their Part B premium. Out-of-pocket limits, provider networks, and extra benefits differ widely, influencing costs and access to care. Plans must provide searchable provider directories through the Medicare Plan Finder tool, with updates required within 30 days of network changes.
Stand-alone Part D prescription drug plans offer traditional Medicare beneficiaries flexibility in selecting coverage tailored to their medication needs. These plans operate independently, requiring beneficiaries to pay a separate monthly premium in addition to their Part B premium, with an average cost of $36 in 2026. Beneficiaries can choose from between 8 and 12 different Part D options available in their region for that year.
Prescription Drug Cost Protections
The annual out-of-pocket spending cap for prescription drugs under Part D reaches $2,400 in 2027, providing financial protection against excessive medication costs. Additionally, the Medicare Prescription Payment Plan, launched in January 2025, allows beneficiaries to spread their out-of-pocket drug expenses across monthly installments rather than paying all at once at the pharmacy. This opt-in program
Initial Medicare Enrollment and Medigap Rights for Younger Adults with Disabilities
Medigap guaranteed issue rights differ for people under 65 who qualify for Medicare due to long-term disability. Federal law does not mandate insurers to sell Medigap policies to individuals with Medicare under 65, though some states require offering at least one policy type. Premiums for these policies are typically higher than those for age 65 or older beneficiaries.
When individuals under 65 with disabilities turn 65 and become age-eligible for Medicare, they gain a six-month Medigap open enrollment period. During this window, they can purchase any Medigap policy without facing higher premiums or coverage denials related to pre-existing conditions.
