Medicare Enrollment Closes December 7: Your Checklist for the Final 40 Days

The window and the dates that matter

Medicare's Annual Enrollment Period runs October 15 to December 7 every year, and any change you make during it takes effect January 1. That is the whole structure, and it matters because the window is the main chance most people get to change a Medicare Advantage plan or a Part D drug plan. Counting from October 28, you have 40 days until the window closes. After December 7, the options narrow sharply. Medicare Advantage Open Enrollment, which runs January 1 to March 31, is often confused with the fall window, but per CMS it only lets people already in a Medicare Advantage plan switch to another plan or return to Original Medicare. It does not let Original Medicare members join a Medicare Advantage plan, and it does not add drug coverage. Outside these windows, you generally need a special enrollment situation, such as moving out of your plan's service area. Treat December 7 as a firm deadline rather than a suggestion.

Start with the Annual Notice of Change

Your plan was required to send the Annual Notice of Change by September 30, so it should already be in your mail or your plan's online account. If you cannot find it, request another copy from the plan or download it from the member portal. The notice lists what changes on January 1: premiums, deductibles, copays, drug tiers, and the provider and pharmacy networks. Read it with a pen and compare each line to what you pay now. Pay particular attention to the pages on prescription drug coverage and on the maximum you could pay out of pocket for covered services. Plans can change these figures every year, and staying put is an active decision with a price. Many people skip the notice because it looks like routine mail, then discover in February that a drug moved to a higher tier or a doctor left the network. By then, your choices are narrower, and a standalone drug plan generally cannot be changed.

Check your drugs against the formulary

The formulary is the plan's list of covered drugs, and it can change from one year to the next. Pull out every prescription you take, with the dose, and look each one up in next year's formulary using the plan's online drug search or the Medicare.gov plan finder. Note the tier, whether the plan requires prior authorization, and which pharmacies are preferred. Here is a hypothetical example with made-up numbers. Suppose you take three medications. Under your current plan, they cost you 10, 40 and 95 dollars a month. In next year's notice, the third drug moves to a higher tier at 150 dollars a month. Your monthly drug cost goes from 145 to 200 dollars, which is 55 dollars more, or 660 dollars across twelve months. If a competing plan charges 25 dollars a month more in premium than your current plan but keeps that drug at 95 dollars, its added yearly cost is 300 dollars, so the switch saves 360 dollars.

Confirm your doctors, hospitals and pharmacies

Plan networks also change, and a doctor you have seen for years can leave a network without any change on your part. Make a list of your primary care doctor, specialists, preferred hospital and pharmacy. Then check each one against the plan's provider directory, and call the doctor's billing office to confirm that they will accept the specific plan for next year, by plan name, not just the insurance company's name. Directories can be out of date, so a phone call is the most reliable check. Ask whether the office is in network for the plan, not merely whether it takes Medicare. Original Medicare lets you see any provider that accepts Medicare, while many Medicare Advantage plans limit you to a network, and some charge more outside it. Write down the date, the name of the person you spoke with and what they said. If a coverage dispute comes up later, that note gives you something concrete to point to.

What people get wrong

The costliest mistakes are quiet ones. The first is assuming last year's plan is still the right plan, when premiums, tiers and networks can all change. The second is comparing only the monthly premium, which ignores drug costs, deductibles and the yearly out-of-pocket maximum. A low-premium plan that covers your drugs poorly can cost more than a higher-premium plan that covers them well, as the example above showed. The third is believing the January through March window is a second full chance. Per CMS, it only lets current Medicare Advantage enrollees switch plans or go back to Original Medicare, so someone who waits to shop for drug coverage may be stuck. The fourth is responding to unsolicited calls or mailers that promise better benefits. The FTC's Consumer Sentinel Network tracks fraud affecting older adults, so treat unexpected offers with suspicion. Never give your Medicare number to a caller you did not contact, and verify any agent through your state insurance department's license lookup.

How to check your own situation

Set aside one hour this week and gather four things: your Annual Notice of Change, your current Medicare card, a list of every prescription with its dose, and the names of your doctors and pharmacy. Then answer five questions. What will my total premium be in January compared with now? What will each of my drugs cost, and are any on a higher tier or subject to prior authorization? Are all my doctors and my hospital in network for the plan I am considering? What is the plan's maximum out-of-pocket amount for covered services? Do I qualify for any special enrollment situation if I miss December 7? Use the Medicare.gov plan finder to compare your current plan against alternatives, and contact Medicare directly if a figure is unclear. If your answers show that nothing material changed, staying put is a reasoned choice. If something did change, switch before December 7. Takeaway: compare the notice to your actual drugs and doctors before December 7.

For general education only. Not legal, tax or financial advice, and not an offer to sell any Medicare plan. Plan benefits, costs and networks vary by plan and location. The dollar figures in the worked example are hypothetical. Confirm details with Medicare.gov, your plan, or a licensed professional before making enrollment decisions.