Start with what you already have

Before you compare plans, find out whether you are already in Medicare and what type of coverage you have now. Call Medicare directly at 1-800-MEDICARE or log into your account at Medicare.gov to see your current plan details. If you are new to Medicare, you will need to know your may be able to access date — usually the month you turn 65 or the month you become may be able to access due to disability or end-stage renal disease.

The reason to start here is straightforward: switching plans has important date, and missing a important date can lock you into your current plan for a full year. If you are already enrolled, you have specific windows when you can change. If you are new, you have a one-time Initial Enrollment Period. Knowing where you stand tells you whether you have time to shop or whether you need to act now.

Key Takeaways

  • Medicare has two main paths — Original Medicare (Parts A and B) plus a separate Medigap or Part D plan, or Medicare Advantage (Part C), which bundles hospital, doctor, and usually prescription drug coverage into one plan.
  • Your choice depends on which doctors and hospitals you want to use, how much you expect to spend on prescriptions, and whether you prefer predictable costs or lower monthly premiums.
  • Open Enrollment runs from October 15 to December 7 each year, and that is when most people can switch plans without penalty.
  • Medicare.gov's Plan Finder tool lets you enter your doctors, hospitals, and medications to see which plans cover them and what your out-of-pocket costs would be.
  • If you miss Open Enrollment, you may still be able to switch during Special Enrollment Periods tied to life changes like moving, losing other coverage, or changes in your health plan's service area.

Understand the two main paths: Original Medicare or Medicare Advantage

Medicare offers two fundamentally different ways to get coverage. Original Medicare is run by the federal government and covers hospital care (Part A) and doctor visits (Part B) anywhere in the United States. You pay a monthly premium for Part B, and you pay a share of costs when you use care. You then add a separate plan for prescription drugs (Part D) and, if you want coverage for gaps like copays and coinsurance, a Medigap policy sold by private insurance companies.

Medicare Advantage (Part C) is sold by private insurance companies and bundles hospital, doctor, and usually prescription drug coverage into one plan. Most Advantage plans have a monthly premium (sometimes zero), but they limit you to a network of doctors and hospitals, and you typically need a referral to see a specialist. Some Advantage plans include dental, vision, or hearing coverage that Original Medicare does not offer.

The trade-off is straightforward: Original Medicare gives you freedom to see any doctor who accepts Medicare, but you manage multiple plans and may have higher out-of-pocket costs. Medicare Advantage locks you into a network but often has lower monthly premiums and may cover extras. Neither is right for everyone — it depends on your doctors, your medications, and how much you expect to spend.

Check which doctors and hospitals are in each plan

This is the single most important step, and it is the one most people skip. Go to Medicare.gov and use the Plan Finder tool. Enter your zip code, your doctors' names, and the hospitals you use. The tool will show you which plans include each doctor and which do not. If your primary care doctor is not in a plan's network, that plan is not a real option for you, no matter how cheap it looks.

For Original Medicare, any doctor who accepts Medicare can treat you, so you do not have to check a network. For Medicare Advantage, network changes happen every year — a doctor who was in the plan last year may not be in it this year. Call the plan directly to confirm that your doctors are still in-network for the coming year, especially if you have a specialist you see regularly.

If you are considering moving or if your doctor is leaving their practice, ask them now which Medicare plans they will accept next year. A plan that covers your doctor today may not cover them next year if the doctor retires or changes their insurance contracts.

Compare prescription drug coverage if you take medications

If you take any prescription medications, the cost of your drugs can be larger than your monthly premium. Use the Plan Finder tool again and enter each medication you take, including the dose and quantity. The tool will show you the monthly premium, your copay or coinsurance for each drug, and your total estimated yearly cost for that medication under each plan.

Pay attention to the plan's formulary — the list of drugs it covers. Some plans cover a drug at a low copay; others may not cover it at all or may require you to try a cheaper drug first. If a plan does not cover one of your medications, you can ask the plan for an exception, but that takes time and is not may provide. It is easier to pick a plan that covers your drugs from the start.

Also check whether the plan has a coverage gap (sometimes called the "donut hole"). In 2024, the gap begins after you and the plan have spent a certain amount on drugs together. Once you are in the gap, you pay a higher share of the cost until you reach catastrophic coverage. Some plans close the gap faster than others. The Plan Finder tool shows you whether you will hit the gap based on your current medications.

Know the enrollment windows and important date

Most people can change Medicare plans only during Open Enrollment, which runs from October 15 to December 7 each year. Any changes you make during this window take effect on January 1. If you miss this window, you are locked into your current plan for the rest of the year.

However, certain life changes open a Special Enrollment Period that lets you switch outside of Open Enrollment. These include moving to a new state or county, losing other health coverage, getting married or divorced, becoming may be able to access for Medicaid, or having a major change in your plan's coverage (such as your doctor leaving the network). You usually have 60 days from the event to make a change. If you experience one of these changes, contact Medicare at 1-800-MEDICARE to confirm you are may be able to access for a Special Enrollment Period.

If you are new to Medicare, your Initial Enrollment Period is a seven-month window centered on the month you turn 65. It starts three months before your birth month and ends three months after. If you miss this window and do not have other may have access to coverage, you may pay a permanent penalty on your premiums. Do not wait — enroll as soon as you are may be able to access.

Calculate your total yearly costs, not just the premium

A plan with a low monthly premium can have high out-of-pocket costs when you actually use care. Use the Plan Finder tool to see your estimated yearly costs under each plan, including premiums, copays, coinsurance, and deductibles. Add in the cost of any medications you take. This total is what you will actually pay, not the premium alone.

For Original Medicare, your costs depend on how much care you use. If you rarely see a doctor, Original Medicare with a low-premium Medigap plan may be cheapest. If you have multiple chronic conditions and see specialists often, a Medigap plan with low copays will protect you from surprise bills. For Medicare Advantage, your costs are usually capped at an out-of-pocket maximum, so you know the worst-case scenario.

Also consider whether you can afford the monthly premium if money is tight. Some people may have access to for Extra Help (for prescription drugs) or Medicare Savings Programs (for premiums and cost-sharing) based on income. These programs are run by your state. Call 1-800-MEDICARE to ask whether you may be may be able to access.

Make your choice and confirm your enrollment

Once you have narrowed your options, you can enroll in a new plan through Medicare.gov, by phone at 1-800-MEDICARE, or directly through the insurance company. If you enroll online, print or save your confirmation notice. If you enroll by phone, ask for a confirmation number and write it down.

After you enroll, you will receive a welcome packet from your new plan in the mail. Review it carefully to confirm your doctors are listed, your medications are covered, and your effective date is correct. If something is wrong, contact the plan when ready — you may be able to make changes before your coverage starts.

Keep your old plan's information until your new coverage begins on January 1 (or the date your Special Enrollment Period change takes effect). Do not cancel your old plan yourself; Medicare will handle that automatically. If you have questions about your transition, call your new plan's customer service number, which will be in your welcome packet.

Frequently Asked Questions

Can I switch plans if I miss the October 15 important date?

You can switch only if you have a may have access to life event, such as moving, losing coverage, or a major change in your plan's network. These Special Enrollment Periods last 60 days from the event. If you do not have a may have access to event, you are locked in until the next Open Enrollment in October. Contact Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

What happens if my doctor leaves the plan's network mid-year?

If your doctor leaves the network after you enroll, you may be able to request a Special Enrollment Period to switch plans. Contact your plan when ready to report the change, and then call Medicare to ask about your options. Some plans also allow you to continue seeing an out-of-network doctor at in-network rates for a limited time.

Do I have to choose a Medicare Advantage plan if it has zero premium?

No. A zero premium sounds good, but you will pay out-of-pocket costs when you use care, and you are limited to the plan's network. Compare your total yearly costs — premium plus copays, coinsurance, and deductibles — under both Original Medicare and Medicare Advantage before deciding. The cheapest plan is the one with the lowest total cost for your situation, not the lowest premium.

What if I take a medication that is not covered by any plan I like?

Contact the plan and ask for a formulary exception. You will need your doctor to write a letter explaining why you need that specific drug instead of the plan's preferred alternative. The plan has 72 hours to respond. If the plan denies the exception, you can appeal. This process takes time, so it is better to choose a plan that covers your drugs from the start if possible.

Can I change my mind after I enroll in a new plan?

Yes, but only during Open Enrollment or if you have a may have access to life event. If you enroll in a plan during Open Enrollment and then change your mind, you have until December 7 to switch to a different plan. After December 7, your choice is locked in until the next Open Enrollment in October, unless you experience a may have access to event.