Your dad's mailbox is full of glossy Medicare ads, and the TV has run plan commercials since September. He says his plan is fine and doesn't want to deal with it. But last year his inhaler suddenly cost more, and his longtime cardiologist mentioned she might leave his plan's network. You want to help him check, without getting pulled into a sales pitch.
This guide uses Medicare.gov. It focuses on what families should check and how to decide. We don't list premiums or plan costs, because they vary by plan, county and year. Use Medicare's plan finder or a free State Health Insurance Assistance Program (SHIP) counselor for numbers specific to your parent3.
What you can change during Open Enrollment
From October 15 to December 7, your parent can1:
- Join, drop or switch Medicare Advantage plans. With or without drug coverage, or add or drop drug coverage.
- Switch between Original Medicare and Medicare Advantage. In either direction.
- Join, drop or switch a Medicare drug plan. If they have Original Medicare.
Changes take effect January 1, as long as the plan gets the request by December 71. If your parent does nothing, they generally stay in their current plan, with whatever changes it makes for the new year. For the basics on the two main paths, see Medigap vs. Medicare Advantage. Signing up late can cost more; see the Medicare late enrollment penalty.
Why review even if nothing seems wrong
Plans can change their costs, covered drugs, pharmacy networks and doctor networks from one year to the next. A plan that fit your parent well this year might not next year. And your parent's health may have changed: a new diagnosis, a new specialist, new medicines or a move to assisted living can all change which plan is best.
Medicare's own advice when choosing a plan is to compare plans available in your area, adding all prescription drugs your parent takes regularly to get the most accurate cost estimate1. That one step catches many costly surprises.
The family review checklist
- Has your parent read any notices from their plan about next year's changes?
- Are all current medicines on next year's drug list, at what cost tier, and with any prior authorization or quantity limits?
- Is their usual pharmacy still in the network, and is it a preferred pharmacy?
- Are their primary care doctor, specialists and preferred hospital in network for next year?
- Did they use services this year that cost more than expected?
- Do they expect surgery, therapy or a move to senior living next year?
- Did their income or savings drop? They may qualify for Extra Help or a Medicare Savings Program.
- Is someone authorized to talk with the plan and Medicare on their behalf?
Gather your parent's Medicare card, plan card, medication list with doses, and a list of doctors before you start.
How to compare plans
- List every medicine and dose. Medicare says to add all regular prescriptions for the most accurate cost estimate1.
- Use Medicare's plan finder. Compare plans in your area by cost and coverage1.
- Check doctors directly. Call the doctors' offices and ask whether they'll be in the plan's network next year.
- Look at the whole year. Premiums, deductibles, copays and, for Medicare Advantage, the yearly out-of-pocket limit4.
- Check rules. Medicare Advantage plans may require approval before seeing a specialist, or prior authorization for some services4.
- Ask for free help. A SHIP counselor isn't connected to any insurance company13.
Medicare also notes you can use the Medicare & You handbook or a trusted agent or broker, and it lists the rules agents must follow1. A SHIP counselor is the only option with no tie to selling a plan.
A simple Open Enrollment timeline
Seven weeks goes fast, especially around the holidays. Breaking the work into steps keeps it manageable:
- Early October. Gather plan notices, the medication list and the doctor list. Book a SHIP appointment early, since counselors get busy3.
- Mid-October to early November. Run the plan comparison with every medicine added1. Call doctors' offices about next year's networks.
- November. Narrow to two or three choices. Read the plan documents and ask questions.
- By early December. Enroll, or decide to stay. Don't wait for the last day, in case something goes wrong; the plan must get the request by December 71.
- January. Watch for the new plan card and welcome materials, fill a prescription early in the month, and make sure the pharmacy has the new plan information.
If anything goes wrong in January, such as a medicine not covered as expected, call the plan right away and ask about a transition supply, then contact a SHIP counselor.
Questions to ask a plan before enrolling
- Are all my parent's medicines covered next year, and at what tier? Ask about prior authorization and quantity limits.
- Which pharmacies are preferred? Costs can differ between pharmacies in the same plan.
- Are these specific doctors and hospitals in network next year? Get names, not general answers.
- Is approval needed to see a specialist? Medicare Advantage rules vary4.
- What is the yearly out-of-pocket limit? Medicare Advantage plans have one; Original Medicare doesn't4.
- Is there coverage when traveling? Original Medicare and most plans generally don't cover care outside the U.S.4
Write down who you spoke with and when. If an answer turns out to be wrong, notes help when you contact the plan or Medicare.
Avoiding pressure and scams
Open Enrollment brings a flood of calls, mail and ads. Some come from legitimate plans and agents; some are aggressive or misleading. A few simple rules protect your parent:
- Never give a Medicare number to an unexpected caller. Medicare doesn't call to sell plans.
- Don't switch based on an ad alone. Check doctors and drugs first.
- Be wary of gifts or urgency. A real plan will still be available tomorrow, until December 71.
- Get it in writing. Ask for plan documents before agreeing to anything.
- Talk to a SHIP counselor. Free, unbiased help3.
If your parent was signed up for a plan they didn't want, contact the plan and Medicare right away. See when an elderly parent is scammed and elder financial abuse.
The Medigap caution
This is the part families most often miss. If your parent has Original Medicare with a Medigap policy and switches to Medicare Advantage, getting a Medigap policy back later may not be easy. Federal law gives a one-time six-month Medigap Open Enrollment Period that starts when someone first has Part B at 65 or older. Outside that window, insurers can generally use medical underwriting, charge more or deny a policy, unless your parent has a guaranteed issue right2. Some states give extra rights, so check with your State Insurance Department2.
The reverse matters too. Someone in Medicare Advantage can switch back to Original Medicare during Open Enrollment1, but may not be able to buy a Medigap policy to cover the 20 percent coinsurance42. Before any switch involving Medigap, talk with a SHIP counselor.
Help with costs
If your parent's income is limited, two programs can lower costs, and neither depends on Open Enrollment. Extra Help lowers Part D costs, and people who get it also have Special Enrollment Period options51. Medicare Savings Programs help pay Medicare premiums and, for some, deductibles and copays. See Extra Help for Medicare Part D and Medicare Savings Programs.
After December 7
If your parent is already in a Medicare Advantage plan, there's a second window from January 1 to March 31. During it they can switch to another Medicare Advantage plan or drop their plan and return to Original Medicare, and join a separate drug plan1. This window is only for people already in Medicare Advantage1.
Special Enrollment Periods allow changes at other times when certain life events happen, such as moving to a new address, losing or changing coverage, getting Medicaid or getting Extra Help16. A move into a nursing home or to another state is a common reason families use one. See moving a parent to senior living.
If your parent lives in senior living
Moving to assisted living, memory care or a nursing home can change which plan works best. Ask the community which pharmacies it uses, which doctors visit, and which Medicare Advantage plans, if any, it works with. If your parent's plan has a narrow network, the community's doctors may be out of network. See medication management.
Helping without overstepping
Plans and Medicare usually need your parent's permission to talk with you. Ask your parent to name you as an authorized contact with the plan, or use a power of attorney if they have one. See power of attorney for an elderly parent. The decision belongs to your parent when they can make it. Your job is to bring the facts to the table.
Once coverage is settled, book your parent's Medicare Annual Wellness Visit for the new year. If you're helping from far away, schedule a video call during Open Enrollment and share screens while you compare plans. See long-distance caregiving.
An example
Dolores, 78, has a Medicare Advantage plan. In October her daughter enters her five medicines into Medicare's plan finder and learns one will need prior authorization next year1. She calls the cardiology office, which confirms it is staying in the network. With a SHIP counselor, they compare two other plans, find one that covers all five medicines with her pharmacy, and enroll by December 7, effective January 11. In the first week of January, her daughter calls the pharmacy to make sure it has the new plan card on file, and Dolores fills her inhaler without a problem. They put a reminder on the calendar for next October to do the same review again. This is an illustration; your parent's best choice depends on their needs.
Getting help
Your local SHIP offers free, personalized counseling3. For broader planning, see managing an elderly parent's finances.
