Annual Medicare Plan Review Checklist: What to Check Each Fall

September 2026 checklist for reviewing 2027 coverage. Sources checked September 29, 2026.

Start your annual Medicare plan review with next year’s plan documents and an updated list of the care and prescriptions you use. This checklist is for people who already have Medicare Advantage or a separate Part D drug plan. Its purpose is to help you record what changed, what matters to you and what you still need to confirm before deciding whether to keep or change coverage.

Medicare365 is a private insurance agency, not a government agency. This is general education, not a recommendation to enroll in a particular plan. Read our comparison methods and compensation disclosures.

1. Gather the right year’s documents

Your plan sends an Annual Notice of Change (ANOC) in September describing changes that take effect in January. If it has not arrived, contact the plan. For this fall’s review, compare your 2026 coverage with the plan’s 2027 terms. Medicare explains the ANOC.

• Gather the ANOC and mark every change that could affect your care or budget.
• Get the next year’s Evidence of Coverage (EOC), Summary of Benefits, drug list and applicable provider and pharmacy directories.
• Write down the plan name, plan ID, county and coverage year. A familiar company name alone does not identify the exact plan.
• Keep any notice saying your plan is ending or changing service area. Ask Medicare or SHIP about the options and deadlines in that notice.

The Evidence of Coverage provides details about covered services and what you pay. Use it to answer questions the ANOC summary leaves open. Medicare explains that plan availability can change each year.

2. Recheck every prescription and pharmacy

A formulary is a plan’s list of covered drugs. Check the actual list for the year you are comparing; coverage this year does not establish coverage next year. Read Medicare’s explanation of formularies and drug tiers.

• Record each drug’s exact name, strength, form, quantity and refill frequency. Remove medicines you no longer take after confirming your current list with your prescriber.
• For each plan, record whether each drug is covered, its tier, your cost and whether the drug deductible applies.
• Check prior authorization, step therapy and quantity limits. Ask the plan and prescriber what would be needed for a new approval or an exception; do not assume an existing approval transfers.
• Confirm whether each pharmacy is in network and, if applicable, preferred. Compare the cost at pharmacies you can realistically use, including mail order if suitable.

Prior authorization means the plan requires approval before covering certain drugs. Step therapy can require trying another drug first, and quantity limits restrict the amount covered over a period. Check Medicare’s drug plan rules. Preferred pharmacies may offer lower cost sharing than other network pharmacies; review Medicare’s pharmacy guidance.

3. Confirm doctors, hospitals and care rules

For Medicare Advantage, review your primary doctor, specialists, hospitals, laboratories, therapy providers and equipment suppliers. Ask both the plan and each important provider about participation in the exact plan for the coming year. Record the date, person contacted and answer.

• Ask whether routine care must be in network and what happens if you use an out-of-network provider.
• Check whether you need specialist referrals or prior authorization for care you expect to use.
• If treatment is already underway, ask how a plan change would affect appointments, authorizations and ongoing care before enrolling.
• If you travel or live elsewhere seasonally, ask about routine, urgent and emergency care in those locations.

Network, referral and approval requirements depend on the plan. Medicare’s coverage comparison explains these distinctions. For a separate Part D plan, focus on drugs and pharmacies here; review medical coverage separately.

4. Compare costs beyond the premium

Use the plan’s next-year documents to record each cost below. Leave unavailable figures marked “not confirmed,” rather than carrying over this year’s amount.

• Premiums: the plan premium and applicable Medicare premiums. A $0 plan premium does not mean all care is free.
• Deductibles: medical and drug deductibles, and which services or drug tiers they apply to.
• Care you expect: copayments or coinsurance for visits, tests, hospital stays, therapy and other likely services.
• Prescriptions: estimated yearly drug spending at your chosen pharmacies, using the same complete medication list for each plan.
• Medical maximum out-of-pocket: for Medicare Advantage, the plan’s limit and any separate in-network and combined limits. Ask which expenses count. Keep premiums, Part D costs and noncovered expenses separate in your budget.

Make two budgets: one based on expected care and one with greater medical use. Neither is a prediction or a guarantee. Medicare describes the factors affecting Medicare Advantage costs. Do not add a deductible again if it is already included in a cost estimate.

5. Check the benefits you would actually use

For dental, vision, hearing and any other advertised extra benefit, record the covered service, allowance or limit, eligible providers, frequency and approval requirements from the next-year EOC. Ask whether a benefit has eligibility conditions and whether you meet them. Weigh its usefulness alongside access to care and total cost.

Illustrative review: suppose your plan premium stays the same, but your regular pharmacy is no longer preferred and a specialist’s network status is unconfirmed. Mark both items for follow-up. The unchanged premium alone does not resolve whether the plan still meets your needs.

6. Record what changed and what remains unanswered

Use one line per issue in a notebook or our Medicare plan comparison worksheet. Keep personal medical information in your own records.

1. Issue: the specific drug, provider, cost or benefit.
2. This year and next year: the two terms you are comparing.
3. Evidence: document name, page, coverage year and verification date.
4. Next action: who to contact and the answer you need.
5. Outcome: confirmed, needs follow-up or does not meet your needs.

Compare alternatives using Medicare Plan Compare. Select the correct coverage year, enter your drugs and pharmacies, and verify unresolved details with the plan. Estimates can change with your medicines, care and plan terms.

7. Confirm timing before changing coverage

Medicare Open Enrollment runs from October 15 through December 7. Under those rules, changes made during fall 2026 take effect January 1, 2027; the plan must receive the enrollment request by December 7. Read Medicare’s Open Enrollment options.

If you are considering leaving Medicare Advantage for Original Medicare, confirm separate drug coverage and Medigap rights before acting. Fall Open Enrollment does not by itself guarantee that you can buy Medigap. Check Medicare’s Medigap enrollment protections. Ask SHIP or your state insurance department about protections that apply to you. If you have employer or union coverage, consult its benefits administrator before making a change.

Before submitting an enrollment request, resolve your essential coverage questions, confirm the effective date and save the confirmation. If you plan to keep your coverage, confirm that it continues and read any renewal instructions. Do not assume that doing nothing is appropriate when you have received a termination notice.

Get help with the review

Call 1-800-MEDICARE (1-800-633-4227), or contact your State Health Insurance Assistance Program (SHIP) for free personalized counseling. SHIP is independent of insurance companies and health plans. Find Medicare’s comparison tools and SHIP help.

Benefits, costs, networks, formularies and enrollment rights depend on the plan, year, location and individual circumstances. Verify them with Medicare, the plan and qualified advisers. Discuss medication or treatment changes with your health-care professional.

Prepared with AI assistance from the primary Medicare.gov sources linked above. Source-checking is not a substitute for accountable human editorial review. This checklist should be revalidated each September and when relevant Medicare rules change.