Published and last reviewed August 2, 2026 · By James O’Neal

What a Medicare plan review is, and why it is worth doing yearly

A Medicare plan review is a short, structured check that the plan you are on is still the right one. It is not a sales appointment and it does not assume you will change anything. Most reviews end with “keep what you have”, and that is a perfectly good outcome.

The reason to do it every autumn is that plans change even when your life does not. Formularies are rewritten, drug tiers move, provider networks gain and lose practices, copays are re-set, and supplemental benefits appear and disappear. A plan that was the cheapest option for you last year can quietly become the most expensive one without a single thing changing at your end.

The window that matters is the Annual Enrollment Period, October 15 to December 7, with changes taking effect on January 1. A Medicare plan review done in early November leaves time to act. One done on December 6 usually does not.

The Medicare plan review checklist

Gather these before the appointment. Everything on this list changes the answer, and missing one is the usual reason a review has to be repeated.

Your doctors and hospitals

Write down every physician and specialist you want to keep, by name, plus the hospital you would choose. Not the health system — the individual practice. A system can be in network while a particular practice inside it is not.

Every prescription, exactly

The drug name, the strength, and how often you take it. “A blood pressure tablet” cannot be priced; “lisinopril 10mg once daily” can. Tier placement moves the annual cost far more than the premium does, and the same drug can sit on tier 2 in one plan and tier 4 in another.

Your pharmacy

Plans have preferred and standard pharmacies, and the difference in copay between the two can be substantial for the same drug on the same plan. Mail order is worth pricing separately if you take maintenance medication.

The notices your plan sent you

The Annual Notice of Change and the Evidence of Coverage, both of which arrive in the autumn. If you have thrown them out, the plan will send them again — but bring them if you have them, because the ANOC is the single most useful document in a Medicare plan review.

Any other coverage you hold

Medicaid, Extra Help, VA or TRICARE benefits, retiree or employer coverage, a Medigap policy. Each of these changes what makes sense, and two of them can make a plan you are considering a poor idea outright.

Finally, bring your ZIP code and county, and your budget question — whether that is a monthly ceiling or a worst-case-year ceiling.

The Annual Notice of Change: the document most people bin

Every Medicare Advantage and Part D plan must send an Annual Notice of Change each autumn setting out exactly what will be different on January 1. It is dull, it looks like junk mail, and it is the most valuable piece of post you get all year.

Read three things in it. What happens to your premium and deductible. What happens to the drugs you actually take — the tier column, not the list. And whether the plan’s out-of-pocket maximum has moved.

If any of those three has changed materially, a Medicare plan review is worth booking rather than assuming. If none of them has, you can usually stay put with confidence.

What actually happens during a Medicare plan review

Twenty to forty minutes, by phone or screen share, with a family member on the line if you want one.

We price your exact drug list across every plan available in your county, check each provider individually, compare the total annual cost rather than the premium, and look at the out-of-pocket maximum as your worst case. Then we put two or three options in front of you in writing, including the option of changing nothing.

There is no cost. Plan prices are set by the insurer and filed with regulators, so they are identical whether you enroll through an agent, through the carrier, or by yourself at Medicare.gov.

When a Medicare plan review should change something — and when it should not

Change is usually warranted when a drug you depend on has moved tier or come off the formulary, when a doctor you will not give up has left the network, when your health has changed enough to alter how much care you expect to use, when you have moved county, or when you have become eligible for Medicaid or Extra Help.

Change is usually not warranted because a different plan advertises a bigger dental allowance, because a neighbor switched, or because a mailer said your plan was being discontinued when it was not. A Medicare plan review exists partly to rule these out cheaply.

One caution that applies in reverse. If you hold a Medicare Supplement policy and are thinking of leaving it, understand that going back may involve health questions and can be refused. That decision deserves more than a review; it deserves a proper conversation.

What a Medicare plan review most often turns up

Unclaimed help with costs. People who would qualify for a Medicare Savings Program or Extra Help and never applied. This is the most valuable thing a review finds and it costs nothing to check.

A drug on the wrong tier. Frequently fixable by moving plan, sometimes fixable by asking the prescriber about a therapeutic alternative.

A pharmacy that is not preferred. Same plan, same drug, lower copay, one street away.

A plan that was right three years ago. Chosen when the person was healthy and never revisited after a diagnosis.

Nothing at all. Which is a real result, and worth the half hour.

Questions people ask about a plan review

Do I have to change anything? No. Most reviews end with the recommendation to stay put, and there is no pressure either way. Nothing is submitted without you asking for it.

Will it cost me? Nothing, and it does not raise your premium. Plan prices are filed with regulators and are identical however you enroll, so there is no version of your plan that is cheaper for going it alone.

Can I do it outside the autumn window? The review itself can happen any time, and often should — it is better to know in June that a drug has moved tier than to discover it in December. Whether you can act on the findings depends on which enrollment period you are in, and a Special Enrollment Period may apply if you have moved, lost other coverage, or gained Medicaid or Extra Help.

What if I am on a Medicare Supplement rather than an Advantage plan? The exercise still applies, but the focus shifts. Medigap benefits are fixed by law and cannot change, so the review is about your premium, your carrier’s rate history, and your separate Part D plan — which changes every year like any other drug plan.

Do I need to bring anything I do not have? No. Bring what you have and we will work with it. A missing pharmacy name or an old notice is not a reason to postpone.

Medicare reference charts

The charts below cover the ground most questions start from.

Diagram showing Part A and Part B as Original Medicare, then the two routes: keeping Original Medicare with a Part D drug plan and optional Medigap, or taking a Medicare Advantage Part C plan that replaces A and B.
The four parts of Medicare and the two routes
2026 Medicare costs: Part A premium free with 40 quarters and a $1,736 deductible per benefit period, Part B at $202.90 a month with a $283 deductible, and Part D capped at $2,100 a year with a maximum $615 deductible.
What Medicare costs in 2026
Calendar showing the Medicare Annual Enrollment Period from 15 October to 7 December, Medicare Advantage Open Enrollment and General Enrollment from 1 January to 31 March, and the seven-month Initial Enrollment Period around your 65th birthday.
The four Medicare enrollment windows

What actually changes between one year and the next

People sometimes ask why a Medicare plan review is needed if nothing in their life has changed. The answer is that the plan changes even when you do not.

Four things are reset every January by the insurer, not by you: the formulary that decides which of your drugs are covered and at what tier, the provider network, the supplemental benefits, and the cost structure including deductibles, copays and the out-of-pocket maximum.

Any one of those can move by more than the premium difference between two competing plans. A single medication shifting up a tier, or acquiring a prior authorization requirement, routinely costs more over a year than switching plans entirely would have.

Star ratings move too, and they move slowly

CMS re-rates every plan each autumn on around forty measures. Ratings feed the bonus payments that fund extra benefits, so a rating drop usually shows up as a thinner benefit package a year or two later rather than immediately.

That lag is the reason a plan can feel fine this year and noticeably worse the next without anything obvious having happened. A Medicare plan review that looks at the rating trend rather than just this year’s number tends to see it coming.

The five checks a Medicare plan review runs, in order

A useful review is not a sales conversation with a checklist attached. This is the actual order, and it is the order because each step can eliminate plans before you waste time on the next.

  1. Your county. Plan availability is set county by county, not by city or ZIP code alone. Getting this wrong invalidates everything after it.
  2. Your prescriptions, by name and dose. Run against each plan’s current formulary. This eliminates more plans than anything else and takes minutes.
  3. Your doctors and hospitals. Checked against each plan’s directory rather than assumed from the insurer’s name.
  4. The out-of-pocket maximum. The number that decides what a bad year costs. CMS caps it at $9,250 in network for 2026; plans set their own below that.
  5. Everything else. Dental, vision, hearing, allowances and extras. Genuinely useful, and last, because they should decide between two plans that are already close rather than choose the plan.

If an agent starts at step five, you are being sold rather than advised.

When a Medicare plan review ends in changing nothing

Most reviews end with no change, and that is a successful outcome rather than a wasted appointment. If your drugs are still covered at the same tiers, your doctors are still in network and the out-of-pocket maximum has not moved much, staying put is the right call.

We say so when that is the case. An agency that finds a reason to switch you every year is either not looking properly or is looking at the wrong thing, and switching carries its own costs: new cards, new prior authorizations, sometimes a new deductible part-way through the year.

The value of a Medicare plan review is knowing, rather than the change itself.

When to book a Medicare plan review

Plan details for the coming year are published on October 1, and the Annual Enrollment Period runs October 15 to December 7. The first two weeks of October are the best time: the information is complete, corrections to the published data have started landing, and nobody is competing for an appointment yet.

The last fortnight before December 7 is the worst. Everything still works, but nothing is unhurried, and a rushed decision about the out-of-pocket maximum is exactly the decision you do not want to rush.

If you are outside that window and something has changed — a move, a new diagnosis, a drug added, coverage lost — a Special Enrollment Period may apply and a review is worth doing straight away rather than waiting for October.

What a Medicare plan review costs

Nothing. A Medicare plan review with us is free, carries no obligation, and does not require you to change anything. We are paid by the insurance company only if you enroll, at rates Medicare itself caps so they do not vary in a way that would push you toward one plan over another. You can ask what we are paid on any plan we show you.

Free reviews are also available from your State Health Insurance Assistance Program, which has nothing to sell at all, and from 1-800-MEDICARE. We would rather you had a review from one of them than from nobody.

Life changes that should trigger a Medicare plan review straight away

The annual cycle is the default, not the only trigger. Several changes make an immediate Medicare plan review worth doing, and most of them open a Special Enrollment Period so you can act on what you find.

You moved. Plans are approved county by county, so crossing a county line can change what you are eligible for entirely. Moving out of a plan’s service area opens a window; so does moving somewhere with plans your current insurer does not offer there.

You were prescribed something new and expensive. This is the most common reason a plan that fitted last year stops fitting. A specialty drug can sit on a tier that costs thousands, or need prior authorization your plan will not grant, while a competing plan covers it routinely.

Your doctor left the network, or you changed doctors. Networks are renegotiated continuously and a practice can leave mid-year. If your consultant is now out of network, the plan you have is no longer the plan you chose.

You gained or lost Medicaid or Extra Help. This changes what you pay for almost everything and opens a generous enrollment window that people routinely fail to use.

Your income dropped. If you retired, cut your hours, sold a business or lost a spouse, you may now qualify for a Medicare Savings Program or Extra Help. You may also be paying an income-related premium surcharge based on a tax year that no longer reflects your circumstances, which form SSA-44 can correct.

You received a non-renewal notice. Your plan is leaving Medicare or leaving your county. Doing nothing here can leave you on Original Medicare with no drug coverage and a penalty accruing.

Two things people forget to bring

Beyond the obvious list, two documents make a Medicare plan review markedly faster and are usually the ones sitting unopened.

The first is the Annual Notice of Change, which arrives each autumn and lists exactly what is different about your own plan next year. It answers half the questions before they are asked.

The second is your most recent Explanation of Benefits or Medicare Summary Notice. It shows what you actually used over the past year rather than what you think you used, and it is the difference between a review based on your real pattern of care and one based on a rough recollection.

If you cannot find either, the review still works. It just takes longer, and we end up estimating things the paperwork would have settled.

Check any of this independently

You can do the whole exercise yourself, free of charge.

Or call (877) 808-2900. Bring the list above and a Medicare plan review usually takes less than half an hour.