Jean Clements, CDES, Practice Manager, Certified Dementia Engagement Specialist

Medicare Open Enrollment  •  October 15 – December 7, 2026

Even if you are happy with your current coverage, review it each year. Plans can change — and your healthcare, prescription and provider needs can change, too.

WHY YOUR CHOICE CAN MATTER LATER

In our work as Care Managers, we often begin working with clients and their families’ decades after they first selected their health coverage. By that time, their healthcare needs may be very different.

We frequently see situations where coverage that once worked well may no longer provide the flexibility a client needs as health and care needs become more complex. For example, some Medicare Advantage and managed-care plans use specific provider networks, which can affect the hospitals, skilled nursing and rehabilitation facilities, specialists and other providers available under the plan. These plans may also require prior authorization for certain services or care.

When a serious illness, hospitalization, rehabilitation stay or home health need arises, understanding these coverage rules can become especially important. That’s why Medicare coverage should not be viewed as a one-time decision: understand your choices when you first enroll, and continue reviewing them as your needs change.

YOUR YEARLY REVIEW

• Are my doctors and specialists still in the plan/network?
• Are my medications still covered, and have coverage requirements changed?
• Is my preferred pharmacy still participating?
• Have benefits, prior authorization requirements or out-of-pocket costs changed?
• Does my coverage give me access to the hospitals, rehabilitation facilities, home health services and other providers I may need?
• Have my own healthcare needs changed?
• Would another Medicare option better meet my needs for 2027?

REVIEW DOESN’T MEAN YOU HAVE TO SWITCH
The goal is to review your coverage every year — not necessarily change it. If your current coverage still meets your needs, keeping it may be the right choice. Review. Compare. Then decide.

NEED HELP? MASSACHUSETTS HAS A FREE RESOURCE

SHINE — Serving the Health Insurance Needs of Everyone

Massachusetts offers free, unbiased Medicare information, counseling and assistance through SHINE. Certified, trained SHINE counselors can help people with Medicare and their caregivers understand coverage options and look for ways to save on health insurance and prescription drug costs.

A SHINE counselor can help you understand Original Medicare and Medicare Advantage, compare Part D and Medigap options, review prescription coverage, and work through Medicare enrollment decisions. Counseling is available through community resources across Massachusetts.

Massachusetts SHINE Program: mass.gov/shine-program

PLAN AHEAD

Appointments can fill quickly as Medicare Open Enrollment approaches. We encourage clients and families to seek guidance early. We can also assist with scheduling a SHINE appointment or arranging transportation to an appointment. Please contact us as early as possible so there is adequate time to review your options.

For current Medicare members:
•  October 1, 2026 — begin reviewing 2027 options
•  October 15–December 7, 2026 — Open Enrollment
•  January 1, 2027 — changes take effect.

Medicare enrollment rules and plan details vary by individual circumstances.
Sources: Medicare.gov and Massachusetts SHINE.

A simpler guide to understanding your choices and reviewing them as your needs change.

NEW TO MEDICARE? START WITH A & B

PART A = HOSPITAL Helps cover inpatient hospital care and certain other services.

PART B = MEDICAL Helps cover doctors, outpatient care, preventive services and other medical care.

Together, Part A + Part B = Original Medicare.

THEN CHOOSE HOW YOU WANT TO RECEIVE YOUR COVERAGE

PATH 1 — ORIGINAL MEDICARE Keep Parts A & B. You may also add: PART D — prescription drug coverage MEDIGAP — supplemental insurance that helps with certain out-of-pocket costs in Original Medicare

PATH 2 — MEDICARE ADVANTAGE (PART C) A Medicare-approved private plan provides your Part A & B benefits. Most plans include Part D and may offer additional benefits. Provider networks and prior authorization may apply.

PART D vs. MEDIGAP — WHAT’S THE DIFFERENCE?

PART D = PRESCRIPTION DRUGS Think: “D = Drugs.” • Helps pay for prescription medications. • With Original Medicare, Part D is generally a separate private drug plan. • Each plan has its own formulary (list of covered drugs), pharmacies and coverage rules. • It does not supplement your hospital and doctor bills.	MEDIGAP = MEDICARE SUPPLEMENT Think: helps fill some of Original Medicare’s “gaps.” • Works with Original Medicare — it does not replace it. • Helps pay certain copayments, coinsurance and deductibles left by Original Medicare, depending on the policy. • Does not include prescription drug coverage in policies sold after 2005. • You cannot use Medigap with Medicare Advantage.
THE SIMPLEST WAY TO REMEMBER IT Original Medicare: A + B  |  Add Part D for prescriptions  |  Add Medigap to help with certain Original Medicare out-of-pocket costs OR  Medicare Advantage (Part C): another way to receive A + B; most plans include Part D.

FIRST-TIME ENROLLMENT IS DIFFERENT

Your Initial Enrollment Period is tied to when you first become eligible for Medicare. Don’t assume you need to wait for the October–December annual Open Enrollment Period to sign up. If you choose Original Medicare, the timing of Medigap can also matter, so consider getting unbiased guidance early.

For additional information in selecting the best plan, Medicare.gov basics