Medicare Plan Review Checklist: 7 Key Steps

Most people I talk to assume their Medicare plan is fine until it isn’t. They picked something three years ago, it was working okay, and so it just… stays. I get it. Reviewing your Medicare coverage feels about as appealing as reorganizing a filing cabinet. But here’s the thing I’ve seen play out too many times in 20 years of doing this work: the plan that was perfect when you enrolled can quietly become the wrong plan, and you won’t notice until you’re staring at an unexpected bill for $800 or your pharmacy is suddenly out of network.

So let me walk you through what a real Medicare plan review actually looks like, not the vague “check your benefits” advice you see everywhere, but a specific, honest checklist of what to look at, when to look, and what surprises to watch for.

Open Enrollment runs October 15 through December 7 every year, and that’s your main window to make changes. But the review itself? That should happen in September, before the chaos starts. I’ve watched too many people scramble in late November, grab whatever plan looks familiar, and miss something important.

Start With the Annual Notice of Change

Every Medicare Advantage (MA) plan and Part D drug plan is required to mail you an Annual Notice of Change (ANOC) by September 30. It’s usually a thin document with small print, and I’ll be honest: most people recycle it without reading it. That’s a mistake.

The ANOC tells you exactly what’s changing next year: new premiums, adjusted copays, changes to the drug formulary, shifts in which providers are in-network. What surprised me the first time I read one carefully, years ago, was how many changes were buried in a table on page 6. A $0-premium plan had quietly added a $45 specialist copay and dropped a major hospital from its network. The beneficiary had no idea until January.

Read it. Specifically look for: premium changes, drug tier changes (if your medication moved from Tier 2 to Tier 3, your cost-sharing just jumped), any changes to the network, and changes to extra benefits like dental or vision if you have a Medicare Advantage plan.

The Drug Check Nobody Does Thoroughly Enough

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This is the one that catches people off guard the most, and I say that having sat across the table from hundreds of seniors who were blindsided by it.

Here’s what I want you to do: go to Medicare.gov’s plan finder tool and type in every single prescription you take, including the dosage and frequency. Don’t approximate. Bring your prescription bottles to the computer if you have to. What you’re looking for is whether each drug is still covered in the coming year, what tier it’s on, and whether there are any prior authorization or step therapy requirements attached to it.

Prior authorization means your doctor has to get the plan’s permission before you can fill the prescription. Step therapy means the plan wants you to try a cheaper drug first. Both can delay treatment and add stress you don’t need.

One specific thing only someone who’s done this will tell you: the formulary tool on Medicare.gov is updated for the upcoming year in October, not September. So your September review should focus on your current plan’s published 2026 formulary documents (available on your plan’s website) and cross-reference with the ANOC. Don’t wait for October to start this piece.

Worked example: A reader from Tucson, Maria, was taking Eliquis (apixaban) for atrial fibrillation. Her 2025 plan covered it at Tier 3. She noticed in her ANOC that it was moving to Tier 4 in 2026, which would have raised her cost from roughly $47 per fill to $115. By switching to a plan where it remained Tier 3, she saved an estimated $816 over the year.

Network Review: Doctors, Hospitals, and Labs

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If you have Original Medicare (Parts A and B) with a Medigap supplement, this section barely applies to you. Original Medicare is accepted nearly everywhere, and that’s one reason I have a soft spot for it despite the premium cost. But if you’re on a Medicare Advantage plan, network matters enormously.

Every year, plans renegotiate contracts with providers. A specialist your cardiologist referred you to might be in-network in July 2026 and out-of-network in January 2027. The plan isn’t required to notify you personally when a specific provider drops out. That feels wrong to me, but it’s legal.

What to do: Call your three or four most important providers (primary care doctor, any specialists you see regularly, your preferred hospital) and ask them directly whether they’ll still be in-network with your plan for next year. Ask specifically for the plan name and plan ID number, not just the insurance company, because a single insurer might run a dozen different plan products with different networks.

Also check your preferred pharmacy. Some plans have preferred pharmacy networks where your copays are lower, and that preferred status can change year to year.

Comparing Total Cost, Not Just the Monthly Premium

Here’s the mental trap I see constantly: someone finds a $0-premium Medicare Advantage plan and stops looking. The premium is one number. The total cost is a completely different story.

A real comparison needs to include: monthly premium, annual deductible, copays for primary care and specialists, copays or coinsurance for inpatient hospital stays, out-of-pocket maximum, and drug costs. Let me put that into a table, because comparing plans mentally is how you miss things.

These are illustrative ranges based on common 2026 plan structures, not quotes. Your actual costs will differ by ZIP code, plan, and health status.

If you’re generally healthy and use few services, the $0-premium plan might genuinely be fine. If you have ongoing conditions, surgery coming up, or take expensive medications, a higher-premium plan with lower cost-sharing often wins on total annual cost. Worked example: Barbara, 71, in Ohio, had knee replacement surgery in early 2026. Her $0-premium plan charged $295 per day for days 1 through 6 of her hospital stay, totaling $1,770 in hospital copays alone, plus specialist copays and physical therapy costs. A plan with a $127/month premium would have cost $1,524 annually in premiums but capped her hospital copays at $500. She paid more in premiums but saved over $800 net.

The Extra Benefits Trap (I’ll Be Honest Here)

Medicare Advantage plans love advertising dental, vision, hearing, and gym memberships. I’ve gotten skeptical of these over the years. Not because they’re worthless, but because the coverage details often disappoint.

“Dental benefits” might mean $500 toward preventive cleanings only, with no coverage for crowns or dentures. “Vision” might mean $150 toward eyeglass frames every two years. These aren’t nothing, but if you’re choosing a plan primarily for extras, make sure the extras actually cover what you need. Read the Evidence of Coverage document, not the marketing flyer. Ask: does this dental benefit cover major restorative work? What’s the annual maximum?

I don’t have good data on how often beneficiaries actually use these benefits versus how often they factor into the enrollment decision, but in my experience the gap is wide.

Getting Help When It Gets Overwhelming

Look, this is a lot. Even I find the comparison process tedious, and I’ve been doing this for two decades.

The single most underused resource in Medicare is the State Health Insurance Assistance Program (SHIP). SHIP counselors are trained, unbiased (they don’t sell anything), and completely free. They will sit with you, pull up the Medicare plan finder, and compare options side-by-side. Many areas offer phone, video, or in-person appointments. Call your state’s SHIP office in September, not November, because their schedules fill up.

AARP’s Medicare resource center also has solid, plain-language explainers if you want to do more of the homework yourself before calling anyone.

Worked example: Gerald, 78, from rural Kentucky, called his state SHIP office in late September 2025. He’d been on the same Medicare Advantage plan for four years. A 45-minute phone call revealed that his rheumatologist was going out-of-network with his current plan in January 2026. He switched plans before the December 7 deadline and kept his doctor with zero interruption to his care.

Sources

• Medicare.gov Plan Compare Tool: Official CMS tool for comparing Medicare Advantage and Part D plans by ZIP code, as updated for 2026.
• CMS Annual Notice of Change (ANOC) requirements: Federal regulation requiring plans to notify enrollees of changes by September 30 each year.
• KFF (Kaiser Family Foundation) Medicare Advantage Fact Sheet: Annual analysis of enrollment trends, plan availability, and out-of-pocket cost data.
• SHIP National Technical Assistance Center: Directory and background on free State Health Insurance Assistance Program counselors.
• Medicare & You Handbook 2026: CMS’s official annual beneficiary handbook with current benefit and cost information.

Photo: RDNE Stock project via Pexels

This article is for informational purposes only. Medicare rules change annually. Always verify current plan details at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). This site does not sell insurance or recommend specific plans.

Recommended Resources

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

• Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
• Get What’s Yours for Medicare (~$17), Maximize your Medicare benefits and minimize out-of-pocket costs. Covers Part D drug coverage gaps and Medigap in depth.