What to Review on Your Medicare Plan at the Start of the Year
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January 15, 2026
The start of a new year is a smart time to look at your Medicare plan with fresh eyes. Benefits, costs, and health needs can change from one year to the next. By taking a little time to review your coverage now, you can make sure your plan still fits your needs and avoid surprises later in the year.
Even if you are happy with your Medicare plan, an annual check can help confirm that nothing important has shifted since you enrolled.
Understand Your Coverage Type and Costs
Medicare is not one static plan. It includes different parts and options, and knowing exactly what you have makes reviewing your coverage easier.
When you look at your plan documents, make sure you know:
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Whether you are in Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C)
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If you have a prescription drug plan (Part D) and how it works
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What your premiums, deductibles, and out-of-pocket costs are for this year
Plans and costs can change year to year, including premiums or how a plan pays for certain services. Reviewing these details from your plan’s Annual Notice of Change helps you understand what costs may be different this year versus last year. Many beneficiaries receive an Annual Notice of Change in the fall that outlines next year’s changes before they go into effect on January 1.
It is worth checking facts like: Does your plan have a new deductible? Are co-pays or coinsurance amounts different? Do you understand which providers are in your network? Knowing this upfront gives you a clearer picture of how your plan works now.
Why do my copays or premiums look different in January?
It’s very common for Medicare beneficiaries to notice changes in their copays, deductibles, or premiums when January arrives. This usually happens because Medicare plans reset and update each calendar year.Many Medicare Advantage and Part D plans make annual changes to costs, including monthly premiums, prescription copays, and deductibles. Even if you stayed on the same plan, the benefits and pricing may not be exactly the same as last year. January 1st marks the start of the new plan year, so deductibles reset and cost-sharing often goes back to the beginning.
Another reason your costs may look different is that prescription drug tiers or pharmacy pricing can change. A medication that was inexpensive last year may move to a different tier or your preferred pharmacy status may have changed.
Additionally, Medicare Part B premiums and deductibles are set by Medicare each year and can increase, which may affect your overall costs even if your plan itself didn’t change.
If your January costs catch you by surprise, don’t panic. It doesn’t necessarily mean something is wrong. It does mean it is a good time to review your coverage and make sure your plan still fits your needs.
A licensed, independent Medicare agent can help explain these changes and review your options so you’re not paying more than you should.
Review Your Prescription Drug Coverage
Prescription drug coverage is one of the areas that often changes from year to year. Even if you are satisfied with your current Part D plan, the list of covered medications or the cost tier your drugs fall into can change. That affects monthly costs and how much you pay at the pharmacy.
Take a moment to check:
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If all your current medicines are still covered by your plan’s formulary
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Whether any drugs have changed tiers or moved to a higher cost level
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Whether your preferred pharmacy is still in your plan’s network
Plans update formularies regularly, and a medicine you took last year may cost significantly more this year or require prior authorization. Knowing what counts as creditable coverage also helps you avoid late enrollment penalties. If you notice major changes, you may want to prepare for plan comparison opportunities during the next enrollment window.
Make Sure Your Doctors and Pharmacies Are Still In Network
Provider networks occasionally change. A doctor or specialist you see regularly might leave your Medicare Advantage network or no longer contract with your plan. Similarly, pharmacies that were in-network in the past might not be covered at the same cost in the coming months.
Check with your doctors and pharmacies to confirm they:
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Accept your Medicare plan for office visits and procedures
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Still participate in your plan’s network
A quick phone call or online check can prevent unexpected out-of-pocket expenses when you need care.
Know If You Have Options to Change Coverage
Once January begins, many beneficiaries think they cannot change their Medicare plan right away. That is partly true, but there are important enrollment opportunities to know about.
The main Medicare Open Enrollment Period runs from October 15 through December 7 each year. Changes made during that period take effect on January 1.
If you already have a Medicare Advantage plan, there is also a Medicare Advantage Open Enrollment Period from January 1 through March 31. During this time, you can change to a different Medicare Advantage plan or return to Original Medicare and join a separate Part D plan. This opportunity is only available if you are already enrolled in a Medicare Advantage plan at the start of the year.
These windows give beneficiaries a chance to adjust their coverage if their current plan is no longer meeting their needs.
Think About How Your Health Has Changed
Your health needs may change from one year to the next, and your coverage should keep up with that. When you review your plan, consider:
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Have you started any new medications in the past year?
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Are you seeing any new specialists?
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Did you use benefits that were harder to access than you expected?
If your health needs have changed, you might want a plan that provides better prescription coverage, lower costs for certain services, or access to a broader provider network.
Confirm Your Additional Coverage Is Still Valuable
Many people have multiple layers of Medicare coverage, including Medicare Advantage, Part D, and sometimes Medigap coverage. If you have secondary coverage or additional benefits like dental or vision through a Medicare Advantage plan, check the fine print to make sure those benefits remain available and useful.
Plans can add, remove, or change extra benefits from year to year, so this review helps you avoid unpleasant surprises.
Ask for Help If You Are Unsure
Reviewing your coverage does not have to be done alone. The Medicare Plan Finder tool on Medicare.gov is designed to help you compare plans in your area. You can also find a Medicare agent to walk you through the details. You can also get connected with a Medicare Agent or Broker in your area right here on Medicare Agents Hub, to get help from a Medicare professional.
In addition, State Health Insurance Assistance Programs (SHIP) offer free personalized counseling to Medicare beneficiaries and their families. Talking with a trained counselor or licensed professional can help you understand your current plan details and whether a change might benefit you.
Look it Over
Reviewing your Medicare plan at the start of the year is a proactive step that helps ensure your coverage still fits your health needs and budget. By checking your coverage type, costs, prescription drug coverage, provider networks, and enrollment opportunities, you can approach the year with confidence and clarity. A small annual review now can prevent confusion and unexpected costs later.
Taking time to review your Medicare coverage at least once a year is one of the best habits you can develop as a beneficiary. It helps you stay informed and ready for whatever the year brings.