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| Five Things to Know

| Stephanie Fajuri

Every year, people who are enrolled in Medicare can make changes to their coverage; this opportunity is called the Annual Election Period, also known as Medicare’s Open Enrollment Period.  This period takes place from October 15 to December 7, and gives Medicare beneficiaries an option to review and potentially make changes to their prescription drug plans or Medicare Advantage plans for the upcoming calendar year. Any changes that are made during Open Enrollment take effect January 1 of the following year.

The Medicare open enrollment period can often be overwhelming and confusing, due to the number of options available, the costs associated with the plans, and the complicated maze of benefits. For example, in Los Angeles County, there are 74 Medicare Advantage plans available in 2026, and that number could increase for 2027. 

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However, did you know that free, unbiased local assistance is available to Medicare beneficiaries in every state? Overseen by the Administration for Community Living (ACL), the State Health Insurance Assistance Program, or SHIP, provides free one-on-one assistance with Medicare questions, concerns, and coverage issues, and education about Medicare. This program goes by different names in different states. For example, in California, it’s the Health Insurance Counseling and Advocacy Program (HICAP), and in Florida, it’s called the Serving Health Insurance Needs of Elders (SHINE) program. Whatever the name of the program, the thing that makes SHIP unique is that its counselors, which includes both paid staff and volunteers, are required to go through extensive training, get registered with the government agency that oversees the program in their state, and are also required to be neutral, unbiased, and cannot be licensed to sell insurance. SHIPs remain one of the only sources of unbiased Medicare information nationwide. 

The Center for Health Care Rights has operated the HICAP for the city and county of Los Angeles for over 40 years, and has worked with tens of thousands of Medicare beneficiaries who have questions about Medicare, often based on things they hear about from friends, family, and in the media. We are dedicated to helping Medicare beneficiaries understand not only what coverage is available, but also what makes the most sense for their situation, like Singh, a client that we helped save over $600 this year just by helping him switch his Part D drug plan, or Tracy, who learned that even though her neighbor loved their Medicare Advantage plan and had recommended it to her, it was not going to be a good fit for her complex needs. 

Medicare’s open enrollment period is typically the busiest time of year for SHIPs. Here are a few things to keep in mind as open enrollment approaches this year.

1. Make sure you understand your current Medicare coverage. Do you know what plan you’re currently enrolled in? In Los Angeles, we often speak with Medicare beneficiaries who do not know which specific plan they are enrolled in, or can’t articulate whether they have a Medicare Advantage Plan (a private insurance plan contracted with Medicare to provide Medicare coverage to members) or Original Medicare with a stand-alone prescription drug plan (the traditional, default option when someone enrolls in Medicare). Understanding your current coverage is important so that you can make accurate comparisons to options available for the upcoming year. You can find this information by looking at your insurance cards in your wallet, by checking your Medicare.gov account, or by calling 1-800-MEDICARE. If you have retiree coverage from a former employer, you can call your benefits administrator for more information about your plan if you have misplaced your insurance cards.
2. Review the Annual Notice of Change (ANOC) from your current plan. Your Medicare Advantage Plan or Medicare Prescription Drug plan should send you a notice by the end of September explaining how your plan is changing for the upcoming year, including any changes to the benefits it is offering, and changes to the monthly premiums they charge. Be sure to read the ANOC as soon as it arrives, so that you can use the information in it to help you make a decision about your coverage during open enrollment.
3. Consider your dealbreakers when it comes to your healthcare. Whether or not you want to change your coverage during open enrollment, it is a good idea to think about what is important to you for the upcoming calendar year. Has your health improved or worsened since last year? Do you have a primary care provider or specialists that you want to make sure you can continue to see? Do you anticipate a major surgery or a change in your prescriptions? Or, as is increasingly common, has your doctor or hospital system notified you that they will be changing which plans they contract with? If so, that might mean that if you want to keep your doctor or hospital, you may be forced to change plans even if you are happy with your coverage. 
4. Compare your options for 2027. Once you’ve gotten a sense of what your current coverage is, how it is changing in the upcoming year, and considered what’s important to you when it comes to your benefits and provider networks, the next step is to compare your options. Medicare has an online plan finder search tool, which gets updated each October with the plan options for the following year. If you create an account on Medicare.gov, you can save your drug list to your account, making it easier to compare plans year after year. Be cautious when it comes to using the provider search that was introduced last year; the best way to confirm whether your doctor or hospital will accept a specific plan next year is to contact the doctor’s office directly.
5. Contact your local State Health Insurance Assistance Program (SHIP) for help. It can be tempting to call the phone numbers on TV commercials promoting specific plans, or to work with a private insurance agent or broker. This open enrollment period, consider seeking assistance from your local SHIP, where you do not have to worry about sales pitches and will be able to get assistance navigating the complicated maze of Medicare coverage options. Find more information about your local program on the back of the Medicare & You book you receive by mail, or by visiting www.shiphelp.org.

Stephanie Fajuri, Esq., is Program Director, Center for Health Care Rights.