Dear Toni: I’m enrolled in Medicare but have not received my Medicare & You Handbook. I need to make some changes, and I’m concerned about what I should do during the fall Medicare season. I need to know which options are right for me. I have some health problems, and I’m concerned that I might make the wrong change to my Medicare and Part D plan.
I know that I will be bombarded by marketing material, and I would really appreciate any advice that you can give me in advance. Thanks, Toni. — Sylvester from Richmond, Texas
Hello Sylvester: The 2026 Medicare & You handbook will be mailed to over 65 million Medicare beneficiaries in September to arrive before October. It’s amazing how efficient Medicare is to have these handbooks arrive every year in time for Medicare’s Open Enrollment Period (OEP)/Annual Enrollment Period (AEP).
Sylvester, you have time to do the correct research, because Medicare’s OEP/AEP period begins enrolling America on Oct. 15, and ends enrollment at midnight on Dec. 7.
Readers, please take your time researching your options, especially if, like Sylvester, you have health issues.
Below are the steps a Toni Says Medicare team uses when helping clients during Medicare’s OEP/AEP:
Step 1: Decide whether you want Original Medicare (Parts A & B) or a Medicare Advantage (Part C) plan.
Ask your doctor’s office which plan it recommends. Most doctors accept Original Medicare, but not all accept Medicare Advantage plans, which are HMO or PPO. If you have a doctor that is in a Medicare Advantage plan’s provider directory, make sure you call to verify that the physician’s office will still be accepting that specific Medicare Advantage plan in the upcoming calendar year.
The main difference between Original Medicare and Medicare Advantage plans is that Original Medicare is administered by Medicare, and the Medicare Supplement plan that’s selected pays the Medicare deductibles and coinsurance. Medicare Advantage plans are administered by private insurance companies that are approved by Medicare.
If you choose a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card.
Step 2: Decide whether you need to enroll in or change your current Medicare Part D (prescription drug coverage) plan during Medicare’s OEP/AEP enrollment time.
If you want Medicare Prescription Drug coverage to go along with Original Medicare, then you must enroll in a stand-alone Medicare Part D plan, and there may be a monthly premium.
If you choose a Medicare Advantage plan, make sure that the plan has Medicare Part D Prescription Drug coverage included to keep from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.
Whichever plan you choose, verify that all prescriptions, both brand name and generic, are covered by the Medicare Part D formulary.
Step #3: Remember, you have from Oct. 15 to Dec. 7 to change or enroll in a new Part D plan for your Medicare Advantage plan or stand-alone Medicare Part D plan, which both begin Jan. 1.
If you miss the deadline of Dec. 7, you will have to wait until the next year’s Medicare OEP/AEP enrollment time.
Medicare’s OEP/AEP is only for enrolling or changing Medicare Advantage Part D or stand-alone Medicare Part D plans. One can change Medicare supplements, long-term care, or dental plans any time of year.
Remember … with Medicare, what you don’t know will hurt you!