October is more than fall colors and football; it’s also the month when Medicare beneficiaries need to revisit their coverage, set up changes, and lock in choices that will affect the entire coming year. Today we’re exploring what’s new this year, how to navigate open enrollment, and how to bring these decisions into your broader retirement strategy. 

Why Open Enrollment Matters More Than Ever

Medicare is not a “set it and forget it” system. Every year, plan premiums, deductibles, drug formularies, provider networks, and coverage rules can shift. What worked well last year might not work well this year, especially with rising health care costs, evolving benefit structures, and new rules rolling out in 2026.  

This year, beneficiaries need to pay particular attention to:  

  • Drug cost structures. Deductibles, coinsurance, and out-of-pocket caps are changing.  
  • Supplemental benefits in Medicare Advantage plans. What was offered last year may no longer be allowed.  
  • New pilot programs. Prior authorization rules are expanding into some states, even in traditional Medicare.  
  • Permanent benefits. Some vaccine coverage, insulin caps, and drug payment-plan features are now baked into the system in a new way.  

Because more provisions from the Inflation Reduction Act and other legislation are being codified into Medicare law, this open enrollment period feels particularly consequential. What you choose now may lock you in to structure changes that no longer shift year to year.  

Three Smart Moves to Make This Month

Here are a few practical steps you should take in October to get ahead of the changes and reduce surprises.  

Analyze Your Drug Spend From Last Year

Pull up your pharmacy statements and list your most frequent medications. Which ones saw big price jumps? Did you reach your previous out-of-pocket maximum?  Compare those with potential plan options for 2026. Because the new cap on Part D out-of-pocket costs is increasing (to $2,100), your past drug usage may push you toward certain plans over others.  

Scrutinize Supplemental Benefits (Especially in Medicare Advantage) 

If you use an MA plan, know what extra benefits you depend on, such as wellness perks, meal deliveries, or services for chronic conditions. But also know that CMS has begun to draw firmer lines around what qualifies as a “health-related” benefit, so some non-essential extras may be trimmed.  

Before the December deadline, see which benefits will survive, and make sure your core needs (therapies, mobility aids, disease management, etc.) remain covered.  

Don’t Assume “Original Medicare” Is Static 

For the first time, traditional Medicare will expand prior-authorization requirements in six states beginning January 1, 2026. If you live in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, your doctor might need to request approvals for certain procedures up front. It’s also wise to confirm that your preferred specialists and facilities will still accept your plan in the new year. That means this open enrollment is as much about “staying connected” to your providers as it is about saving on premiums.  

How to Choose (and What to Watch For)

When comparing plans, it helps to step back and think beyond just the premium. Medicare decisions affect not only your monthly budget but also your access to care, your medication costs, and your long-term financial security. As you weigh your options, keep these key considerations in mind: 

  • Total cost vs sticker price. A plan with a lower premium might leave you exposed to higher deductibles and drug costs. Use your expected health care usage as the baseline.  
  • Consistency of your formulary. If a drug you rely on is being dropped or moved to a higher tier, that plan may carry hidden costs.  
  • Provider network stability. Changes in contracts or participation happen every year—verify that your doctors and hospitals remain in-network.  
  • Flexibility (“opt-out” or renewal protections). Some features, like automatic renewal of prescription cost-spreading programs, are becoming permanent. But make sure you understand how to opt out or switch if needed.  

As always, you don’t have to make your decision in a vacuum. Get a second opinion, use available Medicare tools and resources, and reach out to trusted professionals to help you compare.  

Timing Is Critical 

The open enrollment window for Medicare (October 15 to December 7) is not generous, and missing it can mean staying in a suboptimal plan all year and even beyond. Start now: request your “Annual Notice of Change” communications, compare plans side by side, and reach out for help if you need it.  

Ultimately, choosing a plan is important, but it’s only one piece of the retirement puzzle. ProVise Management Group helps you bring it all together. We take a holistic view of retirement planning, weaving healthcare choices into a strategy that is built to protect your lifestyle, your savings, and the future you imagine. Reach out to start planning for your retirement today.