Medicare open enrollment commenced on October 15, coinciding with a federal government shutdown that began on October 1. This year’s enrollment period, which will continue until December 7, presents unique challenges for beneficiaries looking to update their health insurance plans. The Centers for Medicare and Medicaid Services (CMS) have confirmed that despite the government shutdown, Medicare open enrollment activities will proceed as scheduled.
Philip Moeller, author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs,” advises beneficiaries to delay finalizing their coverage decisions for the upcoming year. “I’m advising people pretty strongly to wait to make their decision about next year’s coverage,” he stated, highlighting that any changes made during the enrollment period would take effect on January 1, 2026. He emphasized that there is no immediate rush to settle on a plan.
From now until December 7, individuals enrolled in Medicare can adjust their coverage options. These adjustments can vary based on whether beneficiaries have original Medicare or a Medicare Advantage plan. Choices include switching between original Medicare and Medicare Advantage, changing Medicare Advantage plans, or securing new Medicare Part D prescription drug coverage for those enrolled in original Medicare.
Juliette Cubanski, deputy director of the KFF’s program on Medicare policy, noted that while many beneficiaries may prefer to stick with their existing plans, it’s essential to assess any changes that could influence out-of-pocket costs, such as the availability of preferred doctors or necessary medications. According to recent research, out-of-pocket healthcare expenses accounted for an average of 39% of Social Security income for Medicare beneficiaries in 2022. “Open enrollment offers people an opportunity to evaluate the coverage that they currently have and explore other options,” she said.
Despite the shutdown, experts believe the impact on Medicare open enrollment will be minor. However, beneficiaries attempting to reach 1-800-Medicare for assistance may experience longer wait times. Crucially, although the government is closed, resources like Medicare’s Plan Finder remain operational, allowing access to valuable information about plans and options.
The shutdown might hinder beneficiaries from getting timely information regarding specific coverage queries, as staffing shortages could lead to delays in responses. The CMS’s website has assured that mission-critical Medicare open enrollment activities will continue despite the shutdown.
As individuals weigh their options between original Medicare and Medicare Advantage plans, it is vital to understand the trade-offs. Medicare Advantage plans often come at no additional premium beyond the Medicare Part B fee, while providing various supplemental benefits. Yet, these plans may limit access to certain services and impose more prior authorization requirements. Conversely, traditional Medicare can be financially burdensome for those needing frequent medical services since it lacks an out-of-pocket maximum.
This year’s enrollment also offers more comprehensive details about Medicare Advantage plans, including supplemental benefits like vision and dental care. Moeller pointed out that the Plan Finder will provide improved information about available doctors and hospitals, although potential hiccups may arise in accessing this information.
For those on original Medicare, Medicare Part D allows coverage for prescription drugs, with affordability considerations becoming increasingly relevant. More zero-premium Part D plans are emerging, which could reduce monthly costs, though annual deductibles are on the rise. The overall array of plans is shrinking, and beneficiaries are advised to carefully consider whether a plan covers all their necessary medications.
The out-of-pocket maximum for Part D drugs will increase to $2,100 in 2026, underscoring the importance of evaluating overall annual costs when choosing plans. “It always pays to shop because you just don’t know what you might be leaving on the table,” Cubanski reiterated, acknowledging that current plans might not offer the best coverage moving forward.
