Your Situation
Is Your Medicare Coverage Still the Right Fit?
Medicare isn't a set-it-and-forget-it decision. Plans change every year — premiums, copays, networks, and drug formularies can all shift on January 1. Your healthcare needs may have changed too. Here's how to evaluate what you have and whether something better exists.
Why Reviewing Each Year Matters
Every fall, your plan sends an Annual Notice of Change (ANOC) — a document listing every change to your plan's costs, coverage, and network for the coming year. Most people don't read it. That's often where problems start.
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Your premium may have increased
Plans can raise monthly premiums each year. A $0 plan may stay $0, or may not.
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Your doctors may have left the network
Provider networks change. Your primary care doctor or specialist may no longer be in-network.
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Your drugs may have changed tiers
Formularies change. A drug that cost $10/month may jump to $50 if it moves to a higher tier.
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Prior auth rules may have expanded
Plans can add or expand prior authorization requirements, creating new hurdles for care you used to receive easily.
When You Can Make Changes
Annual Enrollment Period (AEP) — Oct 15 to Dec 7
The main window to switch Medicare Advantage plans, switch Part D plans, move from MAPD to Original Medicare, or add/drop coverage. Changes take effect January 1.
Medicare Advantage Open Enrollment — Jan 1 to Mar 31
If you're in a Medicare Advantage plan, you can switch to a different MAPD plan or return to Original Medicare (plus a Medigap plan and Part D) during this period.
Special Enrollment Periods (SEPs)
Certain life events trigger SEPs: moving out of your plan's service area, losing employer coverage, qualifying for Extra Help, a plan losing its Medicare contract, and others. SEPs have specific timeframes — act promptly when a qualifying event occurs.
🧀 Wisconsin Medigap Switching Rules
If you have a Medicare Supplement (Medigap) plan, switching to a different Medigap plan in Wisconsin typically requires going through medical underwriting — meaning the insurer can review your health history and may charge you more or decline coverage. There is no annual open enrollment for Medigap in Wisconsin. If you have guaranteed issue rights (triggered by certain events), use them — those windows are limited.
What to Compare When Reviewing
Monthly premium
What will you pay each month? Factor in both your plan premium and your Part B premium ($202.90/mo in 2026 at standard income).
Your doctors and specialists
Are your current providers in the plan's network? If you have a specialist you see regularly, verify their in-network status before switching MAPD plans.
Your prescriptions
Run a drug-by-drug comparison on the plan's formulary. Are your medications covered? At what tier? Is there a deductible that applies?
Expected out-of-pocket costs
Look at what you actually spent on healthcare last year. Estimate what it would have cost under different plan types using our budget tool.
Out-of-pocket maximum
MAPD plans have an annual cap on your medical costs (the MOOP). What's the cap on plans you're considering? Lower isn't always better if you rarely hit it.
Use the Medicare Budget tool to estimate your total monthly cost under different scenarios.
Reconsidering Your Coverage Path
Sometimes a review leads to reconsidering the underlying path — not just which MAPD plan, but whether MAPD or Medicare Supplement is still the right fit given how your situation has changed.
Signs MAPD may no longer fit well
- • Frequent prior authorization denials
- • Your preferred specialist left the network
- • You're traveling or spending time out of Wisconsin more often
- • Your healthcare use has increased significantly
Signs Medigap may no longer fit well
- • Paying a high monthly Medigap premium but rarely using care
- • Managing your costs carefully and want to reduce fixed monthly expenses
- • All your doctors are in-network with local MAPD plans
MAPD vs. Medicare Supplement
Full side-by-side comparison →
My Medicare Budget
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