Every fall, Americans face an important health care decision: open enrollment. This short period of time allows you to review your coverage, compare options, and make changes for the year ahead. Whether you’re 65 and older exploring Medicare, or under 65 and enrolling through the Health Insurance Marketplace, knowing the basics will help you make confident, cost-smart choices.
Medicare Open Enrollment (For Adults 65 and Older)
Medicare is the federal health insurance program primarily for people age 65 and older, but it also covers certain younger individuals who live with long-term disabilities or chronic health conditions such as Lou Gehrig’s disease (ALS) or permanent kidney failure that requires dialysis or a transplant. While Medicare helps with many health costs, it doesn’t cover everything, which makes open enrollment (October 15 – December 7) a vital time to evaluate your options.
The Four Parts of Medicare
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, some home health services, and hospice care.
- Part B (Medical Insurance): Covers doctor visits, outpatient care, durable medical equipment, preventive services, and some limited medications.
- Part C (Medicare Advantage): Private plans approved by Medicare that bundle Part A and Part B (and usually Part D) into one package. Many also include extras like dental, vision, and hearing coverage.
- Part D (Prescription Drug Coverage): Helps pay for prescription medications, either as a standalone plan or built into Medicare Advantage.
Why Review Your Plan?
Medicare costs, covered prescriptions, and provider networks can change each year. That means the plan you had in 2025 may not be the most cost-effective or comprehensive choice for 2026. Reviewing your coverage ensures your doctors, hospitals, and medications are still included and that you aren’t paying more than necessary.
Health Insurance Marketplace Open Enrollment (For Adults Under 65)
If you’re not yet eligible for Medicare, the Health Insurance Marketplace open enrollment runs from November 1 through January 15 in most states. These plans are designed for individuals and families who don’t have coverage through an employer.
Marketplace plans are grouped into “metal tiers”: bronze, silver, gold, and platinum. Bronze plans typically offer the lowest monthly premiums but higher out-of-pocket costs, while platinum plans have higher premiums but lower costs when you receive care.
One of the biggest advantages of the Marketplace is the availability of financial assistance. Many families qualify for subsidies that reduce monthly premiums or help lower deductibles and copayments. But just like with Medicare, it’s important to look beyond the premium. Make sure your preferred doctors, hospitals, and pharmacies are in-network and that your prescription drugs are covered.
Making the Most of Open Enrollment
The best way to prepare is by asking yourself a few key questions:
- Have my health needs changed in the past year?
- Am I taking new prescriptions, or do I expect new treatments or procedures?
- Are my current doctors and providers still in-network?
- How do my total yearly costs (premiums plus deductibles and copays) compare across plans?
Even if nothing has changed in your health, your insurance plan likely has. By reviewing your options now, you can avoid surprises later.
Final Thoughts
Open enrollment is about choice and making sure that choice works for you. Medicare beneficiaries have the opportunity to compare Parts A, B, C, and D, along with supplemental coverage, to create the right mix of benefits. Those under 65 can use the Marketplace to find affordable coverage that balances cost and care.
Taking time to review your options each fall is one of the most important steps you can take to safeguard both your health and your wallet in the year ahead.
Have questions about Medicare or health insurance coverage? Our team at Johnson Insurance is here to help. Send us an email at service@gojohnsonins.com and we’ll guide you through your options.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
