As primary care physicians, every fall we see a familiar wave of questions from patients approaching Medicare eligibility or reevaluating their coverage. Medicare’s Annual Election Period (AEP), also known as Open Enrollment, started on October 15 and runs through December 7 this year. This is when people can sign up for Medicare for the first time and switch between Original Medicare and Medicare Advantage plans.
The choices can feel overwhelming — but they don’t have to be. A thoughtful, step-by-step approach can help ensure your coverage fits your health needs and lifestyle for the year ahead.
Start with your health, not the plans
Before diving into plan brochures, start with your own situation:
• Who are the doctors and specialists you rely on most?
• What prescriptions do you take regularly?
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• Are any major procedures on the horizon?
Then, check with your physicians’ offices to confirm they’ll be in-network for any plan you’re considering. Networks can change yearly, and assuming your doctors are covered can lead to surprises later.
The big three: Original Medicare, supplements, and Medicare Advantage
Original Medicare offers broad provider choice and often doesn’t require referrals, and patients are responsible for 20% of costs not covered by Medicare. Some add a Supplement (Medigap) plan to fill that gap. These plans don’t cover extras like dental or vision and delaying enrollment past age 65 typically increases costs.
Medicare Advantage Plans (Part C) have become increasingly popular because they bundle Parts A, B, and often D into one plan, with predictable costs and added benefits — like dental, vision, hearing, fitness programs—that Original Medicare doesn’t provide. Many Advantage plans emphasize coordinated, patient-centric care, simplifying the experience by bringing services under one umbrella.
Consider a retiree who splits time between Arizona and another state. She takes a costly specialty medication and wants to keep seeing her Arizona physicians during the winter.
With Original Medicare plus a Supplement, she has broad flexibility to see doctors across states, usually without referrals, and her medical costs are generally covered.
She should also review Medicare Advantage options. Some plans now offer national networks, letting members see physicians in multiple states while staying in-network, often with added benefits like dental and vision. And while traditional Part D plans may provide the widest access to brand-name drugs, many Medicare Advantage prescription programs cover those drugs or offer lower-cost generic equivalents.
The right choice depends on her providers, medications, travel habits, and priorities.
The Medicare parts at a glance
• Part A — Hospital care
• Part B — Outpatient and physician services
• Part C — Medicare Advantage (bundled A, B, usually D)
• Part D — Prescription drug coverage
Prescription coverage is especially important for those on high-cost medications. Medicare’s Plan Finder or a licensed insurance agent can help compare total costs.
Timing and cost matter
Medicare isn’t free, and costs vary by income. Higher earners pay more initially, though this can change after retirement. Delaying enrollment without qualifying coverage can trigger penalties, so understanding the rules is critical. If you or your spouse still has employer coverage, coordinating it with Medicare can be complex — consult your benefits office and Medicare resources before making changes.
Practical tips for open enrollment
• Mark your calendar. Missing the window can lock you into your current plan for another year.
• Review annually. Networks, drug formularies, and benefits change.
• Prioritize what matters most. Whether that’s provider choice, lower costs, or extra benefits.
Get help. Independent insurance brokers can model your doctors, prescriptions, and travel patterns to compare options objectively.
The bottom line
There’s no one “best” Medicare plan — just the plan that best fits you. Your health needs, financial situation, travel habits, and preferences should drive the decision. Taking time to review now can save frustration and money later. And don’t hesitate to involve your primary care physician — we’re here to support your health, whichever path you choose.
Drs. Leo Olde and Erica Grabinski are primary care physicians with Optum — Arizona.
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