Costs, Doctors, Prescriptions: The 3 Things to Recheck During AEP

The Annual Enrollment Period (AEP) is like a mountain trail: exciting but full of twists, turns, and hidden obstacles. Every year, Medicare plans may update premiums, provider networks, or prescription formularies. Failing to review these changes can lead to costly mistakes.

That’s where your Medigap Sherpa comes in. Think of us as your guide: pointing out hazards, clarifying confusing paths, and helping you reach the summit of confident decision-making. To keep your journey simple, we’ve created a 3-point checklist for the most important things to recheck before AEP ends on December 7.

1. Costs: Know What You’ll Pay

Even if you’re happy with your current plan, costs can change annually. Reviewing them ensures that you won’t be caught off guard.

Checklist for Costs:

• Monthly Premiums – Compare last year’s premiums with the upcoming plan year. Remember, your Part B premium is separate from your Medicare Advantage or Medigap premium and is usually deducted from your Social Security benefits. Include the 2025 standard Part B premium amount once CMS releases it for context.
• Copayments & Coinsurance – Review costs for primary care visits, specialists, urgent care, and hospital services. Even small increases can add up over the year.
• Deductibles – Check the annual deductible for both medical services and prescription drugs. Higher deductibles can affect your out-of-pocket costs significantly.
• Out-of-Pocket Maximums – For Medicare Advantage (Part C) plans, confirm the annual maximum you could pay. This limit helps protect you from high medical costs if you need frequent care or hospital stays. Medigap plans don’t have an out-of-pocket maximum because they’re designed to cover some or all of the costs left by Original Medicare.
• Extra Fees – Some Advantage plans have additional costs for services like wellness programs or fitness memberships. Know what’s included versus optional.

Example:

John from Florida didn’t review his Medicare Advantage plan’s new copay structure and ended up paying over $200 extra in his first month. After a quick review with his Sherpa, he switched to a plan with predictable costs and avoided further surprises.

For a deeper look at costs and how they compare across plans, visit our Medigap Plans Guide and Compare Medigap Plans.

Learn official cost details from Medicare.gov: Medicare Costs.

2. Doctors: Check Your Provider Network

Access to your preferred doctors and hospitals is one of the most critical elements when selecting a plan. A plan that doesn’t cover your providers can create stress and extra expenses.

Checklist for Doctors:

• In-Network Providers – Confirm that your primary care physician, specialists, and hospitals are still included in your plan’s network.
• Changes to Network – Watch for service area reductions (SARs) where a plan may no longer cover certain counties or ZIP codes. If this happens, you’ll qualify for a Special Enrollment Period (SEP) that allows you to switch to another plan or return to Original Medicare without waiting for the next open enrollment window.
• Referrals – Some Medicare Advantage plans now require referrals for specialist visits, so check if your care team is affected. HMO plans typically require referrals, while PPO plans usually don’t, giving you more flexibility to see specialists without prior approval.
• Telehealth Options – If you rely on telemedicine, make sure the platform and providers are covered by your plan. CMS has extended most telehealth flexibilities through 2025, allowing beneficiaries continued access to virtual visits. For more details, visit Medicare.gov’s telehealth coverage page.

Example:

Sarah from Arizona stayed with her Medicare Advantage plan without reviewing the network. During AEP, she found her cardiologist was out-of-network. Her Sherpa guided her to a plan that included all her essential doctors, preventing interruptions in care.

Learn more about Medicare Advantage Plans and network rules.

Check official provider network guidance at Medicare.gov: Understanding Your Medicare Advantage Plan.

3. Prescriptions: Review Your Medications

Prescription coverage can change each year, even in the same plan. Formulary updates, tier changes, or pharmacy restrictions can affect your costs and access.

Checklist for Prescriptions:

• Formulary Updates – Confirm your medications are still included in the plan’s coverage list.
• Tier Changes – Check if any of your prescriptions have moved to a higher-cost tier, as this can increase your copays or coinsurance. Each plan’s formulary tiers reset annually, and tier placement is determined by the plan, not the member. If your drug costs rise, you can compare and switch to a different plan during the enrollment period.
• Pharmacy Network – Ensure your preferred pharmacy remains in-network to keep your costs down. Some plans now restrict certain medications to specific pharmacies and may distinguish between preferred and standard pharmacies, with preferred pharmacies usually offering lower copays.
• Prior Authorizations or Quantity Limits – Verify whether your plan now requires special approvals or limits the quantity of your medications.

Example:

James from Texas didn’t review his prescription coverage during AEP and discovered one of his essential medications had moved to a higher tier. With guidance from his Sherpa, he adjusted his plan early and avoided costly delays.

For more details, see Part D Prescription Drug Plans.

Why Rechecking All Three Matters

Failing to review costs, doctors, and prescriptions together can lead to:

• Unexpected medical bills and higher out-of-pocket costs
• Stress and confusion during the busy AEP season
• Potential gaps in care if your doctor or medications are not covered

Your Medigap Sherpa acts as a guide to prevent these pitfalls, ensuring your coverage is complete and tailored to your health needs. Think of us as a trusted companion who checks every step of your path before you set out.

Your AEP Recheck Checklist

Here’s a printable checklist for quick reference:

Completing this checklist before AEP ends (December 7) is the best way to avoid last-minute surprises and make sure your coverage still fits your needs. The Annual Enrollment Period applies to Medicare Advantage and Part D plan changes — not Medigap, which can generally be changed anytime (though it may involve underwriting). Still, it’s smart to review your Medigap coverage during AEP to confirm it continues to meet your health and budget needs.

Common Mistakes Beneficiaries Make

Even experienced Medicare beneficiaries sometimes overlook details:

1. Assuming last year’s plan is still perfect – Plans change every year.
2. Waiting until the last week of AEP – Limited time increases stress and mistakes. AEP ends December 7, so start reviewing your options early to avoid rushed decisions.
3. Focusing only on premiums – Doctors and prescriptions are equally important.
4. Ignoring service area reductions (SARs) – Your plan may no longer cover your county or ZIP code.

Sherpa Tip: Reviewing your ANOC (Annual Notice of Change) letter when it arrives in September helps you spot changes early and prevents costly errors later in AEP.

How a Medigap Sherpa Guides You

A licensed Medigap Sherpa doesn’t just provide information—we guide you step by step:

• Reviews your current plan documents and Annual Notice of Change (ANOC)
• Highlights cost, network, and prescription changes
• Compares Medigap vs. Medicare Advantage options for your lifestyle
• Ensures enrollment before deadlines to avoid coverage gaps

With a Sherpa by your side, you navigate AEP with confidence, clarity, and peace of mind.

Helpful Resources

• Medigap Plans – learn supplemental coverage options
• Compare Medigap Plans – see all plan options side by side
• Medicare Advantage Plans – review Part C options

• Medicare Costs Overview – official guide on costs
• Medicare Advantage Network Guide – official provider guidance
• Medicare Part D Guide – official prescription coverage resource

Final Thoughts

AEP doesn’t have to be confusing. By systematically reviewing costs, doctors, and prescriptions, you ensure your Medicare plan fits your life and health needs. Early preparation reduces stress, prevents surprises, and keeps your coverage smooth for the coming year.

Your Medigap Sherpa is ready to walk with you through this journey, helping you make confident, informed choices.

Call us today to speak with your licensed Medigap Sherpa and complete your AEP checklist with ease.