Choose Carefully: Five Medicare Pitfalls to Avoid

Medicare’s Annual Enrollment Period gives people with Medicare a chance to join a plan, review current coverage, and make changes for the year ahead.

As a primary care doctor, I see that Medicare decisions can affect patients well beyond enrollment season. A plan may look appealing on paper but still fail to match the care you actually need.

When reviewing Medicare options, keep these five mistakes in mind.

1. Don’t assume next year’s plan will mirror this year’s coverage.

Coverage, costs, and provider networks can shift from one year to the next. Each fall, Medicare Advantage plans send an Annual Notice of Change that explains what will be different in January.

Read it carefully. Make sure your doctors, hospitals, and medications will still be covered at a price you can manage. If not, compare other choices during open enrollment.

2. Don’t assume every doctor and hospital is included in every Medicare Advantage plan.

If a certain physician, specialist, or hospital is important to you, verify it before you enroll.

Medicare Advantage plans often use provider networks. Check that the doctors, specialists, and hospitals you rely on participate in the specific plan you are considering. A doctor who accepts Medicare does not necessarily participate in every Medicare Advantage plan.

3. Don’t change plans while you are in active treatment without a transition plan.

Medicare Advantage coordinated care plans must offer at least a 90-day transition period when a member receiving active treatment moves to a new plan. During that time, the new plan cannot interrupt treatment or require new authorization.

This protection is especially important if you are undergoing chemotherapy, rehabilitation, or another ongoing course of care. Before switching, find out how the new plan will handle your doctors, scheduled treatments, medications, and existing approvals after the transition period ends.

4. Don’t mistake spreading prescription costs for reducing them.

The Medicare Prescription Payment Plan lets people with Medicare drug coverage, including those in Medicare Advantage plans with drug benefits, spread eligible out-of-pocket prescription costs across the year at no extra cost instead of paying all at the pharmacy when prescriptions are filled.

That can make larger prescription bills easier to manage, but Medicare makes one thing clear: the program does not lower drug costs or save money.

For some people, paying over several months may help with budgeting. Just be clear about what the program does and does not do.

5. Don’t ignore prior authorization.

Prior authorization means a health plan may require approval before it covers certain services or medical items. Medicare says people enrolled in Medicare Advantage usually need prior authorization for some services or supplies.

Before enrolling, learn which services or supplies require approval and how quickly the plan must respond. Starting with the 2026 plan year, Medicare Advantage plans and other affected insurers generally must rule on expedited requests within 72 hours and standard requests within seven calendar days. Beginning in 2027, affected plans must also use electronic prior authorization systems so doctors and insurers can exchange coverage requirements, documentation, and decisions electronically.

Medicare decisions are personal. Your health conditions, medications, doctors, finances, and priorities may be different from someone else’s. During open enrollment, ask how a plan will work for the care you actually use. A little research now can help avoid surprises later.