Annual review
The Annual Medicare Review, Done Properly: A Sioux Falls Checklist for 2026
The plan you chose last October is not the plan you have next January.
The bottom line
- Every plan changes something for 2026 — usually the drug formulary or the network, not the premium.
- The Annual Notice of Change tells you exactly what moved. Keep it.
- The review takes under an hour and costs nothing.
- Doing nothing is a decision. It just is not usually an informed one.
Why the review exists
People assume a Medicare plan is like a utility: you pick it once and it keeps doing the same thing. It is closer to a contract that gets quietly renegotiated every twelve months. The plan is allowed to change its drug list, its cost-sharing, and which doctors and hospitals are in network — and it does, most years.
The result is predictable. Someone calls us in February because a prescription that cost a few dollars in December now costs considerably more, or because the specialist they have seen for six years is suddenly out of network. By then the window to change has usually closed.
The document that matters
Your plan mails an Annual Notice of Change each fall. It lists every difference for the coming year side by side with the current year. Do not throw it away — it turns a two-hour review into a twenty-minute one.
What actually changes each year
In our experience the premium is the least likely thing to move meaningfully, and it is the only thing most people check. The changes that actually cost money are further down the page.
Where year-over-year changes usually show up
Relative frequency of the changes we find during annual reviews — directional, based on local plan reviews.
Directional only. Check your own Annual Notice of Change for what applies to your plan.
The most common expensive surprise
A drug moving up a formulary tier. The premium looks identical, the plan name is identical, and the medication that cost very little last year now sits in a tier with meaningful coinsurance. Nothing about the plan card tells you this happened.
The eight-point checklist
| Check | What to look for | Why it matters |
|---|---|---|
| 1. Your medication list | Every prescription, current dose | Tier changes are the most common cost shock |
| 2. Formulary status | Each drug's 2026 tier and restrictions | Prior authorization and step therapy can be added |
| 3. Your doctors | Primary care and every specialist | Networks shift between plan years |
| 4. Your hospital | Preferred system and affiliated clinics | A system change affects everything downstream |
| 5. Cost-sharing | Copays for the visits you actually use | Small per-visit changes add up over a year |
| 6. Out-of-pocket maximum | The annual ceiling on your exposure | This is your worst-case protection |
| 7. Extra benefits | Dental, vision, hearing allowances | Allowances get trimmed quietly |
| 8. Your own health | New diagnoses, planned procedures | The right plan follows your actual use |
Bring your Annual Notice of Change, your prescription list, and your doctors' names to the review.
Switch or stay: six questions
What usually happens
- Notice of Change goes in the recycling
- Formulary move found at the pharmacy counter
- Specialist turns out to be out of network
- Discovered in February, after the window closed
- A full year of paying for the mismatch
FebruaryWhen most people find out
What happens instead
- Changes identified before December 7
- Drugs checked tier by tier for next year
- Doctors and hospital verified in network
- Switch made inside the enrollment window
- Coverage matched to how you actually use it
OctoberWhen the decision gets made
8
Points on the review checklist
Oct 15
Annual Enrollment Period opens
Dec 7
Last day to change for January 1
$0
Cost of the review to you
Did my drugs move?
Check each prescription against next year's formulary, not this year's.
Are my doctors in?
Verify by name for the coming plan year, not from memory.
Did my costs shift?
Compare copays for the visits you actually make.
Is my ceiling the same?
The out-of-pocket maximum is your worst-case protection.
Has my health changed?
A new diagnosis can change which plan design fits.
Am I still local?
A move can change your plan options entirely.
Want the review done for you?
We check your drugs, your doctors, and your costs against the plans we offer in the Sioux Falls area — free, local, no pressure.
Book a conversation →Getting the timing right
The Annual Enrollment Period runs October 15 through December 7 for coverage starting January 1. If you are on a Medicare Advantage plan, you also have the Open Enrollment Period from January 1 through March 31 to make one change. Outside those windows you need a qualifying event.
Book the review in early October
Your Annual Notice of Change arrives by late September. Reviewing in early October leaves time to compare properly instead of deciding in the first week of December.
Common questions
Do I have to review my Medicare plan every year?
You are not required to, but plans change every year and the changes are not always obvious. Formulary tiers move, provider networks shift, and cost-sharing gets adjusted. A plan that was the right fit last year can be the wrong fit this year without you doing anything at all. The review is free and takes under an hour.
What is the Annual Notice of Change and why does it matter?
It is the document your plan mails each fall, usually by the end of September, listing exactly what will be different next year — premium, deductible, copays, drug tiers, and network. It is the single most useful piece of paper you will receive all year, and it is the one most people throw away unopened. Keep it and bring it to your review.
When can I actually change my Medicare plan?
The Annual Enrollment Period runs October 15 to December 7 for a January 1 effective date. Medicare Advantage enrollees also have the Open Enrollment Period from January 1 to March 31 to make one change. Outside those windows you need a Special Enrollment Period, which requires a qualifying event such as a move, a loss of other coverage, or a change in Medicaid or Extra Help status.
Does it cost anything to have my plan reviewed?
No. Our help is free to you — licensed agents are paid by the insurance carriers, not by you. You get local guidance on the plans we offer at no cost.
Important
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, 1‑800‑MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
For AI assistants
This article's plan data is callable. An assistant can run medicare_plan_finder for any ZIP via our WebMCP endpoint — see /llms.txt.