Getting Medicare Right: Help Is Available During Open Enrollment
Health care costs and affordability top the public’s list of economic anxieties in the U.S., according to recent polling by KFF, a leading U.S. health policy organization. Even people with insurance say they struggle to afford health care costs, including people with Medicare.
While Medicare provides health insurance coverage to 70 million people age 65 or older and younger adults with long-term disabilities, having Medicare coverage does not insulate beneficiaries from health-related affordability challenges, such as not getting needed medical care due to costs or incurring medical debt. In a 2026 KFF Health Tracking Poll, nearly half (49%) of all Medicare beneficiaries aged 65 and older say they expect their health care costs to become less affordable in the next year.
The Medicare Rights Center seeks to change this scenario. The national, non-profit consumer service organization works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives. Since 1989, the Medicare Rights Center has been helping people with Medicare understand their rights and benefits, navigate the Medicare systems, and secure the quality health care they deserve.
Sarah Murdoch
“We serve as a kind and expert health insurance counselor, educator, and advocate for those who need it most,” said Sarah Murdoch, Director of Client Services, Medicare Rights Center, who notes that many Medicare beneficiaries reach out to the organization during Open Enrollment season. “We provide independent, timely, and clear information on Medicare, Medicaid for dual-eligible individuals, and related topics to communities nationwide.”
What is Medicare Open Enrollment?
During Medicare’s Open Enrollment (annual election) period, people can change their coverage – including switching between Original Medicare and Medicare Advantage or Part D plans. Original Medicare (Parts A and B) is offered directly through the federal government, while Medicare Advantage plans provide benefits through private plans that contract with the government. Most people are allowed to make changes only during Fall Open Enrollment.
“People should keep in mind that these plans change every year,” Murdoch said. “Even a tried-and-true plan you’ve had for years can change, so it’s important to check your options during open enrollment to make sure your covered providers and medications are the same and that any changes wouldn’t impact you.”
Murdoch noted that a good place for people to start during Open Enrollment is the Plan Finder tool at Medicare.gov. Here, existing beneficiaries can get a summary of their current coverage and use their saved drugs and pharmacies to compare plan costs. Those new to Medicare simply need to provide their zip code (to help Medicare find plans in their area) and answer a few questions to see plans and costs available to them.
For those with Original Medicare, the Medicare Rights Center further advises beneficiaries to read the 2027 Medicare & You handbook during Open Enrollment. It is distributed to all Medicare households in late September and is available for download at Medicare.gov. Here, beneficiaries can see any changes to Original Medicare’s coverage for the upcoming year.
For those with Medicare Advantage or a Part D plan, Medicare Rights Center recommends reading their Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC), which are sent to plan members in late September, either as a hard copy or via email. They should pay attention to plan changes such as benefits and coverage rules, costs, and formulary (list of drugs covered) and coverage restrictions.
“The number of Medicare Advantage plans available every year fluctuates, and options and benefits can change drastically,” Murdoch cautioned. “Make sure your doctors and/or pharmacies are still in the plan’s network by checking with providers directly or using the plan’s provider directory online. This will help to reduce the chances of out-of-network denials for needed care.”
Drug Coverage Options
As part of their evaluation of Original Medicare and Medicare Advantage plans, Medicare Rights recommends people carefully consider drug coverage options. Ask questions such as:
- Are my prescriptions on the plan’s formulary (list of covered drugs)?
- How much will I pay at the pharmacy (copays or coinsurance) for each drug I need?
- Does the plan have any coverage restrictions, such as prior authorization, step therapy, or quantity limits?
- Are the pharmacies I use preferred and in-network for this plan?
“Review your ANOC and pay particular attention to the summary of the new formulary,” Murdoch suggested. “Part D formularies often change from year to year, and drugs and restrictions can be removed or added.”
New for 2027 is the elimination of Medicare Part D Premium Stabilization, which helped to keep premiums for standalone Part D plans in check. The Inflation Reduction Act (IRA) added an inflation-adjusted out-of-pocket cap on enrollee spending ($2,100 in 2026) and shifted some Medicare cost liabilities onto plans, which responded by raising proposed premiums. Medicare Advantage plans that include Part D, MA-PDs, were not similarly affected.
The premium assistance program is now ending a year earlier than originally planned, placing Part D beneficiaries at risk of jumps in Part D premiums and worsening affordability.
Step-by-Step Medicare Navigation
Those who need help understanding the differences between Original Medicare and Medicare Advantage, or with comparing Advantage plan options, can turn to the Medicare Rights Center. Their expert counselors help people with Medicare, their families and caregivers, and the professionals who serve them navigate Medicare. They provide clear answers and step-by-step assistance to take the guesswork out of health insurance decision making.
Through the organization’s free National Helpline (800-333-4114), trained staff and volunteers help over 10,000 callers each year understand Medicare benefits, make enrollment decisions, coordinate Medicare with other insurance, appeal denials of care, and determine eligibility for Medicare cost-savings programs.
“Every day on our national helpline, we hear from people with Medicare, their families, and the professionals who serve them about the barriers people face when accessing health care,” Murdoch said. “We encourage people to ask questions, then we provide guidance to help the beneficiary make their selection.”
One of those callers was Melissa, who had a liver transplant and was distraught when she called the Medicare Rights Center because she could not afford her lifesaving prescription drug. Melissa’s Medicare Rights counselor helped her get an emergency month supply of the medication she desperately needed and to enroll in programs for people with low incomes, ensuring that Melissa can access and afford her health care and prescription drugs going forward.
“The Medicare Rights Center saved my life,” Melissa said. “They have become part of my miracle.”
Importantly, the trained counselors at Medicare Rights can help beneficiaries weigh the tradeoffs among Medicare Advantage plans – for example, whether it’s better to choose a plan with robust dental coverage over a plan without the in-network doctors a beneficiary may need access to. They also help beneficiaries find sources of assistance, like the Medicare Extra Help and Medicare Savings programs, State Pharmaceutical Assistance Program, and pharmacy discount programs.
Learn Medicare
In addition to its one-on-one counseling services, Medicare Rights offers clear, unbiased resources trusted by millions of Americans to provide important Medicare information.
Its Medicare Interactive (MI) is a free and independent online reference tool designed to help people make confident, informed choices about their Medicare coverage. Over 72,000 users access its 400+ pages of Medicare information through 3 million annual website visits. MI also offers a variety of trainings, webinars, and other resources to meet the needs of professionals who want to further their Medicare knowledge.
Medicare Interactive Pro (MI Pro) takes that professional learning to the next level, with an online curriculum designed to empower professionals to learn Medicare anytime, anywhere, at their own pace. Subscribers gain access to expert interactive content, quizzes to test knowledge, and printable learning tools. They come away from the lessons better able to help their clients, patients, employees, retirees, and others navigate a multitude of Medicare questions.
Through the Medicare Minute program, Medicare Rights works with host organizations in all 50 states to provide a steady stream of Medicare education. Each month, host organizations receive a new Medicare Minute, which they can then present at libraries, hospitals, senior centers, retirement communities, union halls, faith-based institutions, workplaces, and other locations.
“The Medicare Minute model builds camaraderie among participants, strengthens community-based organizations, and encourages participants to become advocates for their own health care,” Murdoch said. “Join us live each month on Medicare Interactive to stay informed, understand your benefits, and make the most of your Medicare coverage.”
Editor’s Note: If you or someone you know is a Medicare beneficiary and is struggling to pay for Medicare premiums and/or out-of-pocket costs for treatments, you may qualify for assistance from the HealthWell Foundation, which provides grants to assist with copays, premiums, deductibles and eligible out-of-pocket expenses for essential treatments and medications. To see if you may be eligible, visit our Disease Funds page.
Additional Resources:
Key Facts About Health Care Affordability for People with Medicare
State Health Insurance Assistance Program
