Every fall, open enrollment arrives. This checklist is designed to help you do exactly that. Whether you’re on a Marketplace health plan, enrolled in Medicare, or helping a family member figure out their options.
Open enrollment timelines vary depending on what type of coverage you have.
For Medicare, the Annual Enrollment Period runs from October 15 through December 7 each year. This is the window when you can switch from Original Medicare to Medicare Advantage, switch back, change your Part D drug plan, or move from one Medicare Advantage plan to another. Changes made during this period take effect January 1. There’s also a separate Medicare Advantage Open Enrollment Period from January 1 through March 31, which allows people already in a Medicare Advantage plan to make one change if their fall selection isn’t working out.
For ACA Marketplace health insurance, open enrollment typically runs from November 1 through January 15 in most states, including Florida. Enroll by December 15 and your coverage starts January 1. Enroll between December 16 and January 15 and your coverage starts February 1. Miss January 15 and you’ll need a qualifying life event to get coverage outside of open enrollment.
If you get insurance through your employer, your open enrollment period is set by your company and usually runs in the fall as well. Check with your HR department for your specific dates.
Every September, Medicare Advantage and Part D plan members receive an Annual Notice of Change letter. This document outlines what is changing about your plan for the coming year, including premium changes, changes to your drug formulary, adjustments to copays and deductibles, and any network changes.
Check Your Prescriptions
Drug formularies change every year. A medication that was on your plan’s preferred tier last year might be on a higher-cost tier this year, or it might not be covered at all. Pull out your current list of prescriptions and verify that each one is still covered under your plan at a cost that works for you.
If you’ve been prescribed any new medications in the past year, this is especially important. A plan that made sense before a new prescription might not be the best fit anymore.
Provider networks also shift from year to year. Your primary care physician, any specialists you see regularly, and your preferred hospital should all be checked against your plan’s network for the coming year.
This is particularly important for Medicare Advantage plan members. If a key provider has left your plan’s network, that’s a strong reason to look at other options during enrollment.
Even if your current plan looks fine on the surface, it’s worth taking a few minutes to see what else is available. New Medicare Advantage and Part D plans enter the market each year, and existing plans often update their benefits. You might find a plan with better drug coverage, lower out-of-pocket costs, or added benefits like dental, vision, or hearing coverage.
You don’t have to do this comparison on your own. An independent insurance broker can pull up side-by-side comparisons for you at no charge.
If you’re on Original Medicare without a supplement plan, every doctor visit, hospital stay, and procedure comes with cost-sharing that can add up quickly. Medicare Supplement (Medigap) plans help cover those gaps. Unlike Medicare Advantage and Part D plans, Medigap plans don’t have an annual open enrollment window tied to the fall period in most states. However, if you’re newly enrolled in Medicare Part B, you have a six-month window during which you can enroll in any Medigap plan without medical underwriting. After that window closes, it gets harder. If Medigap is on your radar, don’t wait.
Just like Medicare plans, Marketplace plans can change significantly from year to year. Your premium, deductible, copays, and network can all look different in the new plan year. Log in to your HealthCare.gov account or check your insurer’s renewal notice to see what’s changing.
Your premium tax credit is based on your projected household income for the coming year. If your income has changed since you last enrolled, updating that estimate is important. Overestimating can mean you pay more in premiums than necessary. Underestimating can mean you owe money back at tax time.
If your income has been variable, for example, if you’re self-employed or work hourly – be conservative in your estimate and check in with your Marketplace account if things change during the year.
The enhanced premium tax credits that were in place from 2021 through 2025 have expired. Under those expanded rules, subsidies were available at nearly any income level. Starting in 2026, eligibility for premium tax credits is once again limited to households with income between 100% and 400% of the federal poverty level. For a single person, that upper limit is roughly $62,760. For a family of four, it’s around $129,600.
If your income puts you above those thresholds, you may find that Marketplace premiums in 2026 are significantly higher than what you paid in recent years. This makes it even more important to compare your options carefully and, if you have access to employer coverage, evaluate whether the employer plan might now make more financial sense.
The same advice that applies to Medicare enrollees applies here. Confirm your doctors are in-network and that your prescriptions are covered at a reasonable cost tier on any plan you’re considering.
This one deserves its own line. Auto-renewal is convenient, but it can be costly. Premiums change, networks change, and your personal situation changes. Taking thirty minutes to actually compare your options during open enrollment can save you hundreds of dollars over the course of the year.
Start early. Open enrollment feels long until it doesn’t. Starting your review in early October gives you plenty of time to gather information, ask questions, and make a thoughtful decision without the pressure of a deadline.
Gather your information before you sit down. You’ll want a list of your current medications and dosages, the names of your doctors and any specialists, a general sense of your household income for the coming year, and your current plan information. Having all of this ready before you compare plans saves a lot of back and forth.
Think about how you actually use your coverage. A plan with a low monthly premium might look attractive, but if you have regular medical needs, a higher-premium plan with lower cost-sharing might save you more in the long run. Think through how many doctor visits, prescriptions, and procedures you realistically expect in the coming year.
Don’t go it alone. Comparing insurance plans is genuinely confusing. The plan documents are dense, the terminology is technical, and the differences between options aren’t always obvious. Working with an independent insurance agent costs you nothing and can make the whole process a lot clearer.
At Martindale Insurance Services, open enrollment is one of the busiest and most important times of the year. Dain works with clients throughout Florida to review their current coverage, compare available options, and make sure the plan they choose actually fits their needs and budget.
Whether you’re on Medicare, shopping the Marketplace, or just not sure which direction to go, a conversation with an independent agent is the best first step. There’s no cost, no obligation, and no phone tree to navigate.
Give Dain a call at (727) 513-2767 or book an appointment online at martindaleinsuranceservices.com. Open enrollment comes once a year. Let’s make sure you get it right.
