Millions of people are just days away from locking in a Medicare choice that could quietly cost them thousands of dollars—and most have no idea. And this is the part most people miss: doing nothing can be just as risky as picking the wrong plan.
Right now, about 68 million Americans who are 65 or older, or who live with serious disabilities, have a fast-approaching deadline to choose their Medicare coverage for next year. They must make their decisions by December 7 so that their new coverage can begin on January 1, 2026, which is why this period—called Medicare Open Enrollment—is such a critical window. Yet research from the University of Michigan shows that many people on Medicare skip simple steps during Open Enrollment that could save them money, reduce stress, and give them more peace of mind.
Based on that research and expert guidance, here are five key strategies for people with Medicare—and the friends or family members who may be helping them—to make smarter, more confident decisions. But here’s where it gets controversial: a lot of the advice people hear from TV ads, sales reps, or even neighbors may not actually be in their best financial interest.
Tip 1: Use the official Medicare tools
The official Medicare website offers clear, easy-to-use tools that walk you through your coverage choices, whether you are exploring options for yourself or helping a loved one. These tools can help you compare the different types of Medicare coverage, understand what is available in your area, and see how plan details differ.
Despite this, a recent University of Michigan study found that only about one-third of people with Medicare use the internet at all to explore their options, even though the number of available plans can be overwhelming. In many areas, people can choose from more than 10 Medicare Advantage plans, plus multiple Part D prescription drug plans and Medigap supplemental policies if they prefer traditional Medicare. For someone who is not comfortable with technology or insurance jargon, it’s easy to shut down and just stay with the same plan—sometimes to their own disadvantage.
A smart place to begin is the Medicare Plan Compare website, starting with the “Your Medicare Options” page to get a high-level overview of what types of coverage exist. From there, you can view which Medicare Advantage and Part D prescription drug plans operate in your area, what they cover, how much they charge in monthly premiums, and what your out-of-pocket costs could be when you actually use care or pick up prescriptions. The tools also show each plan’s star rating, which reflects experiences and satisfaction reported by other enrollees.
If you already have a Medicare Advantage plan, the comparison tool can tell you whether your current plan will still be offered next year and whether it has changed or merged with another plan. Plans can withdraw from a market or combine, and many people never realize this until they face an unexpected bill or find out a doctor is no longer in-network. The site also lets you enter the names and doses of your prescription drugs, so you can compare how much those medications would cost under different Part D plans and which nearby pharmacies are considered in-network.
This drug-cost feature includes the prescription coverage bundled with many Medicare Advantage plans as well as stand-alone Part D plans for those on traditional Medicare. University of Michigan researchers have shown that using these drug comparison tools to estimate costs can lead to substantial savings, even before recent policy changes that added an annual cap on Medicare prescription expenses. Their view is that everyone with Medicare drug coverage should take a few minutes to run their medications through the tool each year.
If navigating these tools feels intimidating, it’s absolutely okay to ask for help from a tech-savvy friend, relative, or neighbor. You can also turn to independent counseling programs described in the next tip, which can walk you through creating an account and using the website without any sales pressure. Here’s a question that might spark debate: should Medicare do more to make these tools easier for people who are offline or uncomfortable with technology, or is it up to individuals and families to adapt?
Tip 2: Get unbiased, independent help
About half of all people with Medicare are enrolled in Medicare Advantage plans offered by private insurance companies. Of the rest who choose traditional Medicare, nearly half also buy private Part D prescription drug plans and Medigap policies. These companies spend heavily on marketing: they send letters and emails, make phone calls, run ads, and host local events with free meals in exchange for listening to their pitch. None of that is illegal—but it does mean their primary goal is to grow enrollment, especially among people who are relatively healthy and use fewer services.
Insurance brokers and agents add another layer. They often provide one-on-one consultations but are paid commissions when they enroll someone in a specific company’s plan. While many agents genuinely try to help, there is an unavoidable financial incentive that can pull recommendations in a particular direction.
All of this means that, while these sources can provide information, they are not neutral. That’s why a key resource many people overlook is the State Health Insurance Assistance Program, commonly called SHIP. Every state has a SHIP program staffed by paid professionals and trained volunteers who do not earn money based on which plan you choose, and their purpose is to give unbiased guidance.
You can locate your state’s SHIP through its national website and then connect to your local program. A University of Michigan survey of older adults found, however, that three out of four had never even heard of SHIP, and another large group had heard of it but never used its services. Only a small fraction—around 4%—had actually gotten help from SHIP, even though the service is free for anyone eligible for Medicare.
Take Michigan as a concrete example: residents can call a dedicated number on weekdays to reach the state’s SHIP program. Callers can speak with someone who sets up an appointment or refers them to a certified counselor in their community. The same helpline, known as MiOptions, also helps older adults and caregivers learn about other assistance programs they may qualify for, beyond Medicare itself.
In many communities, SHIP volunteers also offer free in-person counseling at public libraries, senior centers, and similar locations. You can look at local event calendars or community newsletters to see if a SHIP event is scheduled and how to book a time slot. If you like the idea of giving back, you can even apply to train as a SHIP volunteer and provide independent guidance to others, with training and support from the program.
This raises a provocative question: if impartial help is available for free, why do so many people still rely more on TV ads, sales calls, or free-lunch events? Is it a lack of awareness, or do people actually trust sales-driven advice more than neutral experts?
Tip 3: Consider total costs, not just premiums
When shopping for any insurance, many people zero in on the monthly premium and stop there—but that narrow focus can be misleading. Medicare is no exception. A low advertised premium does not automatically mean a plan is cheaper or better for you overall.
Through the Medicare Plan Compare tool, you can line up the monthly premiums for different Medicare Advantage plans and view them side by side. Just as important, you can also see copayments, coinsurance amounts, deductibles, and annual out-of-pocket maximums, all of which shape what you will pay when you actually go to the doctor, get tests, or fill prescriptions. These numbers can vary widely from plan to plan, especially for people who use a lot of health care.
One limitation is that Plan Compare cannot directly weigh Medicare Advantage plans against traditional Medicare plus a chosen Part D plan and Medigap policy in a single, unified comparison. To get the full picture, you need to look up the standard costs under traditional Medicare, then separately check the available Part D and Medigap plans for your region. This takes a bit more work but can reveal that a slightly higher premium with better protections might save you money in the long run.
It’s also crucial to understand what a “$0 premium” Medicare Advantage plan really means. That $0 typically applies only to the extra coverage beyond Part B. Unless the plan specifically offers a Part B premium reduction (most do not), you still must pay your regular monthly Part B premium, usually at least $185 per month, and more if your income is higher. So a “zero premium” headline can be emotionally appealing but financially misleading.
In some situations, a plan with a higher monthly premium can actually be a better deal because it has lower out-of-pocket costs at the point of care or a lower yearly cap on what you could be required to spend. The National Council on Aging has published a helpful guide that breaks down all these types of Medicare costs and explains how they work together. When it comes to picking Part D and Medigap plans to pair with traditional Medicare, it is especially important to think about your current medications, likely future needs, and lifestyle factors like frequent travel or seasonal moves.
Interestingly, University of Michigan research suggests that cost is not the main reason many people switch Medicare Advantage plans. Instead, problems with access to providers and dissatisfaction with care quality tend to drive plan changes more than premiums alone. That same research found that difficulties accessing care are a major factor pushing some people to leave Medicare Advantage entirely and return to traditional Medicare.
For that reason, it’s important to pay attention to each Medicare Advantage and Part D plan’s star rating, which summarizes experiences of current and past enrollees. Just as critical is understanding each plan’s network—what hospitals, doctors, specialists, and other providers are included, and what restrictions apply to specific drugs or services. This level of detail is usually available on each plan’s own website, not just in broad summaries.
Researchers have also examined what they call Medicare’s “revolving door”—the patterns of people shifting back and forth between Medicare Advantage and traditional Medicare. One concerning finding is that most states do not require insurers to guarantee people the right to buy a Medigap plan at standard rates after their initial enrollment window, regardless of health status. Outside that first enrollment period, people with serious or costly health conditions may be denied Medigap coverage or charged much higher premiums.
This can create a form of “lock-in” for some Medicare Advantage enrollees with high care needs. They might want to switch to traditional Medicare for more provider flexibility, but if they cannot get an affordable Medigap plan, they risk facing large uncovered costs. If you already have significant health issues and are considering moving from Medicare Advantage back to traditional Medicare, it is essential to investigate ahead of time whether a reasonably priced Medigap policy will be available to you. Here’s a controversial angle: should states be required to protect people’s ability to buy Medigap coverage later in life, even if it raises premiums for everyone, or should the burden stay on individuals to decide correctly the first time?
Tip 4: Explore extra help if your income is limited
For older adults and people with disabilities who have lower incomes or limited financial resources, there is a growing number of programs designed to reduce Medicare-related costs in 2026, building on those that already exist in 2025. Some of these benefits are applied automatically, while others require you to submit an application.
Your state’s SHIP program can help you sort through which programs you might qualify for and how to apply. However, it helps to have a basic overview of the major types of assistance so you know what to ask about.
One important category is people who are “dually eligible,” meaning they qualify for both Medicare (usually because of age or disability) and Medicaid (because of limited income or serious disability). Each state sets its own rules for Medicaid eligibility, and national Medicare and Medicaid websites can help you learn more and connect with your state’s Medicaid agency. If you qualify for both, Medicaid may help cover some of your Medicare premiums and other costs, but you must usually renew Medicaid eligibility each year—a step many people are unaware of and accidentally miss.
Another option is Medicare Savings Programs, which are four separate programs for people with limited income and assets. These programs can help pay Medicare premiums and sometimes other expenses. Information about who qualifies is available on official Medicare pages, and enrollment is handled through your state’s designated agency, often the same office that manages Medicaid.
For help with prescription drug costs, the Extra Help program is a major resource. It is designed for people with lower incomes and limited assets who have Part D coverage. Extra Help can reduce or eliminate monthly premiums and deductibles for drug coverage and keep copayments for medications low. Some people are enrolled automatically due to their participation in other programs, while others must actively apply.
There is also the Medicare Prescription Payment Program, available to anyone with Part D drug coverage. This program does not cut your overall medication costs but instead lets you spread what you owe over the course of the year, preventing large one-time spikes that might be hard to afford. You must enroll in this payment program through your Part D plan, and you need to renew your enrollment every year; it does not happen automatically.
For people who need more comprehensive support, the Program of All-inclusive Care for the Elderly (PACE) is an option in some areas. PACE is geared toward adults aged 55 and older who qualify for both Medicare and Medicaid and need a level of care similar to what is provided in a nursing home. The goal is to help people continue living at home by covering a wide range of services beyond what standard Medicare and Medicaid pay for.
Special Needs Plans are another set of Medicare plan options tailored to people with particular circumstances. These plans may be available to individuals who are dually eligible for Medicare and Medicaid; those with certain serious health conditions such as cancer, heart failure, dementia, diabetes, disabling mental health disorders, or stroke; or those who need nursing-home-level care for any reason. You can use the Medicare plan comparison tools or contact SHIP to see if any of these plans operate in your area and whether you qualify.
Here’s a question that might spark discussion: given how many types of assistance exist—and how complex and fragmented they are—does the current system truly help the people who need it most, or does it unintentionally favor those who are already better informed and more organized?
Tip 5: Don’t assume couples need the same plan
If you are married or live with a partner, it might feel simpler to sign up for the same Medicare plan as your spouse or partner. On the surface, that seems logical and convenient. However, this approach can backfire because Medicare is highly individual, and health and work situations often differ significantly within a couple.
You and your spouse or partner may have very different medical needs, prescription lists, or preferred doctors. One of you may still be working and have employer coverage, while the other is fully retired. You might also have different coverage options tied to military service or past employment. In some cases, a person with dementia or complex chronic conditions might benefit from special plans or programs that their healthier partner does not need.
Despite this, University of Michigan research indicates that people with and without dementia often end up choosing very similar Medicare Advantage plans, suggesting that many families are not fully exploring tailored options. Another study found that many couples with Medicare Advantage coverage make plan changes in sync with each other, almost as if they are “bundling” their decisions rather than choosing based on individual needs.
Because Medicare’s online tools are designed for individual use, there is no built-in “couples mode.” Each person should enter their own information, medications, doctors, and priorities to get accurate comparisons. Couples can certainly sit side by side and go through the process together, or attend a SHIP counseling session together, but they may need separate appointments or separate sessions to fully address each person’s situation.
This raises a deeper, potentially controversial question: are couples unintentionally prioritizing emotional togetherness over financial and medical practicality when it comes to Medicare? Should they be encouraged more strongly to “split” their coverage choices when it makes sense, even if it feels less convenient?
Bonus tip: You may have a second chance
Choosing a plan during Medicare Open Enrollment does not always lock you in for the entire year. There is a bit more flexibility than many people realize. For instance, if you enroll in a Medicare Advantage plan for 2026 and then discover in the early months of the year that it does not meet your needs—maybe your doctor is out of network, or your medications cost more than expected—you generally have until March 31 to switch to a different Medicare Advantage plan or move back to traditional Medicare.
In addition, if you experience major life changes during 2026—such as a significant shift in income, a change in employment, a move to a new address, or a change in your living situation—you may qualify for a Special Enrollment Period. Special Enrollment Periods allow you to change your Medicare coverage outside of the usual Open Enrollment timeframe so that your insurance can better match your new circumstances.
The information summarized here draws on research and expertise from members of the University of Michigan’s Institute for Healthcare Policy and Innovation. Contributors include Lianlian Lei, Ph.D., from the U-M Medical School Department of Psychiatry; Geoffrey Hoffman, Ph.D., from the U-M School of Nursing; Kristian Stensland, M.D., M.P.H., M.S., from the Department of Urology; and A. Mark Fendrick, M.D., and Renuka Tipirneni, M.D., M.Sc., from the Division of General Medicine in the Department of Internal Medicine. Data about awareness of SHIP programs come from the National Poll on Healthy Aging, which is based at this institute.
Now it’s your turn: Do you think Medicare’s complexity is an unavoidable side effect of offering choice, or has the system become so confusing that it borders on unfair—especially for people who are older, sicker, or have limited income? Would you personally trust a free lunch seminar, an online ad, or an independent counselor more when choosing a plan—and why? Share your thoughts, experiences, or disagreements in the comments; your perspective might help someone else make a better decision this year.
