What Central Oregon Seniors Need to Know About The Upcoming Year With Medicare

For many Central Oregon residents, fall doesn’t just mean changing leaves and cooler temperatures. It also marks the arrival of Medicare’s Annual Enrollment Period. Running from Oct. 15 to Dec. 7, AEP is the one time of year when most people with Medicare can make changes to their coverage for the following year.

Whether you’re already enrolled in Medicare or turning 65 soon, understanding your options during AEP is essential to making informed decisions that affect your health and finances. The options that exist are far from a one-size-fits-all decision. Many factors play into your decisions and the process can be extremely confusing. Rest assured that Central Oregon offers access to a number of licensed insurance agents who are independent brokers. Some of these brokers solely focus on Medicare, which assures that they don’t have their skill-set spread too thin or trying to focus on multiple lines of business. It’s also important to know that you’ll never have to pay for these agents’ services. They are compensated by the insurance carrier that you choose to be insured with and you’ll never have to pay a higher premium, deductible, or copays/coinsurance when using their services. Be sure to choose an independent broker that you connect with, trust, and can see yourself working with for years to come. They often become an invaluable resource that you rely on year in and year out.

Why AEP Matters

AEP allows you to:

Switch from Original Medicare to a Medicare Advantage Plan (Part C)
Switch from a Medicare Advantage Plan back to Original Medicare
Change from one Medicare Advantage Plan to another
Enroll in or switch Prescription Drug Plans (Part D)

Any changes you make during this window will take effect Jan. 1, 2026.

What’s Changing in 2026?

Each year, Medicare Advantage and Part D plans can change. This could mean adjustments to:

Premiums
Out-of-pocket costs
Prescription drug coverage
Provider networks

Even if you’re happy with your current plan, take time to review your Annual Notice of Change (ANOC). This document outlines everything your plan is changing for the upcoming year. That includes premiums, deductibles, copays, covered medications, and provider networks.

Your plan might still have the same name, but the details inside it may be changing drastically. A prescription you take today could move to a higher tier or no longer be covered at all. Your favorite doctor could no longer be in-network. Your maximum out-of-pocket cost could increase by hundreds or even thousands of dollars.

Many people stick with their plan without reading the ANOC. That can lead to surprise costs in January. Reviewing this notice is the easiest way to make sure your plan still fits your needs and your budget. Still, we recommend utilizing the “free to you” professional services of a local independent insurance broker.

Even if you don’t switch plans, comparing what else is available in your ZIP code is a wise choice. You may very well find better coverage for less money. Furthermore, you may find that you have a unique opportunity to switch Medicare insurance coverage formats due to a unique situation that you may not be aware of.

Set aside 15 minutes to read through your ANOC. Then talk with a local independent agent if anything seems unclear or if you want to see how your options stack up. This simple step could save you from unexpected costs next year.

Common Mistakes to Avoid During AEP

Ignoring the Deadline
If you miss the AEP window, your options for making changes become limited unless you qualify for a Special Enrollment Period.
Assuming Your Plan Hasn’t Changed
Even if your premium stays the same, your covered medications or doctors might not. Review your plan’s changes carefully.
Choosing Based on Premium Alone
A low monthly premium does not always mean lower total costs. Look at copays, medical/prescription deductibles, and your annual out-of-pocket maximum.
Not Checking Drug Coverage
Part D formularies change. A medication covered this year might be excluded or more expensive next year.
Going At It Alone
Comparing plans is not easy. Take advantage of the local services that are available to you.

Original Medicare vs. Medicare Advantage: A Quick Refresher

One of the biggest decisions people face is whether to stay on Original Medicare (Parts A & B) or move to a Medicare Advantage Plan (Part C).

Original Medicare is the traditional program offered through the federal government. It allows you to visit any doctor or hospital that accepts Medicare. It does not include prescription drug coverage. You would need a separate Part D plan and possibly a Medicare Supplement plan to help cover deductibles and coinsurance.

Medicare Advantage Plans are offered by private insurance companies. These plans often include prescription drug coverage and may come with added benefits like dental, vision, or hearing. However, they usually have provider networks and out-of-pocket costs can vary by plan.

Local Help for Local Decisions

In Oregon, available plans and provider networks vary by ZIP code. What works in Portland or Eugene may not work well in Deschutes County.

Talk to someone familiar with local providers, plan availability, and how Medicare works here in Central Oregon. A quick review with a local broker could save you money or prevent coverage issues in 2026.

About the Author: Jesse Zimmermann is a licensed insurance agent and independent broker who solely works in the Medicare space. He is the owner of Mountaintop Insurance Solutions, based in Bend, Oregon, and his family has over 20 years of experience in Medicare. Jesse focuses on helping Central Oregon residents understand their options and make confident decisions. His goal is “Making Medicare Simple & Stress-Free.” Learn more at mountaintopins.com or by calling him at 541-641-8886.

This article appears in the Source November 6, 2025.