Medicare Annual Enrollment Basics & the Social Work Role
Part 1 in the NASW Series Helping Medicare Beneficiaries Plan for & Navigate Coverage in 2026
Chris Herman, MSW, LICSW
Senior Practice Associate–Aging
December 2025
This Tips & Tools for Social Workers is the first publication in a four-part series addressing Medicare annual enrollment and changes to Medicare in 2026. It addresses the following topics:
- overview of the Medicare annual enrollment period (AEP)
- impact of Medicare enrollment decisions
- resources that can inform beneficiary decision making regarding original Medicare or Medicare Advantage
- social work role in helping beneficiaries navigate the AEP and understand coverage for 2026
- resource list
Please visit https://bit.ly/NASW-MedicareAEP25 to read the other three publications in this series:
Part 2—Navigating Medicare Annual Enrollment for 2026
Part 3—Out-of-Pocket Health Costs & Financial Assistance for Medicare Beneficiaries in 2026
Part 4—Other Changes to Medicare Coverage in 2026
Medicare Annual Enrollment Basics
The Medicare annual election period (or annual coordinated election period, or AEP) opened on October 15 and will end on December 7. During the AEP people who are already enrolled in Medicare can review, compare, and modify their coverage options. Changes made during the 2025 AEP affect Medicare coverage between January 1 and December 31, 2026.
The Medicare AEP differs from the initial enrollment period for people newly eligible for Medicare by virtue of age (Center for Medicare Advocacy [CMA], n.d.). It is also distinct from the Affordable Care Act (ACA) Health Insurance Marketplace Open Enrollment, which began on November 1 and will end on December 15 (Centers for Medicare & Medicaid Services [CMS], n.d.-a). (Visit https://www.healthcare.gov/medicare/ and https://justiceinaging.org/open-enrollment-guide/ to learn about the relationship between the ACA marketplace and Medicare.)
During the AEP, beneficiaries may make one of the following changes:
- join a Medicare Part D stand-alone prescription drug plan (PDP), switch from one Part D plan to another, or drop Part D coverage
- switch from one Medicare Advantage (MA) plan to another, including shifting between plans with or without prescription drug coverage
- switch from MA to original Medicare (also known as traditional Medicare) or vice versa
Impact of Medicare Enrollment Decisions
Medicare is integral to the economic security and health of people with disabilities and older adults. As noted in the previous section, the type (or types) of coverage selected by beneficiaries during the AEP can have profound effects on health care access and cost—exacerbating, in turn, health and financial inequities.
CMS (2024b) encourages beneficiaries to review coverage options annually because the needs of each beneficiary and the coverage available change frequently. Yet, navigating Medicare annual enrollment can be challenging even for long-time beneficiaries and experienced family care partners (also known as family caregivers, with recognition of and respect for whomever a beneficiary considers “family”). Beneficiaries younger than 65 who live with disabilities are especially likely to experience difficulty with Medicare enrollment and comparing coverage options, including ascertaining whether they qualify for financial assistance (Cubanski et al., 2023). Perhaps it is not surprising, then, that almost 70 percent of beneficiaries do not compare their coverage options during the AEP (Ochieng et al., 2024).
Distinguishing Original Medicare & MA
The changes possible during the autumn AEP—particularly the choice to enroll in original Medicare or in an MA (privatized) plan—have many implications for beneficiary out-of-pocket (OOP) cost and access to health care providers. The following sources provide additional information on these distinctions:
- Decision Tree: Traditional Medicare or Medicare Advantage—infographic developed by the Center for Medicare Advocacy (CMA, 2018), a national nonprofit organization with which NASW works closely; similarly, please refer to Traditional Medicare or Medicare Advantage? A Case Study in Favor of Traditional Medicare (CMA, 2023)
- Two analyses by KFF (an independent nonprofit organization devoted to health policy research, polling and news) on MA limitations to care access: (1) Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 (Fuglesten Biniek et al., 2025) and (2) Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries (Rae et al., 2025); additionally, please refer to the fact sheet Medicare Coverage Outside the United States (CMS, 2024a) to learn how the federal government defines “outside the U.S.” for purposes of original Medicare coverage
- Understanding the Medicare Advantage and Medigap Dilemma—article (Clark 2024) by the Medicare Rights Center (MRC), another national nonprofit organization with which NASW collaborates; likewise, please refer to Liu et al. (2024) for a study of the “Medicare Advantage Trap” and to an article by CMA (Kertesz, 2022) addressing Medigap consumer protections in greater detail
- Clearer Choices: Why Medicare Advantage Enrollees Need Better Information on Supplemental Benefits, an article (Gershon & Carter, 2025) by MRC and Justice in Aging (JIA), another national nonprofit organization with which NASW works; likewise, please refer to the CMA issue brief Supplemental Benefits: Main Driver of Enrollment in Medicare Advantage, But Underutilized by Beneficiaries (Kertesz, 2025)
- How Do Medicare Advantage Plans Vary? and How Do Part D Plans Vary?—sections 7 and 8, respectively, of a KFF issue brief (Cottrill et al., 2025)
Visit NASW’s fall 2022 Practice Alert on the Medicare AEP (
https://bit.ly/NASW-MedicareOEP22) for messaging about original Medicare and MA.
How Social Workers Can Help Beneficiaries Navigate Annual Enrollment & Understand Coverage for 2026
This Tips & Tools series makes clear the complexity of Medicare coverage and the consequences of enrollment decisions. As social workers, we can mitigate the challenges of annual enrollment and help reduce Medicare-related disparities in multiple ways:
- Explain to beneficiaries the significance of the Medicare AEP.
- Inform beneficiaries of upcoming changes to Medicare coverage, as described in parts 2, 3, and 4 of this series.
- Help beneficiaries reassess their health needs (such as changes in their medications, health care providers, and health condition, along with necessary care and services).
- Provide unbiased information to beneficiaries about Medicare coverage options and help beneficiaries consider the implications of each option.
- Encourage beneficiaries who are enrolled in a Part D prescription drug plan or an MA plan to read two documents from their plan sponsor. The plan’s Annual Notice of Change, or “ANOC,” details changes to the plan for 2026 and should have been sent to the beneficiary by postal mail or email in September (National Council on Aging [NCOA], 2024). The Evidence of Coverage, or “EOC,” delineates the plan’s coverage as a whole for 2026 and the beneficiary’s rights in relation to the plan; if the beneficiary did not receive the 2026 EOC, they can find it on the plan sponsor’s website or request a copy from the plan by phone (NCOA, 2024).
- Support beneficiaries in verifying inclusion of their prescription drugs in their Part D plan or MA plan. For beneficiaries who are considering MA, support them in confirming that their providers participate in the MA plan network.
- Help beneficiaries understand the difference between official Medicare mail—such as ANOCs, EOCs, and CMS’s Medicare & You handbook for 2026 (CMS, 2025)—from MA and Part D marketing ads (NCOA, 2025b).
- Educate beneficiaries about Medicare AEP–related fraud, including marketing rules that MA and Part D plans and insurance agents and brokers must follow (California Health Advocates, n.d.; CMS, n.d.-b, n.d.-c; Fletcher, 2025; NCOA, 2025a, 2025c). (Read an Urban Institute report [Skopec et al., 2025] to learn how agents, brokers, and marketers influence beneficiaries’ Medicare enrollment decisions; read a CMA issue brief [Bers et al., 2025] for detailed information regarding regulation of MA and Part D marketing and legal challenges to that regulation.)
- Refer beneficiaries with concerns regarding violations of Medicare marketing rules to the federally funded Senior Medicare Patrol (SMP) by visiting https://smpresource.org/ and clicking on “Find Help in Your State” or by calling by calling 1-877-808-2468. SMP sites are located in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.
- Help beneficiaries whose MA or Part D plans are ending to navigate the annual enrollment process. Depending on the circumstances, these beneficiaries may be enrolled automatically either in another MA plan offered by the same MA sponsor or in original Medicare, without Medigap or Medicare part D, if they don’t select another coverage option during the AEP (Ayeh, 2025; Lipschutz et al., 2025). Beneficiaries whose MA plan is terminating at the end of 2025 qualify for an SEP from December 8 to February 28, 2025 (Ayeh, 2025; Choi, 2025). Changes made during this SEP will take effect on the first day of the following month (Choi, 2025, Other enrollment periods section).
- Refer beneficiaries who may qualify for the Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information to 1-800-MEDICARE for assistance. (Part 2 of this series addresses this topic.)
- Refer beneficiaries to the State Health Insurance Assistance Program (SHIP) and other reliable entities for additional assistance. These entities are listed in the resources section of this publication and described in greater depth in Parts 2 and 3 of this series.
Resource List
CMS
Information & Enrollment
Medicare & You handbook (includes information about Medicare coverage and enrollment; help paying for out-of-pocket health costs; and beneficiary rights and protections): https://www.medicare.gov/medicare-and-you
Medicare Plan Finder (can be used to compare coverage options and to enroll; please refer to Part 2 of this series cautionary information regarding Medicare Advantage supplemental benefits and provider directories within Plan Finder): https://www.medicare.gov/plan-compare
Phone: 1-800-MEDICARE (1-800-633-4227)
TTY: 1-877-486-2048
Live chat: https://www.medicare.gov/talk-to-someone
CMS personnel are available to provide live support by phone, TTY, or chat 24 hours a day, 7 days a week, except for some federal holidays.
Beneficiary-Oriented Educational & Outreach Materials for the Medicare AEP
Medicare AEP Information & Training for Professionals
In previous years, CMS hosted a two-hour webinar through its National Medicare Education Program (NMEP) and two half-day trainings through its National Training Program (NTP). The Trump Administration has suspended NMEP meetings, closed the NTP, and removed archived NTP materials from the CMS website.
CMS retains one webpage oriented toward partners (professionals). At the time of this Tips & Tools publication, the CMS webpage provided limited, basic information about AEP, with links to the beneficiary-oriented educational and outreach materials listed previously. https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources
Additionally, CMS posted customizable slides about the current AEP; visit https://www.cms.gov/files/document/medicare-general-oe-outreach-customizable-oct-2025-final-508c.pptx to download this content.
Medicaid
Find a local office (for Medicare Savings Program enrollment): https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip#statemenu
Phone: 1-877-267-2323
TTY: 1-800-877-8339
Social Security Administration
Part D Extra Help (Low Income Subsidy) application: https://www.ssa.gov/medicare/part-d-extra-help
Phone: 1-800-772-1213 (8 a.m.–7 p.m. ET, Monday–Friday)
TTY: 1-800-325-0778
Find a local office: https://secure.ssa.gov/ICON/main.jsp
Similar to 1-800-MEDICARE, the Social Security Administration’s call center remained staffed during the federal shutdown. However, services in local offices were reduced, and a backlog may exist for beneficiaries seeking help with LIS enrollment.
Other Federally Funded Resources
State Health Insurance Assistance Program (SHIP)
https://www.shiphelp.org/SHIPs/
Phone: 1-877-839-2675
Senior Medicare Patrol (SMP)
https://smpresource.org/ (Click “Find Help in Your State”)
Phone:
1-877-808-2468
State Pharmaceutical Assistance Programs (SPAPs)
https://www.medicare.gov/plan-compare/#/pharmaceutical-assistance-program/states?year=2025&lang=en
AIDS Drug Assistance Program (ADAP)
https://adap.directory/directory
National, Nonprofit, Beneficiary-Focused Organizations
Center for Medicare Advocacy
https://medicareadvocacy.org/
Medicare Rights Center
https://www.medicarerights.org/
National Helpline for beneficiaries: 1-800-333-4114 (Press 8 for Spanish)
Justice in Aging
https://justiceinaging.org/
National Council on Aging
BenefitsCheckup®: https://benefitscheckup.org/ & 1-800-794-6559
Benefits Enrollment Centers: https://www.ncoa.org/article/what-are-becs/
BenefitsCheckup® and Benefits Enrollment Centers receive both federal and private funding.
Relevant Content Excluded from This Series
Please visit NASW’s Practice Alert for the fall 2022 Medicare annual enrollment period (https://bit.ly/NASW-MedicareOEP22) for an overview of the following Medicare coverage options:
- Medicare Part A and Part B (original Medicare)
- Medicare Part D
- Medigap, also known as Medicare supplemental insurance
- Medicare Advantage—privatized plans, such as such as Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans; also known as Part C
- Program of All-Inclusive Care for the Elderly (PACE)
Terminology Used in This Series
The autumn Medicare annual election (enrollment) period (AEP, also known as the annual coordinated election period) is often referred to as the Medicare Open Enrollment Period (OEP) or Medicare open enrollment. In previous years, NASW used the “open” terminology for consistency with public-facing messaging from CMS. However, some beneficiary advocates have used the terms “annual enrollment” and “AEP” to distinguish the autumn enrollment period for all Medicare beneficiaries with the Medicare Advantage OEP (January 1 through March 31); likewise, some CMS materials have incorporated this change. For this reason, NASW uses “annual enrollment” or AEP throughout this series, other when quoting other materials, and we will continue to use this terminology going forward.