Navigating Medicare Annual Enrollment for 2026

Part 2 in the NASW Series Helping Medicare Beneficiaries Plan for & Navigate Coverage in 2026
Chris Herman, MSW, LICSW
Senior Practice Associate–Aging

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December 2025

Introduction

This Tips & Tools for Social Workers is the second publication in a four-part series addressing Medicare annual enrollment and changes to Medicare in 2026. It addresses the following topics:

• tools and resources for Medicare annual enrollment from the Centers for Medicare & Medicaid Services (CMS) and other sources
• impact of the recent federal government shutdown on the annual enrollment period (AEP)
• expanded information about Medicare Advantage (MA) supplemental benefits within the Medicare Plan Finder
• integration of MA provider directories within Medicare Plan Finder
• special enrollment periods (SEPs) for Medicare outside of annual enrollment, including a temporary SEP throughout 2026 for errors related to inaccurate MA provider directories in Medicare Plan Finder
• resource summary & additional tools

Please visit https://bit.ly/NASW-MedicareAEP25 to read the other three publications in this series:
Part 1—Medicare Annual Enrollment Basics & the Social Work Role
Part 3—Out-of-Pocket Health Costs & Financial Assistance for Medicare Beneficiaries in 2026
Part 4—Other Changes to Medicare Coverage in 2026

Enrollment Tools & Resources, Including Shutdown Impact

CMS’s Medicare.gov website (https://www.medicare.gov) is the primary federal tool for beneficiary-friendly information about Medicare. Users can read any page on the website in Spanish by clicking “Cambiar a español” in the upper right corner of the page. Website navigation will continue in Spanish until the user clicks “Change to English” in the upper right corner of any webpage.

Descriptions of specific CMS tools and resources follow.

Medicare & You Handbook

CMS sent a copy of its Medicare & You 2026 handbook (CMS, 2025) by postal mail or email to all Medicare beneficiaries in September. The handbook includes information about Medicare coverage and enrollment; help paying for out-of-pocket health costs; and beneficiary rights and protections.

A beneficiary may download or order a copy of Medicare & You at any time. The 2026 handbook is available in the following languages and formats:

• English: print versions (paper copies) in standard print, large print, and Braille; portable document files (PDFs) in standard print and large print; eBook in ePub and Mobi formats; audio in MP3 format and compact disc (CD)
• Spanish: print versions in standard print, large print, and Braille; PDFs in standard print and large print; audio in MP3 and CD
• Chinese, Korean, and Vietnamese: standard print available in print (paper) or PDF
• Arabic, Russian, and Tagalog: standard print available in PDF only

Visit https://www.medicare.gov/publications/search?keywords=10050 and select the applicable language in the “filter by” option above the item listing for more information. The English-language and Spanish-language landing pages will list only PDF and print options; click “Get More Formats” below each item listing for additional options.

Although Medicare & You is updated annually, it includes only basic information regarding Medigap, Part D, and MA plans. Moreover, some financial information in the 2026 handbook reflects figures from 2025 rather than the upcoming year. CMS encourages beneficiaries to use the handbook for quick comparisons and to seek more thorough information from the following resources.

Medicare Plan Finder

For users who have access to and are comfortable (or can receive assistance with) digital technology, the Medicare Plan Finder (also known as MPF or Plan Finder) is a key tool for obtaining information about Medicare coverage options and can be used to complete enrollment. MPF is accessible by direct link (https://www.medicare.gov/plan-compare) or by clicking “Find plans” in the left side of the Medicare home page (https://www.medicare.gov), under “It’s open enrollment – now to Dec 7.”

In its 2025 Medicare AEP fact sheet for advocates, Justice in Aging (JIA)—a national, nonprofit organization with which NASW collaborates—included a helpful list of tips for using Plan Finder with Medicare beneficiaries; visit https://justiceinaging.org/open-enrollment-guide/ for information.

Expanded Information Describing MA Supplemental Benefits

Many Medicare beneficiaries are drawn to the prospect of MA supplemental benefits that are not available in original Medicare. However, information about such benefits is often scarce, including before enrollment (Gershon & Carter, 2025; Kertesz, 2025b). Accordingly, beneficiary use of supplemental benefits tends to be low, and MA plan data regarding this utilization is scarce (Gershon & Carter, 2025; Kertesz, 2025b). Moreover, some beneficiaries have encountered problems in coordinating the use of MA supplemental benefits with other public programs, such as Medicaid (Kertesz, 2025b) and rental assistance (Kertesz, 2025a), even losing some public benefits erroneously because of MA supplemental benefit use (Kertesz, 2025a).

In late August, CMS announced that it would update Plan Finder by expanding the display of MA supplemental benefits (Booth & Duran, 2025). Previously, MPF displayed details regarding in-network and out-of-network cost sharing, prior authorization requirements, and plan limits only for hearing, vision, and dental care benefits. Plan Finder displayed 30 other supplemental benefits—including fitness benefit, health education, health-related emergency device, and over-the-counter drug benefits—solely with labels reading “some coverage” and “no coverage.” By October 1, those 30 benefits were to be updated to match the detail of hearing, vision, and dental care benefits (Booth & Duran). Moreover, CMS was going to add to MPF (with equally detailed information), six additional supplemental benefits: adult day health services; home-based palliative care; postdischarge in-home medication reconciliation; readmission prevention; weight management programs; and wigs for hair loss related to chemotherapy (Booth & Duran, 2025).

These changes could help mitigate the problems associated with MA supplemental benefits. At the same time, much work remains to be done to mitigate a core problem identified by CMS in a 2025 final rule governing MA:

We are also concerned that some MA plans may be using these supplemental benefits primarily as a marketing tool to steer enrollment towards their plan and are not taking steps to ensure that their enrollees are using the benefits being offered or tracking if these benefits are improving health or quality of care outcomes or addressing social determinants of health. (Medicare Advantage and Prescription Drug Benefit, Contract Year 2024/MA, Cost Plan, and PACE Policy and Technical Changes, Contract Year 2025, p. 30562)

Integration of MA Provider Directories

A more complicated change announced by CMS in August 2025 was the integration of MA provider directories within Plan Finder (Booth & Duran, 2025). The goal of this change was to enable beneficiaries to search for in-network providers within MPF rather than having to visit external websites of one or more MA plans (Carter, 2025c; Lambert, 2025). Had this change been implemented as CMS had proposed under the Biden–Harris administration (Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, proposed 2024), each MA plan would have been required to submit directory information to CMS for incorporation in MPF; to attest to the accuracy of the directory information; and to attest that both the directory and the network adhered to network adequacy rules (Carter, 2025c). However, the Trump administration did not include these provisions in the April 2025 final rule (Contract Year 2026 … 90 F.R. 15792). Consequently, the August 2025 CMS memo to MA did not compel all MA plans to submit directory information, nor did it include safeguards to address long-standing, well-publicized problems with MA provider directories (Booth & Duran, 2025). These problems include not only inaccurate listings and limited provider networks, but also “ghost” or “phantom” providers—that is, inactive providers who do not provide services to plan enrollees (Lipschutz, 2025b; Rae et al., 2025). Inclusion of these inactive providers can result in “ghost networks,” “where plans hide the small number of in-network providers by including inactive providers” (Carter, 2025b). (This problem can include practitioners who provide services for mental health conditions and substance use disorders. In fact, an October 2025 HHS report found that, on average, 55 percent of MA plans’ network behavioral health providers were inactive.)

Fortunately, CMS strengthened these MA directory requirements by issuing another final rule in mid-September 2025 (Contract Year 2026 … 90 F.R. 45140). The Medicare Rights Center (MRC)—a national nonprofit organization with which NASW works closely—summarized the final rule in this manner:

All MA plans will now be required to submit directory information to CMS in a format that can be integrated into MPF, to keep their directories up to date within 30 days of a known change, and to attest at least annually that their data are accurate. (Carter, 2025a, para. 4)

CMS informed stakeholders that it was able to update Plan Finder before the federal shutdown. Nevertheless, Washington Post investigators reported when MPF launched in mid-October:

The results in the directory are inconsistent and contradictory. In some cases, the tool includes duplicative addresses, with the same provider appearing to be simultaneously in-network and out-of-network. In other cases, the tool initially informs users that a provider is covered by a plan but lists that provider as out-of-network on other pages. (Diamond & Johnson, 2025, para. 5).

Moreover, the Washington Post article cited findings from a KFF expert, who said that the new tool doesn’t enable users to search by hospitals or skilled nursing facilities and limits provider searches within 50 miles of the beneficiary’s home.

Similarly, the Center for Medicare Advocacy (CMA)—yet another national nonprofit organization with which NASW collaborates regularly— reported on October 23:

The provider directory tool only allows beneficiaries to include up to 5 providers. Beneficiaries who wish to search for more than 5 providers must restart their search. Additionally, not all physical office locations are listed for some providers who show up as in-network in the provider directories, leading to confusion as to whether a provider is truly in-network for a given plan. (Lambert, 2025, pp. 2–3)

Furthermore, AARP has reported, “CMS has given participating plans until Jan. 1 to upload their network information to the directory, almost a month after the end of open enrollment” (Pugh, 2025, “Tech glitches” section, para. 5). Given this delayed timing and the impact of the federal shutdown, directory errors and inconsistencies on Plan Finder are likely to continue for the foreseeable future. Additionally, the long-standing reality of ghost networks render provider directories on MA plan sites unreliable.

Therefore, NASW seconds the advice of other advocates to support informed decision making by Medicare beneficiaries, both during and beyond the current Medicare AEP:

• Encourage beneficiaries not to rely solely on MA provider directories, whether those directories are listed in Plan Finder or on the websites of MA plan (Carter, 2025a, 2025b; JIA, 2025; Lambert, 2025).
• Encourage any beneficiary who calls an MA plan directly to record all details of the conversation, including the name of the representative and the date of the call (Carter, 2025a, 2025b).
• Call the health care provider directly to confirm whether the individual or entity is in the MA network (Carter, 2025a, 2025b; JIA, 2025; Lambert, 2025). Additionally, verify the provider is accessible geographically—and, if applicable, virtually—and is accepting new clients.

A subsequent section of this Tips & Tools addresses a temporary special election period for beneficiaries who wind up in a plan without their preferred provider because of these directory problems.

CMS Live Support

Live support from CMS is available 24 hours per day, seven days per week, except on some federal holidays. The agency offers three options for live support:

Telephone

Users who do not have internet access or who wish to talk with a CMS representative can call 1-800-MEDICARE (1-800-633-4227). CMS representatives can converse directly with beneficiaries in English and Spanish, and language line interpretation is available for more than 200 other languages. Additionally, representatives can help a beneficiary complete enrollment in their preferred coverage option.

Teletypewriter (TTY)

Beneficiaries who are Deaf or hard of hearing can obtain assistance by calling 1-877-486-2048.

Live Chat

Users can initiate a live chat by clicking the chat icon in the top right corner of any Medicare.gov page or by clicking “Start a Live Chat” on the “Contact Medicare” page (https://www.medicare.gov/talk-to-someone).

During a national training program for the fall 2024 AEP, CMS staff stated that the busiest hours for live support were from 10 a.m. to 4 p.m. EST on any given day, with Mondays and Tuesdays being the busiest days of the week. CMS has not provided similar information for fall 2025.

Through its work in various coalitions, NASW learned that many beneficiaries did not experience problems in reaching CMS by phone during the shutdown—perhaps, in part, because in late October CMS recalled an undisclosed number of furloughed staff members temporarily to help with the Medicare AEP and ACA open enrollment (Mahatole, 2025). However, this potential challenge could resurface should the government shut down again in early 2026.

State Health Insurance Assistance Program

Another resource for Medicare beneficiaries who need live assistance with Medicare information and enrollment is the State Health Insurance Assistance Program (SHIP), a federally funded program that provides free, one-on-one counseling, assistance, and education regarding Medicare (Administration for Community Living, 2025). SHIP operates in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands; program names may vary by state (SHIP Technical Assistance [TA] Center, n.d.-a). Operated in partnership with state offices, local agencies, grantees, and community providers, SHIP can be especially helpful for the following Medicare beneficiaries:

• people with low literacy, including health, financial, or digital literacy
• people with end-stage renal disease or other complex health conditions
• people with a second type of health coverage, including Medicaid

Unlike agents, brokers, and other insurance marketers, SHIP counselors do not sell Medicare plans or receive commissions for enrollments; as a SHIP flier states, “SHIP is supported through state and federal partnerships that are not reimbursed by private health insurance plans or entities. SHIP is not paid per enrollment” (SHIP TA Center, n.d.-b, footer). Consequently, SHIP is an unbiased, trustworthy source of information (SHIP TA Center, n.d.-a).

According to communication sent from the U.S. Department of Health and Human Services (HHS) to various stakeholders on October 1 (and summarized by CMA), “State Health Insurance Assistance Programs (SHIPs) should be able to continue their regular program activities but designated HHS staff will not be able to assist with SHIP-related activities, questions or provide technical assistance” (Lipschutz, 2025a, para. 2). Although SHIP continued to operate during the federal government shutdown, availability of virtual and in-person appointments varied by location and beneficiary need. In-person and virtual appointment access continues to be limited in some areas; nonetheless, SHIP sites without available appointments may be able to help beneficiaries by phone.

To find a SHIP site in your state or jurisdiction, visit the SHIP Locator at https://www.shiphelp.org/SHIPs/ or call 1-877-839-2675. For greatest accuracy when using the online SHIP Locator, click on the website of the applicable state and browse for local sites and phone numbers; some states have sites in multiple jurisdictions.

Medicare Rights Center National Helpline

1-800-333-4114 (Press 8 for Spanish)

This free, confidential, nongovernmental service helps callers understand Medicare benefits, make enrollment decisions, coordinate Medicare with other insurance, determine eligibility for Medicare cost-saving programs, and enroll in benefits, among other topics.

Temporary Special Enrollment Period for 2026

The fall Medicare AEP is but one of multiple enrollment periods available to Medicare beneficiaries. As described in Part 1 of this series (“Medicare Annual Enrollment Basics & the Social Work Role”), people newly eligible for Medicare by virtue of age have an initial enrollment period (CMA, n.d.). An open enrollment period specific to MA (MA OEP) which occurs January 1 through March 31 of each year; during this time, MA enrollees have one more opportunity to switch from one MA plan to another or from an MA plan to original Medicare (with or without a Part D plan) (MRC, 2025, sec. 2). Moreover, various special enrollment (or election) periods, or “SEPs,” also exist for beneficiaries in certain circumstances, such as for the following groups of people:

• people who enroll in an MA plan when they are newly eligible for Part A at the age of 65
• people who are dually eligible for Medicare and Medicaid (whether for an MSP or full Medicaid)
• people who are eligible for Extra Help
• people who live in states or other jurisdictions with a state pharmaceutical plan
• people who have moved within or from outside the country
• people who have transitioned into or out of a nursing home or other institutional care setting
• people who have reentered their communities following incarceration
• people whose plan contract ends (for any reason) or whose plan has been sanctioned by CMS
• people who have lost other coverage, including Medicaid, employer group coverage, or union coverage
• people who experience an employer or health plan error regarding timely Medicare enrollment
• federal employees who enroll erroneously in Part D
• people affected by an emergency or disaster
• people enrolled in Part D or MA who want to switch to a parallel plan with a five-star quality rating
• people with other exceptional circumstances (CMA, n.d.; CMS, n.d.; Cottrill et al., 2025; National Council on Aging, 2025)

(This list is not comprehensive.)

To mitigate the challenges with MPF during this fall AEP, CMS established a temporary SEP for 2026: “Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information.” CMS has provided the following parameters for use of this SEP:

• The beneficiary relied on MPF provider directory information.
• The beneficiary enrolled in an MA plan through Plan Finder during any available election period, including the current fall 2025 Medicare AEP.
• The MA plan in which the beneficiary enrolled was effective between January 1 and December 1, 2026.
• The beneficiary learns within the first three months of MA coverage that their preferred provider is not in the MA plan’s provider network.
• The beneficiary must call 1-800-MEDICARE so that a customer service representative can confirm the enrollment occurred directly through Plan Finder during the specified time frame.
• The beneficiary may switch to a new MA plan (with or without prescription drug coverage) or may enroll in original Medicare (with or without a stand-alone Part D plan). This enrollment change must be processed by the 1-800-MEDICARE customer service representative.
• The beneficiary’s new coverage will be effective the first day of the month after the application date. (Mulcahy, 2025, pp. 1–2)

As KFF has clarified, this new, temporary SEP “is distinct from an existing SEP that allows Medicare Advantage enrollees to make changes to their coverage if their plan makes certain changes to its provider network that are deemed ‘significant,’ such as terminating a large number of in-network providers (Cottrill et al., 2025, sec. 3, para. 4).

Emphasizing the ongoing challenges in maintaining accurate MA directories even with monthly updates to Plan Finder—and the fact that SHIP personnel rely on MPF as they counsel Medicare beneficiaries—MRC has urged CMS to make this SEP permanent (Carter, 2025a). NASW will monitor opportunities to bolster this advocacy.

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Please refer to Part 1 of this series, “Medicare Annual Enrollment Basics & the Social Work Role,” for information about how social workers can help beneficiaries navigate the AEP and understand coverage for 2026.

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Resource Summary & Additional Tools

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

• English https://www.cms.gov/outreach-and-education/reach-out/find-tools-to-help-you-help-others/open-enrollment-outreach-and-media-materials
• Spanish https://www.cms.gov/outreach-and-education/reach-out/find-tools-to-help-you-help-others/open-enrollment-materials-for-spanish-speakers
• Content for American Indian & Alaska Native (AI/AN) communities
  In previous years, CMS created public-service announcements (PSAs) for the Medicare AEP in 10 Indigenous languages. The Trump administration has not created these PSAs this year. The administration has retained six English-language fliers that had been designed for AI/AN communities. https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Open-Enrollment-materials-for-other-audiences
  To find more Medicare resources for AI/AN communities, visit https://www.cms.gov/training-education/partner-outreach-resources/american-indian-alaska-native/medicare-ia-ans and click on the topics under “Brochures and fact sheets” in the right sidebar. Visit https://www.cms.gov/training-education/partner-outreach-resources/american-indian-alaska-native/outreach-education-resources#outreach for related resources.
• Arabic, Chinese, Creole, Khmer, Korean, Polish, Russian, & Vietnamese
  Written materials had been available in these languages in previous years. The Trump administration has removed this content and has not created new content.

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.