Care Playbook
Medicare Open Enrollment Review
Use this playbook to review Medicare coverage before Open Enrollment decisions: doctors, hospitals, prescriptions, pharmacies, premiums, IRMAA, prior authorization, and total yearly cost.
Use as a working checklist. Complete what is useful now and return when the situation changes.
Timing banner
Medicare Open Enrollment runs October 15 through December 7. Changes made during this period are effective January 1 of the next year if the plan receives the request by December 7.
This playbook does not recommend a plan or replace Medicare, SHIP, insurer, or licensed professional guidance.
Applies to 2026
This playbook uses 2026 Medicare planning anchors and should be reviewed annually before Medicare Open Enrollment.
Medicare Open Enrollment runs October 15 through December 7, with accepted changes effective January 1.
CMS lists the 2026 standard Part B premium as $202.90 and the annual Part B deductible as $283.
Medicare lists a 2026 Part D deductible maximum of $615 and covered Part D out-of-pocket drug spending threshold of $2,100.
Social Security explains that certain life-changing events that reduce household income may support an IRMAA reduction request.
Medicare describes SHIP counseling as free, personalized, and not connected to insurance companies or health plans.
Who this playbook is for
- People reviewing Medicare coverage before Open Enrollment.
- Family caregivers helping compare doctors, drugs, pharmacies, and total cost.
- Households with drug changes, provider changes, IRMAA notices, or plan-rule concerns.
Common triggers
Quick situation intake
These answers personalize the callouts and summary. They do not block access to the playbook.
What to do now
What to do in the next 24 hours
What to do this week
What to document
These fields feed the shareable Family Care Plan Summary.
Annual Medicare review checklist
Review the plan against real life, not just the premium.
Professional question builder
Can you help verify doctors, drugs, pharmacies, total yearly cost, and plan rules?
SHIP can provide free, unbiased Medicare counseling.
Can you confirm this doctor, hospital, drug, and pharmacy list for the coming plan year?
Networks, formularies, and pharmacy pricing can change.
Does a life-changing event support an IRMAA reduction request?
Income-related adjustments may change after qualifying events.
Who to call
SHIP
Call when
Call when the family wants free, unbiased Medicare counseling or needs help comparing options.
What to say
We are reviewing Medicare coverage for Open Enrollment. We need help checking doctors, prescriptions, pharmacy costs, total yearly cost, and plan rules.
Medicare plan or insurer
Call when
Call when provider network, drug formulary, prior authorization, pharmacy, or premium details are unclear.
What to say
Can you confirm whether these doctors, hospitals, prescriptions, and pharmacies are covered for the coming plan year?
Social Security
Call when
Call when IRMAA, Part B premium deductions, or income-related adjustment notices are involved.
Licensed Medicare professional
Call when
Call when the user wants individualized plan guidance, enrollment help, or policy comparison.
Escalation triggers
- If a must-have doctor, drug, hospital, or pharmacy is not covered, pause before enrollment.
- If IRMAA or income changed, check Social Security guidance before assuming the bill is final.
- If the decision is unclear, use Medicare, SHIP, plan documents, or a qualified professional before enrolling.
Set a suggested review date
Before December 7, and again after plan confirmation
Suggested review date: June 26, 2026
Generate care summary
Medicare Review Summary
Send the intake, documentation, checked actions, recommended tools, questions, and review date to the Family Care Plan Summary.
Kefiw Medicare Review Summary Date created: May 27, 2026 Suggested review date: June 26, 2026 Situation intake What coverage does the person currently have?: Not entered Why are you reviewing coverage?: Not entered Have current doctors and specialists been checked?: Not entered Have prescriptions been checked against plan coverage?: Not entered Has preferred pharmacy pricing been checked?: Not entered Are prior authorization, referrals, or network rules a concern?: Not entered Has income changed because of retirement, death of spouse, divorce, work stoppage, or another major life change?: Not entered Would unbiased Medicare counseling be useful?: Not entered Documentation Current Medicare coverage: Not entered Doctors and hospitals checked: Not entered Prescriptions checked: Not entered Preferred pharmacies checked: Not entered Estimated annual Medicare cost: Not entered IRMAA notes: Not entered Open questions before enrollment: Not entered Completed actions None checked yet Recommended next steps - Open the Medicare Plan Comparison Worksheet. - Use Part D Estimate. - Use Medicare Cost Calculator. - Use Medicare IRMAA Calculator if needed. - Generate a Medicare Review Summary. Questions to ask - Are current doctors and preferred hospitals covered for the coming plan year? - Are all prescriptions covered at the preferred pharmacy? - Which prior authorization, referral, or network rules apply? - What is the estimated bad-year cost? - Should SHIP, Medicare, or a licensed professional review this before enrollment? Recommended Kefiw tools - Medicare Cost Calculator: Compare yearly Medicare-related cost exposure. - Part D Estimate: Estimate drug-plan cost pressure and penalty risk. - Medicare IRMAA Calculator: Check income-related premium adjustment risk. - Part B Premium Calculator: Separate Part B premium, deductible, and coinsurance exposure. - Medicare Plan Comparison Worksheet: Use pass/fail checks before comparing cost. - Medicare Plan Red Flags Guide: Review common plan-comparison traps. Family script Let's not stay with a plan just because it worked last year. We need to check doctors, drugs, pharmacies, total cost, and what changed.
You have a starting plan.
You documented what happened, identified the next care steps, and selected tools to continue planning.
Related guides
Review and scope
Recommended reviewer type: Medicare specialist, Licensed insurance professional. Last reviewed: April 30, 2026. Next scheduled review: annual update cycle or sooner when guidance changes.
Kefiw provides educational planning tools and guides. This playbook does not provide legal, tax, financial, Medicare enrollment, Medicaid planning, insurance, investment, or benefits advice. Costs, eligibility, coverage, premiums, formularies, networks, tax treatment, benefit rules, and state Medicaid rules can vary by person, plan, policy, state, provider, and year. Confirm details with Medicare, Social Security, SHIP, insurers, Medicaid, an elder law attorney, tax professional, licensed insurance professional, or qualified advisor as appropriate.