Each year, Medicare beneficiaries have the opportunity to review and make changes to their health and prescription drug coverage during the Medicare Annual Enrollment Period (AEP). Many people are unaware that provider networks, benefits, drug formularies, and out-of-pocket costs can change from year to year. Taking time to review your options can help ensure your coverage continues to meet your health care needs while preserving access to your trusted UTMB Health primary care physicians, specialists, hospitals, and pharmacies.
Understanding the basics of annual enrollment
The AEP runs from Oct. 15 through Dec. 7, with coverage changes taking effect Jan. 1. During this period, you can return to Original Medicare or switch to a new Medicare Advantage plan. If you return to Original Medicare, you can also review and select a Part D prescription drug plan.
Even if you are satisfied with your current plan, it’s important to know that insurance carriers update provider networks, copays, and covered drug lists each year. Taking time to review your options can help you avoid unexpected out-of-pocket costs or coverage surprises in the new year.
If you happen to miss the Dec. 7 deadline or later find that your selected coverage isn’t meeting your needs, Medicare offers a secondary Open Enrollment Period (OEP) from Jan. 1 through March 31. This additional enrollment window allows Medicare Advantage members to make a one-time plan change. However, because federal regulations prohibit insurance companies from actively marketing or sending reminders about OEP, many members are unaware of this option. The UTMB Insurance Resource Team can connect you with resources to help you understand your coverage options.
Common misconceptions about Medicare enrollment
One of the most frequent mistakes people make is assuming that because their primary care doctor or specialist accepted their plan this year, they will automatically remain in-network next year. Provider networks can change from year to year, making it important to review your coverage annually.
Additionally, choosing a plan simply because a spouse, neighbor, or friend recommended it can lead to unexpected out-of-pocket expenses. Medicare coverage is highly individualized. As UTMB Health Insurance Specialist Brittany Grimaldi emphasizes, “Just because your neighbor has one plan, that doesn’t necessarily mean it’s the best one for you. You’re going to have different circumstances, different doctors, different medications. There’s no one-size-fits-all plan.”
That’s especially true when evaluating plan features. Many patients are drawn to extra benefits, such as dental coverage or gym memberships, and may overlook whether their primary care physician, specialists, hospitals, or medications are covered by the plan.
Preserving access to your UTMB Health care team
Selecting a plan that includes UTMB Health in its network can help keep health care costs more predictable and reduce out-of-pocket expenses. While Preferred Provider Organization (PPO) plans typically offer out-of-network coverage at higher cost-sharing rates, Health Maintenance Organization (HMO) plans generally require members to receive most nonemergency care from in-network providers.
Patients considering HMO plans should also pay attention to referral requirements. Some plans require a referral from a primary care provider (PCP) before a patient can see a specialist. If you see UTMB Health specialists regularly, verifying these requirements can help ensure your care remains seamless and uninterrupted.
Questions to ask before selecting a plan
Before finalizing your Medicare coverage for the coming year, ask these questions to help avoid surprises in January:
Is my primary care physician in-network for the upcoming plan year?
Are my preferred UTMB Health specialists, clinics, and hospital facilities in-network?
Are my prescription medications included on the plan’s formulary?
Does the plan require a referral from my primary care provider (PCP) before I can see a specialist?
What are the plan’s annual deductible, copay, coinsurance amounts, and maximum out-of-pocket costs?
Navigating Medicare Part D and prescription coverage
Prescription drug benefits under Medicare Part D continue to evolve. Many carriers have shifted prescription pricing away from flat copays and toward percentage-based coinsurance for higher-tier medications, which can lead to unexpected costs at the pharmacy counter. Reviewing your drug list each fall can help prevent surprises in the new year.
Under Part D, beneficiaries benefit from a capped annual out-of-pocket drug cost ($2,100 in 2026), after which covered prescriptions cost $0 for the remainder of the calendar year. In addition, federal price negotiations under the Inflation Reduction Act continue to lower costs for certain high-use medications, such as Eliquis, reducing out-of-pocket expenses for eligible patients.
Specialty medication and GLP-1 support at UTMB Pharmacy
For patients taking GLP-1 medications for weight management, navigating insurance coverage can be challenging because of high deductibles and cost-sharing requirements. Through the Medicare GLP-1 Bridge program, eligible beneficiaries who meet clinical criteria may receive covered GLP-1 weight management medications for a flat $50 monthly copay.
UTMB Pharmacy plays an active role in supporting patients throughout the process. The pharmacy team verifies coverage, evaluates eligibility for assistance programs, coordinates prior authorizations directly with prescribing providers, and offers convenient home delivery.
UTMB Health support and coverage verification resources
Ensuring your preferred doctors, specialists, and hospital facilities are in-network is one of the easiest ways to help keep your care seamless in the coming year.
If you have questions or need personalized guidance reviewing your coverage, UTMB Health offers dedicated support resources:
UTMB Insurance Resource Team: Contact the team via the UTMB Access Center at (409) 747-1810 or email InsuranceQuestions@utmb.edu for assistance reviewing your coverage options and verifying plan participation.
UTMB Pharmacy Services: Call (832) 505-3170 for assistance reviewing Part D drug benefits or navigating the Medicare GLP-1 Bridge program.
Accepted insurance plans: Review the latest list of accepted Medicare Advantage and commercial insurance plans at utmbhealth.com/billing-insurance/insurance.