Medicare AEP 2025: Step-by-Step Guide to Comparing Plans (in 45 Minutes)

​Annual Enrollment Period (AEP) runs Oct 15–Dec 7. Plans change their formularies, pharmacy networks, premiums, and copays every year. In 2025, the Inflation Reduction Act continues phasing in Part D redesign—including the $2,000 annual cap on Part D out-of-pocket—but premiums, tiers, and pharmacy status can still make the total cost swing by thousands.

This guide walks you through a precise, 45-minute comparison you can do with us or on your own.

​Part 1: Build your “AEP dossier” (10 minutes)

Create one page with:
1. Medicare number + current plan names and member IDs
2. Medication list: drug, dosage, frequency, quantity per 30 days (or 90-day mail)
3. Pharmacies you actually use: retail + mail order
4. Doctors/facilities (include specialists and preferred hospitals)
5. IRMAA status (if applicable)—know your 2-year lookback MAGI
6. Dental/vision/hearing needs (cleanings vs. crowns; hearing aids; cataracts)
7. Travel habits (snowbird? out-of-state kids?)
8. Care management needs (PT/OT, home health, durable medical equipment)

Pro tip: Snap your prescription labels. Dosage errors are the #1 reason people mis-quote drug costs and pick the wrong plan.

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Part 2: Formulary math—how to model “total cost” (15 minutes)

People often shop premiums first. The right way: Total Annual Cost = Premium + (Copays/Coinsurance × Utilization) + Deductibles.

Step A — Price your exact drug list
• Verify each drug is on formulary and note tier and utilization rules (PA, ST, QL).
• Price your pharmacy (preferred vs. standard network can change copays dramatically).
• Price 90-day mail if you use it—often cheaper for maintenance meds.
• If you take high-cost drugs, note how the $2,000 Part D cap changes your year-end spend (you’ll stop paying for Part D drugs after the cap is reached in 2025).

Step B — Add medical exposure

For Medicare Advantage (MA), check:
• Max Out-of-Pocket (MOOP) for in-network and out-of-network (PPOs).
• Copays for specialist, imaging, hospital, ER, urgent care.
• Prior auth common triggers (inpatient, high-tech imaging, DME).
• Network: ensure your doctors/hospitals are in-network.

For Medigap + Part D:
• Medigap premium + small Part B costs + Part D drug math.
• Consider underwriting if switching (outside Guarantee Issue).

Pro tip: Build a low-use and high-use scenario. If a bad year happens, does the MOOP or Medigap premium give you more sleep at night?

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Part 3: Pharmacy networks & tiering (10 minutes)

The same plan can have very different costs by pharmacy.
• Confirm your pharmacy is Preferred for 2025.
• If it’s not, ask: “What’s my cost at a preferred location two miles away?”
• Some plans exclude specific national chains as “standard” only—watch copays.

Formulary traps to check:
• Tier changes (Tier 3 → Tier 4)
• New step therapy or prior auth rules
• Quantity limits (esp. inhalers, injectables)

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Part 4: Non-medical add-ons that matter
• Dental: Does the plan cover major services (crowns/implants)? Is the benefit a true insurance or a discount? Are there waiting periods?
• Hearing: What is the allowance? Which partners (e.g., TruHearing) and what are brand restrictions?
• Vision: Is the frame allowance realistic?
• Travel: PPO out-of-network coverage vs. national MA networks; snowbird months.
• Care coordination: In-home care, meals after discharge, transportation visits—how many?

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Part 5: Decision grid + tie-breakers (10 minutes)

Make a 4-column grid: Plan A, Plan B, Plan C, Your Current Plan.
• Row 1–3: Total annual cost at your pharmacy (low-use / high-use)
• Row 4–6: Doctors/hospital in-network? Y/N
• Row 7–8: MOOP (in/out)
• Row 9–11: Dental/hearing/vision value
• Row 12: Travel needs
• Row 13: Prior auth density (light/medium/heavy)

Pick the plan that wins your pharmacy math and protects the bad year.

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Switching rules & timing
• AEP changes take effect Jan 1.
• Medigap changes can require underwriting outside guarantee windows.
• Keep confirmation numbers and a plan welcome kit proof of enrollment.

We’ll do the 45-minute math for you. Bring your drug list and doctors; we’ll compare real costs at your pharmacy and model MOOP for a “bad year” so you’re not surprised.