Every year between October 15 and December 7, Medicare beneficiaries across Virginia have a window to change their coverage for the following year. Miss it and you’re locked in until next October — even if your plan raises its premiums, drops a drug you depend on, or quietly removes a specialist you’ve been seeing for years. Most people don’t find out their plan changed until January when they show up at the pharmacy or get an unexpected bill.
This year’s Annual Enrollment Period closes December 7, 2026. Here’s what Northern Virginia Medicare beneficiaries need to review before that date and why this year’s review matters more than you might think.
What Is the Medicare Annual Enrollment Period?
AEP runs October 15 through December 7 each year. Any changes you make take effect January 1, 2026. During this window you can:
- Switch from one Medicare Advantage plan to another
- Move from Original Medicare to Medicare Advantage, or back
- Add, drop, or change your Part D prescription drug plan
What you generally cannot do during AEP is switch to a Medicare Supplement (Medigap) plan without going through medical underwriting. In Virginia, that means your health history can be reviewed and you can be charged more or denied coverage based on pre-existing conditions. If you’re thinking about moving from Medicare Advantage to Original Medicare plus a Supplement, talk to a licensed advisor before AEP — there are specific situations where guaranteed issue rights apply, and missing those windows can be costly.
If you miss AEP entirely, the Medicare Advantage Open Enrollment Period runs January 1 through March 31 and allows you to switch from one Advantage plan to another or return to Original Medicare — but your options are more limited than during AEP. Review the Medicare Guide for more about the basics of Medicare.
(703) 969-1811 jeremy.stern@healthmarkets.com
Why You Should Review Your Plan Every Year Even If Nothing Feels Broken
This is the part most people skip, and it’s the most expensive mistake of the enrollment season.
Every fall, Medicare Advantage and Part D plans file updated benefit structures with CMS. Premiums change. Drug formularies change. Networks change. The dental allowance, OTC credit, or fitness benefit that helped you choose your current plan may be reduced or gone entirely in 2026. CMS requires plans to mail you an Annual Notice of Change (ANOC) every September — that’s the document most people set aside to read later and never do. It contains every change to your plan for the coming year.
We had a client in Fairfax whose Part D plan quietly moved her blood pressure medication from Tier 2 to Tier 4 in the annual update. Her monthly cost would have gone from $15 to $78. We caught it during her AEP review and moved her to a plan where the same medication stayed at Tier 2. The switch took about 20 minutes. The savings were over $750 a year. – Mary Crispino, Medicare Expert
That kind of change happens more often than people realize and it happens silently, buried in a letter most people don’t read.
What Northern Virginia Medicare Beneficiaries Should Review Before December 7th
Your prescription drug coverage
Pull out your current medication list and check every drug against your plan’s 2026 formulary. CMS requires all Part D plans to publish updated formularies by October 1. If any of your medications moved to a higher tier or were removed from the list entirely, this is the AEP to switch. Don’t wait until January to find out at the pharmacy counter.
Your doctors and specialists
Go to your plan’s website and search for each of your providers by name. Don’t assume they’re still in-network, because networks change at renewal and your plan is not required to notify you individually when a specific doctor leaves. If your primary care physician, cardiologist, oncologist, or any specialist you see regularly is no longer listed, your out-of-pocket costs for 2026 under your current plan could be significantly higher.
Your premium and out-of-pocket maximum
Read the ANOC letter. It shows your 2026 premium, deductible, and annual out-of-pocket maximum.
“The most important thing to do is to compare your 2026 costs to what you paid in 2025. A plan that looked competitive last year may no longer be the best value, especially if the out-of-pocket maximum increased while the extra benefits stayed the same.” – Cory Weaver, 15 year veteran Medicare expert.
Your extra benefits
If dental, vision, hearing coverage, an OTC allowance, or a gym membership factored into your plan choice, verify those benefits are carrying over at the same level in 2026. These are frequently the first things plans adjust at renewal.
Whether Medicare Advantage still makes sense for your life right now
This is worth asking honestly. If you received a serious diagnosis this year, have upcoming surgery, or are now seeing multiple specialists regularly, the network restrictions that worked fine when you were healthy may become a real problem. It may be worth comparing your Advantage plan against Original Medicare plus a Supplement — not because Advantage is wrong, but because your situation may have changed enough that a different structure serves you better.
Northern Virginia-Specific Considerations
Not every Medicare Advantage plan works the same way across Northern Virginia — and some details matter more here than they would in other parts of the state.
Inova Health System is the dominant health system across Fairfax, Loudoun, and Prince William counties. Not every Medicare Advantage plan contracts with Inova, and those that do may not include all Inova facilities. If you have an Inova physician you want to keep, especially a specialist, your plan needs to specifically include that provider in-network. Verify it, don’t assume it.
Kaiser Permanente operates as a fully integrated HMO. Medicare Advantage plans through Kaiser require you to use Kaiser providers for all covered services outside of emergencies. For people who are already Kaiser patients this can work well. For anyone with established relationships outside the Kaiser system, it’s a hard constraint worth understanding before you enroll.
Plan availability in Northern Virginia is also county-specific. What’s available in Loudoun County may differ from what’s offered in Prince William or Fairfax. Residents near county lines — Gainesville, Ashburn, Herndon — should verify which county their address falls into for Medicare plan purposes, since it affects which plans they can access.
What Happens After December 7th
If you make a change during AEP, your new coverage begins January 1, 2026. Keep your current plan’s member ID card until then because your old coverage is still active through December 31.
If you realize in January that you made a mistake or want to make a different change, the Medicare Advantage Open Enrollment Period runs January 1 through March 31. During OEP you can switch from one Advantage plan to another, or drop Advantage and return to Original Medicare. You cannot, however, use OEP to switch from Original Medicare to Advantage or to add a standalone Part D plan if you’re in Original Medicare.
Special Enrollment Periods exist outside of these windows for specific circumstances such as moving to a new address, losing other coverage, or qualifying for Extra Help with drug costs. If something significant changes in your life after December 7th, don’t assume you’re stuck. Call us and we’ll tell you what options you have.
How The Stern Team Helps During Medicare AEP
The Stern Team has been helping Northern Virginia families navigate Medicare enrollment since 2003. During AEP we do the following at no cost:
- Compare every Medicare Advantage and Part D plan available in your county
- Review your current medications against 2026 formularies before you make any changes
- Verify that your specific doctors and specialists are in-network on any plan you’re considering
- Walk you through the tradeoffs between plans in plain language.
We’re independent advisors and we work with all major carriers, so our only job is finding what works best for you.
AEP appointments fill up quickly in November as the December 7th deadline approaches. If you want a review before the window closes, schedule early.
Key Dates
- October 1 — Plans publish 2026 formularies; ANOC letters arrive
- October 15 — Annual Enrollment Period opens
- December 7 — Annual Enrollment Period closes
- January 1 — New coverage takes effect
- January 1 – March 31 — Medicare Advantage Open Enrollment Period
The Bottom Line
The right Medicare plan isn’t the one with the lowest premium. It’s the one that covers your doctors, your medications, and your life as it actually is right now, not as it was last year. An annual review costs nothing and takes less than an hour.
The Stern Team has been doing these reviews for Northern Virginia families for more than two decades. Contact us before December 7th.
Want more info? Read the Medicare Guide here
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