December Medicare Checkup: What to Review Before Jan 1

Medicare shouldn’t feel like a moving target — but December is the month when many retirees discover that their health coverage, drug plan, or out-of-pocket costs will shift on January 1. And even small gaps in coverage can lead to significant, unexpected expenses in the new year.

A December Medicare checkup is one of the most important year-end steps retirees can take to protect their retirement income, avoid unnecessary premiums, and ensure their healthcare fits their evolving needs. The good news? A quick review now can prevent costly surprises later.

Here is a clear, retirement-focused Medicare checklist designed to help you review what matters most before the calendar resets. 

1. Review Changes to Your Medicare Advantage or Part D Drug Plan

Every fall, Medicare Advantage (Part C) and Part D prescription drug plans release their Annual Notice of Change (ANOC). Many retirees overlook this document — but this is where cost and coverage changes are listed.

Before Jan 1, review whether your:

• Monthly premiums are increasing
• Deductibles or copays are changing
• Pharmacy networks are shifting
• Preferred drug pricing tiers are different
• Medications are being added or removed from the formulary
• Out-of-pocket maximum is increasing

Even a small premium or copay adjustment can add up across 12 months. If one of your medications moved to a higher tier, switching plans before the deadline may save you hundreds of dollars next year.

2. Confirm Your Doctors and Specialists Still Accept Your Plan

Provider networks change quietly.
A doctor who accepted your plan in 2024 may not participate in the same plan for 2025, especially with Medicare Advantage networks.

Before January:

• Confirm that your primary care doctor remains in-network
• Review specialists you see regularly
• Check hospital network status
• Verify urgent care and telehealth access

This simple step helps retirees avoid surprise out-of-network bills — one of the most common, costly Medicare-related issues.

3. Compare Medicare Advantage vs. Original Medicare for 2025

Many retirees remain in the same plan year after year without comparing alternatives. December is the ideal time to determine whether your coverage still matches your needs.

Medicare Advantage (Part C)

• Bundled coverage (hospital, doctor, often drug coverage)
• May include dental, vision, or wellness benefits
• HMO or PPO-style managed care networks
• Annual out-of-pocket maximum

Original Medicare

• Use any doctor nationwide who accepts Medicare
• Requires a separate Part D drug plan
• Can be paired with Medigap coverage
• No out-of-pocket maximum

Your lifestyle, travel frequency, prescription needs, and provider preferences should influence whether you stay with your current plan or switch.

4. Reevaluate Your Medigap (Supplement) Plan

Medigap benefits remain consistent year to year, but premiums typically increase over time. This can impact retirement budgets if not monitored.

In December:

• Review premium changes for your current plan
• Compare costs for the same plan type (Plan G, Plan N, etc.)
• Explore whether switching is possible without underwriting
• Ensure your benefits still match your health needs

A modest premium increase may be expected, but larger jumps are worth reevaluating.

5. Check for New Out-of-Pocket Exposure in 2025

Even if you stay in the same plan, rising deductibles or copays can affect your healthcare budget next year.

Review changes to:

• Deductible amounts
• Coinsurance percentages
• Copayment structures
• Maximum out-of-pocket limits

For retirees on fixed income or relying on guaranteed income streams, healthcare costs directly affect lifestyle, cash flow, and retirement planning.

6. Verify Your Prescription Drug List (Formulary) for Tier Changes

Medication tier changes are one of the most common — and expensive — Medicare surprises.

Before January, review:

• Tier changes for each medication
• Prior authorization requirements
• Quantity limits
• Step therapy rules
• Generic or lower-cost alternatives

If one of your essential medications moves to a higher tier, review whether switching to a different drug plan may reduce your annual costs.

7. Evaluate Whether Your Health Has Changed This Year

Your Medicare plan should match your actual health needs — not your needs from last year or five years ago.

Ask yourself:

• Have you been diagnosed with a new condition?
• Are you visiting new specialists?
• Do you expect any surgeries in the upcoming year?
• Has your mobility, dental, vision, or hearing changed?

Updated health needs may require additional benefits or a different Medicare structure.

8. Consider Whether You Need Additional Protection for 2025

Some retirees benefit from extra coverage, especially as health needs evolve with age.

Consider whether you may need:

• Dental or vision protection
• Hearing coverage
• Cancer, heart, or hospital indemnity plans
• Long-term care or home health support

These protections can reduce major, unexpected medical bills and help maintain stable retirement income.

9. Watch Out for Medicare Scams During December

December is a prime month for Medicare-related scams. Be alert to:

• Calls claiming your Medicare card is expiring
• Offers for “free” medical equipment
• Emails requesting your Medicare number
• High-pressure tactics to switch plans immediately

Medicare will never contact you unprompted to ask for personal information.

10. Factor Medicare Changes Into Your 2025 Retirement Income Plan

Healthcare and Medicare costs play a major role in long-term financial security. When premiums, copays, or drug costs shift, they impact:

• Cash flow
• Withdrawal strategies
• Travel and lifestyle budgeting
• Long-term projections

Your December Medicare review should be part of your broader retirement income plan to help maintain stability and predictability throughout the upcoming year.

Tootsie’s Takeaway 🐾

Just like I check my food bowl every night before bedtime (priorities!), retirees should check their Medicare coverage before Jan 1. A quick December review keeps surprises out of your mailbox — and money in your pocket.

Written by Brent Meyer, founder of SafeMoney.com. With more than 20 years of experience helping families navigate retirement and legacy planning, Brent is committed to making financial education simple, clear, and trustworthy.

Disclaimer: This article is for informational and educational purposes only. It should not be construed as financial, tax, or healthcare advice. Consult a licensed professional for guidance specific to your situation. Medicare rules and benefits are subject to change; always refer to official Medicare resources or a qualified advisor before making decisions.