Seniors in the south suburbs and across the country are in the midst of what can be a challenging and confusing period — Medicare open enrollment season.
They need to get up to speed on changes in their health care plans that will take effect in January and act now to avoid making mistakes that can have costly repercussions. So say senior advocates who note free help is available to help navigate the process.
Open enrollment, which began Oct. 15 and runs through Dec. 7, is the one time each year when seniors can review their Medicare health care coverage and change plans if needed.
“There are lots of challenges. The top 1 is that there are multiple options to choose from, and the plans don’t provide uniform formularies (drug lists); not all have the same formularies,” said Georgia Gerdes Avisery, senior training specialist with AgeOptions.
AgeOptions is the Area Agency on Aging for suburban Cook County, and its partner organizations assist seniors for free in navigating the Medicare open enrollment process via funding from the Illinois Department on Aging’s senior health insurance program.
For many seniors, dealing with the paperwork during open enrollment is a struggle, said Christine Suddreth, a senior health insurance program counselor with Palos Heights-based eldercare services provider Pathlights.
While much information is available online, for seniors who aren’t computer savvy or don’t have Internet access, it’s particularly difficult to compare plans, she said. Pathlights has senior health insurance program counselors, including four employees and five volunteers, who assist seniors.
Among common mistakes many seniors make are not realizing they can make changes and not doing their homework to check to see if premiums and copays have increased, if their medicines are still covered by the plan and for the same costs and if their preferred health care providers are still in the plan, counselors said.
“Premiums change from year to year,” said Gerdes. “We are seeing some plans, about 30% to 40% of Part D plans in Illinois, increasing their premiums. So it’s really important to determine if your plan is going to continue to work for you.”
Suddreth said Pathlights helped clients make choices that saved Medicare recipients $130,505 last year just by helping them review prescription drug plans.
One person saved $33,872, she said.
“If this client remained with his recent plan, he would have paid $34,071 for medications in 2025,” she said. “We did the comparison, and the best plan found reduced his cost to $199 per year.”
A second person saved $11,266, Suddreth said. A previous plan cost her $13,077, and the one that she signed up for was $1,811 per year.
Christine Suddreth, a senior health insurance program counselor with Palos Heights-based eldercare services provider Pathlights and manager of community relations, speaks to a senior group in Orland Park in 2024. (Pathlights)
During open enrollment seniors can switch from original Medicare to a Medicare Advantage plan or vice versa, switch from one Medicare Advantage plan to another and join, drop or switch to a Medicare Part D prescription drug plan.
The federal government’s original Medicare program includes Part A, which covers hospitalization, and Part B, which covers doctors’ services, diagnostic screenings, durable medical equipment, lab tests, outpatient care and preventive services.
But Part B covers only 80% of the cost. Seniors can purchase supplemental Medigap Part C plans to help cover the remaining 20%. Medicare Part D covers prescription drugs.
Medicare Advantage plans, offered by for-profit insurance companies, are all-in-one plans. They combine Part A and Part B, and most include prescription drug coverage.
There can be tradeoffs in choosing between original Medicare and Medicare Advantage plans.
With original Medicare you can choose and go to any doctor or hospital that takes Medicare anywhere in the U.S., you don’t need referrals to see any provider and you don’t have to worry about your doctor leaving a plan’s network, AARP notes. Only 1% of doctors who treat adults don’t participate in Medicare, according to KFF, formerly the Kaiser Family Foundation.
By comparison, Medicare Advantage enrollees on average had access to just under half (48%) of the physicians in their area who were available to people enrolled in original Medicare, an analysis released last month by KFF found.
But with original Medicare. there’s no yearly limit on what you pay out-of-pocket, unless you have supplemental Medigap coverage, Medicaid, employer, retiree or union coverage, according to Medicare.gov. You will pay a monthly premium for Part B, Medigap and Part D coverage.
Some Medicare Advantage plans may have no premium and may help pay all or part of your Part B premium and may have no deductibles for prescription drugs. But there may be fewer drugs covered. Medicare Advantage plans must cover all medically necessary services that original Medicare covers. It may also offer extra benefits that original Medicare doesn’t such as vision or dental coverage.
But Medicare Advantage plans, which are being marketed widely, work like HMOs; you must use doctors and other providers who are in the plan’s network and service area otherwise you will be hit with higher costs, senior advocates note. You may also have to get preauthorization before the plans cover certain services or supplies, and there may be limits on the extra benefits they provide.
There may also be limits on the quantities of drugs, and you may be required to take certain steps before certain drugs are approved. For example, you may have to try taking a preferred medication before they’ll pay for a non-preferred one. It can also be more difficult if you enroll in a Medicare Advantage plan and then decide the following year you want to switch back to original Medicare.
Medicare Advantage plans do have a yearly limit on what you pay for covered Medicare services which may include different limits for in-network and out-of-network services, according to Medicare.gov. Once you reach your plan’s limit, you’ll pay nothing for covered services for the rest of the year.
AARP notes among Medicare changes in 2026, seniors should be aware that the top 10 most expensive prescription drugs that Medicare covers are now going to be negotiated resulting in lower costs, said Courtney Hedderman, senior associate state director with AARP Illinois. The medicines include Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and NovoLog/Fiasp.
Also new in 2026, the cap on annual out-of-pocket expenses for Part D drugs will increase to $2,100 from $2,000 this year, Hedderman said.
Suddreth notes seniors need to research which of their medicines count toward the cap, and she recommends seniors not delay visiting the doctor until January. You don’t want to find out in January that you need to take a new drug that isn’t covered by the plan you’ve chosen.
Experts stress during open enrollment seniors need to thoroughly examine what coverage they have and any pending changes and comparison shop. If you’re comfortable with the cost and coverage, stick with it. If not now is the time to make the change.
Keep in mind open enrollment is also a prime time for fraud, warns AARP. Scammers may pose as Medicare representatives and are out to get your personal information. Don’t give it out. Medicare will never call, email or text out of the blue to ask for personal information or payment. If you’re unsure, hang up and call 1-800-MEDICARE to verify, AARP advises.
During open enrollment seniors in the south suburbs can find free help by calling Pathlights at 708-361-0219. Free help is also available here:
Senior health insurance program, ilaging.illinois.gov/ship, hotline 1-800-252-8966
Medicare Help Line: 1-800-633-4227
Medicare Plan Finder: Medicare.gov and aarp.org/medicare/
Francine Knowles is a freelance columnist for the Daily Southtown. She is also a grants specialist at Chicago-based CJE SeniorLife, which receives funding from AgeOptions.
https://www.chicagotribune.com/2025/11/10/column-senior-advisers-medicare-open-enrollment/