Medicare’s open enrollment runs from October 15 to December 7. Any change you make takes effect on January 1, 2027.
Most people think of Medicare as something that starts at 65. People under 65 get it too, usually after 24 months of Social Security disability benefits.
Here is how this fall can look. The family below is made up. The rules are real. Medicare’s enrollment rules are the same in every state. The Medicaid and Medigap details here are North Carolina’s.
Dana’s son, Eli, is 34 and has Medicare because of a disability. He also has Medicaid. In September, his drug plan sent him a letter called the Annual Notice of Change, which lists what changes in January.
Start with that letter.
If nothing in it affects Eli, he may not need to do anything. If something changed, Dana and Eli can check three things.
- Are his medicines covered and what will they cost? Medicare’s online Plan Finder shows this.
- Do his doctors, therapists, and equipment suppliers take the plan? Medicare Advantage plans come from private companies. Many use networks and need the plan’s approval before some care.
- What will the whole year cost? Add the monthly premium, the deductible, and the copays. In 2027, once someone pays $2,400 out of pocket for covered drugs, they pay nothing more for them that year.
Because Eli has Medicaid, he has more room.
People with Medicaid or Extra Help can generally change drug plans once a month, not just in the fall. Extra Help is a federal program that lowers drug costs for people with limited income and resources. People with full Medicaid or Supplemental Security Income (SSI) get it without applying.
Not sure if you qualify? Call Social Security about Extra Help. Ask your county Department of Social Services about the Medicare Savings Programs, North Carolina’s help with Medicare costs.
Medicare does not replace Medicaid.
Medicare generally does not pay for ongoing personal care or day programs. Eli gets those through Medicaid, which is why many people keep both. North Carolina’s new Medicaid work requirement also does not apply to people with Medicare.
One caution before switching.
During open enrollment, you can change plans, including moving between Original Medicare (the government plan) and Medicare Advantage. If a Medicare Advantage plan does not work out, there is another chance to switch from January 1 to March 31.
Medigap is extra insurance that helps pay what Original Medicare leaves behind. In North Carolina, people under 65 with Medicare because of a disability can buy certain Medigap plans within a time limit. After that, an insurer may turn you down or charge more because of your health.
Before you drop Medigap or leave a Medicare Advantage plan, check with the free counselors below.
Free help
- North Carolina Seniors’ Health Insurance Information Program (SHIIP), free counseling for people with Medicare and their caregivers: 1-855-408-1212
- Medicare: 1-800-MEDICARE (1-800-633-4227), text telephone (TTY) 1-877-486-2048, or medicare.gov/plan-compare
Outside North Carolina, your State Health Insurance Assistance Program offers the same free help.
If you want help seeing how Medicare fits with SSI, Medicaid, trusts, and the rest of your family’s plan, a Trailhead Meeting is a good place to start. And if you know a family like Dana and Eli’s, send this their way.
Figures current as of October 2026.