Medicare Open Enrollment Ends December 7: What Changing Your Plan Does and Does Not Do for Long-Term Care

Imagine a woman in Decatur sitting at her kitchen table in early November with a stack of mail in front of her. Her plan sent her an Annual Notice of Change. Three insurers sent brochures. A man on television told her she might be leaving benefits on the table.

She spends an afternoon comparing plans, picks a new one before the deadline, and feels like she has finally handled something.

Eight months later her husband has a stroke, and she finds out that nothing she chose that afternoon has any bearing on the bill in front of her.

I want to be careful here, because this is not an argument against reviewing your Medicare coverage. You should. The deadline is real and it matters. But every year I meet families who believe that choosing a Medicare plan is the same thing as planning for long-term care, and those are two completely different things.

The dates, first

Medicare Open Enrollment runs from October 15 to December 7, 2026. Changes you make take effect January 1, 2027.

During that window you can switch from Original Medicare to a Medicare Advantage plan, switch back, change Advantage plans, join or drop a Part D drug plan, or change drug plans.

There is a second, smaller window. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs January 1 to March 31, and it lets you switch to a different Advantage plan or go back to Original Medicare. It does not let someone on Original Medicare switch into Advantage.

If you do nothing by December 7, you stay in your current plan.

What this review is genuinely worth doing for

Three things change every year, and all three can cost you real money.

Your drug plan’s formulary. The list of covered drugs, and what tier each one sits on, changes annually. A medication that cost very little this year can move tiers and cost a great deal next year. This is the single most common reason a plan that fit last year does not fit now.

The provider network. Medicare Advantage plans work through networks. Doctors and hospitals leave networks. If your cardiologist is out of network in January and nobody told you, you find out at the worst moment.

The plan’s own terms. Premiums, deductibles, copays and extra benefits all move. The Annual Notice of Change your plan mailed you in September is the document that spells out exactly what is different. Most people throw it away. It is the one piece of mail in the stack worth reading.

Now the part families get wrong

Here is what I want you to realize. No Medicare plan you can choose during Open Enrollment covers long-term custodial care. Not Original Medicare. Not any Medicare Advantage plan, however good the brochure looks.

Custodial care is the help a person needs with daily living: bathing, dressing, eating, moving from a bed to a chair, managing medication. It is the kind of care most people actually end up needing, and it is the kind of care that costs the most, because it goes on for years.

Medicare pays for skilled care, and only for a limited time. After a qualifying inpatient hospital stay, Medicare Part A can cover a stay in a skilled nursing facility for up to 100 days. Days 1 through 20 are covered in full. From day 21 through day 100 there is a daily coinsurance amount, and after day 100 Medicare pays nothing toward that stay.

One hundred days is the ceiling, and it is a ceiling very few people reach, because coverage stops as soon as you no longer need daily skilled care. Needing help is not the same as needing skilled care. Families are often shocked when coverage ends at day 32 while their mother is plainly still unable to go home.

What that leaves you facing in Georgia

In Georgia a semi-private room in a nursing home runs in the neighborhood of $8,800 a month, and a private room closer to $9,400. In metro Atlanta those figures run higher still. Assisted living averages around $5,000 a month.

When Medicare stops, there are four ways that bill gets paid. You pay privately. A long-term care insurance policy pays, if one exists. Veterans benefits help, if the family qualifies. Or Medicaid pays, which has its own eligibility rules around income and assets, and a five-year lookback at transfers.

That is the planning conversation, and no Open Enrollment decision touches it.

What I would do this month

Read the Annual Notice of Change. Compare your prescriptions against next year’s formulary. If you take a drug that moved tiers, price the alternatives before December 7.

Check your doctors against the network. Call the office and ask directly, rather than trusting a plan directory, which is often out of date.

Then ask the separate question. If you or your spouse needed daily help for two years, who pays for it, and out of which account? If you do not have an answer, that is not a Medicare problem. It is a planning problem, and it is the one with a five-year clock attached.

Three things to carry with you

The December 7 deadline is real, and reviewing your plan is worth the afternoon. Drug formularies and networks genuinely change.

No plan on that menu pays for custodial care. If someone tells you otherwise, ask them to show you where the policy says so.

The long-term care question has its own timeline, and it is longer than you think. Medicaid looks back five years at transfers. Planning done calmly, years ahead, has options that planning done during a hospital discharge simply does not.

If you want to understand where your family actually stands, we offer a complimentary 15-minute Strategy Session with one of our non-attorney team members. Fifteen minutes is usually enough to tell you whether you have a gap and how urgent it is.

This Is Educational, Not Legal Advice

This is being presented for educational purposes only and nothing here should be treated as legal advice. What applies to you is very fact specific to your circumstances. I am licensed in Georgia and Michigan only, and this area of law changes frequently. If you are outside Georgia, take the foundation here and go find a wealth protection attorney in your jurisdiction.

Your Next Step

Reviewing your Medicare plan is worth the afternoon, but it is a different question from how your family would pay for long-term care. If you do not have an answer to the second one, that is worth a conversation. We offer a complimentary 15 minute Strategy Session with one of our non-attorney team members. Call 404-549-5001 or schedule online at elderlawgeorgia.com/contact. Fifteen minutes is usually enough to tell you whether there is something worth doing and how quickly it needs to happen.

   

Looking to find an experienced estate lawyer in the Georgia area who is skilled in asset protection and estate plan preparation? Shannon Pawley is an attorney in Georgia with expertise in estate planning and asset protection. Shannon can provide assistance with creating an estate plan to include making a will and how to establish a trust properly. If you have questions about asset protection or questions about making an estate plan, reach out to Shannon and she will be glad to help answer all the estate planning questions you might have!