In the southwestern Amazon, the tectonic Lakes Rogaguado and Ginebra reveal a landscape shaped by generations of human innovation. Beneath the open grasslands and shallow waters lie the remains of extensive earthworks, raised agricultural fields, and interconnected canals that reflect a long history of people adapting to a dynamic environment.

These lakes sit within the Municipal Protected Area of Grandes Lagos Tectónicos de Exaltación and form part of the Río Yata Ramsar wetland complex, which is recognized by UNESCO for both its ecological and cultural value. Set in the Llanos de Moxos, a vast network of savannas, gallery forests, and floodplains that make up the largest wetland system in the Amazon basin, this area has inspired curiosity for centuries. Ethnohistorical accounts even linked it to the legendary ‘Land of Paititi.’ Only recently has its deep human past begun to come into clearer view.

Mapping a Long History of Settlement

Using a combination of surveys, excavations, and LiDAR imaging, the research team documented several archaeological sites: Paquío, Coquinal, Isla del Tesoro, and Jasschaja. Each site represents a different stage in the long sequence of habitation across this region.

Radiocarbon dates reveal repeated occupations from roughly 600 to 1400 CE. Findings at Paquío show an early settlement beginning around 600 CE, followed by a more intensive occupation between 1000 and 1200 CE. This later phase included shell middens, dense ceramic refuse, and a sophisticated system of canals and raised fields connected to maize-based farming. Jasschaja, which dates from 1300 to 1400 CE, reflects broader landscape alterations and greater botanical diversity, suggesting intensified forest and crop management during its occupation.

Innovations in Water Management and Agriculture

The terrain of the Llanos de Moxos is filled with geometric forms that reveal themselves on closer inspection. Circular and rectangular ditches, drainage channels, raised planting platforms, and clusters of mounds create a complex network designed for water control and cultivation. These structures were built to regulate seasonal flooding, guide water flow, and create stable areas for living and farming within a wetland that changes dramatically throughout the year.

Their many shapes, ranging from geometric enclosures to long elevated fields, indicate that there was no single standardized design. Instead, they represent centuries of experimentation as communities responded to shifting ecological and social conditions. Together, these features highlight the cultural diversity and long-term resilience of the people who developed them.

Excavations at Paquío and Jasschaja also revealed details about a varied pre-Hispanic diet that relied on wetland resources. Fish such as wolf fish, peacock bass, and South American lungfish were especially common, accompanied by reptiles including caimans and turtles, and mammals such as capybaras, pacas, and armadillos. Plant remains show the use of maize, legumes, and multiple palm species — moriche palm, corozo palm, cumare palm, totai palm, palmita, and peach palm. Together, these remains point to a balanced subsistence strategy that combined fishing, hunting, gathering, and farming.

Biocultural Knowledge and Indigenous Leadership

The Cayubaba and Movima communities continue to live in these landscapes, where rich biodiversity is deeply connected to cultural heritage. Their long-standing presence and environmental knowledge help maintain a unique form of biocultural heritage in which ecological and cultural diversity have developed side by side over many generations.

During the post-Covid-19 field seasons, collaboration with local communities was rooted in open communication and mutual respect. Representatives of the Cayubaba Indigenous Council, which includes 21 Cayubaba and Movima communities, assisted researchers in identifying areas for study, providing access to culturally important places, and specifying sites that should not be disturbed. While interactions were limited for health reasons, this partnership ensured that the research reflected community priorities and contributed to a fuller understanding of the living heritage of the region.

Through the GTLM, Indigenous leaders and scientists are working together to link archaeological and ecological research with conservation initiatives. These efforts emphasize that the Llanos de Moxos is not only a center of biodiversity but also a landscape shaped through long human histories, and they support continued management of the Yata River Ramsar site and the protected areas connected to it.

Lessons From the Past for a Changing Amazon

As deforestation, expanding agriculture, and climate change put increasing pressure on the Amazon, the landscapes around Lakes Rogaguado and Ginebra highlight the importance of sustainable land-use traditions. Archaeological evidence shows that past communities developed flexible ways of living that combined farming, fishing, and forest management. Rather than seeking to control or overexploit the environment, they adapted to its seasonal cycles and used periodic flooding as an opportunity.

Although raised-field agriculture eventually ended — likely because of population decline and social upheaval after European colonization — this does not diminish the effectiveness of these systems. For centuries, communities maintained productive landscapes by working with the region’s natural rhythms. Their practices challenge modern assumptions about what counts as “development” and remind us that resilience often emerges from diversity: of species, of knowledge, and of cultural traditions.

Protecting this biocultural heritage is now a global responsibility. The wetlands of the Llanos de Moxos continue to store carbon, moderate water systems, and support a wide range of species. Conservation efforts must also respect the people who have cared for these landscapes for generations. In this way, archaeology becomes more than a study of the past; it becomes a means of reconnecting ancient knowledge with today’s urgent debates about sustainability and environmental justice.

The Llanos de Moxos demonstrate that the Amazon has always been a place where people and nature have shaped one another. Its monumental earthworks, forest islands, and living cultural traditions suggest that part of our shared future may depend on listening more closely to these landscapes that remember.

Rapa Nui is widely recognized for its hundreds of stone statues (moai), crafted by Polynesian settlers beginning in the 13th century. Archaeological work has repeatedly shown that the island was home to many small family groups rather than a unified political system. This background has prompted researchers to explore whether the carving of moai followed the same decentralized structure.

High-Resolution 3D Modeling Reveals 30 Quarry Work Zones

For this study, scientists gathered more than 11,000 photographs of Rano Raraku, the primary moai quarry. These images were merged into a detailed 3D reconstruction that captured hundreds of moai preserved in different stages of production. After analyzing the model, the team identified 30 distinct quarrying areas, each showing unique carving approaches. Additional clues indicate that completed or partially shaped moai were moved away from the quarry along several different paths. Taken together, these patterns suggest that statue creation reflected the island’s broader social organization, with carving efforts carried out independently rather than through centralized oversight.

New Evidence Challenges Long-Held Assumptions

The findings call into question the idea that projects of this scale require strict hierarchy or a single coordinating authority. Similarities between moai appear to come from the sharing of cultural knowledge instead of coordinated, joint labor. The new quarry model also provides a valuable dataset that can support future investigations and guide cultural management at this UNESCO World Heritage site. The same methods used here can also be applied to study other archaeological locations.

The authors explain: “Much of the so-called “mystery” of Rapa Nui (Easter Island) comes from the lack of openly available, detailed evidence that would allow researchers to evaluate hypotheses and construct explanations. Here, we present the first high-resolution 3D model of the moai quarry at Rano Raraku, the central quarry for nearly 1,000 statues, offering new insights into the organizational and manufacturing processes of these giant megalithic figures.”

Fieldwork for this research was supported by a National Science Foundation grant (Award #2218602). The funders had no involvement in study design, data collection and analysis, decisions related to publication, or manuscript preparation.

“That’s the major conclusion of this paper: There are targeted projections for targeted impact,” said senior author Mriganka Sur, Paul and Lilah Newton Professor in The Picower Institute for Learning and Memory and MIT’s Department of Brain and Cognitive Sciences.

Investigating Customized Prefrontal Signals

Scientists have long proposed, including Sur’s colleague Earl K. Miller at MIT, that the prefrontal cortex can guide the activity of more posterior areas of the brain. While anatomical evidence has supported this idea, the goal of the new study was to determine whether the prefrontal cortex sends one broad type of signal or instead crafts distinct messages for different target regions. Lead author and Sur Lab postdoctoral researcher Sofie Ährlund-Richter also sought to identify which specific neurons receive these signals and how the communication influences downstream processing.

Different Prefrontal Regions Serve Different Roles

The team identified a number of new insights. Two areas in the prefrontal cortex, the orbitofrontal cortex (ORB) and the anterior cingulate area (ACA), were found to relay information about both arousal and movement to two other regions: the primary visual cortex (VISp) and the primary motor cortex (MOp). These messages appear to have unique effects. For example, higher arousal increased ACA’s tendency to help VISp sharpen its visual representations. ORB, however, became influential only when arousal was very high, and its involvement appeared to decrease the clarity of visual encoding. According to Ährlund-Richter, ACA may help the brain focus on potentially meaningful visual details as arousal rises, while ORB may act to reduce attention to distracting or overly strong stimuli.

“These two PFC subregions are kind of balancing each other,” Ährlund-Richter said. “While one will enhance stimuli that might be more uncertain or more difficult to detect, the other one kind of dampens strong stimuli that might be irrelevant.”

Mapping and Monitoring Brain Circuits

To better understand the involved pathways, Ährlund-Richter performed detailed anatomical tracing of the connections ACA and ORB form with VISp and MOp. In additional experiments, mice ran freely on a wheel while viewing structured images or naturalistic movies at different contrast levels. At certain moments, small air puffs increased the animals’ arousal level. Throughout these tasks, researchers recorded the activity of neurons in ACA, ORB, VISp and MOp, with particular attention to the signals traveling along the axons linking prefrontal and posterior areas.

The tracing work showed that ACA and ORB each communicate with a variety of cell types in their target regions rather than a single cell class. They also connect in distinct spatial patterns. In VISp, ACA primarily targeted layer 6, while ORB communicated mainly with layer 5.

How Arousal and Movement Shift Visual Processing

When the team examined the transmitted information and neural activity, several consistent patterns emerged. ACA neurons conveyed more detailed visual information than ORB neurons and were more responsive to changes in contrast. ACA activity also tracked closely with arousal level, while ORB responded only when arousal reached a high threshold. When signaling to MOp, both regions conveyed information about running speed. When signaling to VISp, however, they only indicated whether the mouse was moving or still. The two prefrontal regions also carried information about arousal and a small amount of visual detail to MOp.

To see how this communication affects visual processing, the researchers temporarily blocked the pathways leading from ACA and ORB to VISp. This allowed them to measure how VISp neurons responded without these inputs. They found that ACA and ORB exerted specific and opposing effects on visual encoding depending on the mouse’s movement and level of arousal.

A Specialized Model of Prefrontal Feedback

“Our data support a model of PFC feedback that is specialized at both the level of PFC subregions and their targets, enabling each region to selectively shape target-specific cortical activity rather than modulating it globally,” the authors wrote in Neuron.

In addition to Sur and Ährlund-Richter, the research team included Yuma Osako, Kyle R. Jenks, Emma Odom, Haoyang Huang, and Don B. Arnold.

The work was supported by a Wenner-Gren foundations Postdoctoral Fellowship, the National Institutes of Health, and the Freedom Together Foundation.

Recent findings show that long-term memories form through a sequence of molecular timing mechanisms that activate across different parts of the brain. Using a virtual reality behavioral system in mice, scientists identified regulatory factors that help move memories into increasingly stable states or allow them to fade entirely.

A study published in Nature highlights how several brain regions work together to reorganize memories over time, with checkpoints that help assess how significant each memory is and how durable it should be.

“This is a key revelation because it explains how we adjust the durability of memories,” says Priya Rajasethupathy, head of the Skoler Horbach Family Laboratory of Neural Dynamics and Cognition. “What we choose to remember is a continuously evolving process rather than a one-time flipping of a switch.”

Moving Beyond the Classic Memory Model

For many years, researchers focused on two primary memory centers: the hippocampus, which supports short-term memory, and the cortex, which was believed to store long-term memories. These long-term memories were thought to sit behind biological on-and-off switches.

“Existing models of memory in the brain involved transistor-like memory molecules that act as on/off switches,” says Rajasethupathy.

This older view suggested that once a memory was marked for long-term storage, it would persist indefinitely. Although this framework provided useful insights, it did not explain why some long-term memories last for weeks while others remain vivid for decades.

A Key Pathway Linking Short and Long-Term Memory

In 2023, Rajasethupathy and colleagues described a brain circuit that connects short-term and long-term memory systems. A central element of this pathway is the thalamus, which helps determine which memories should be kept and directs them to the cortex for long-term stabilization.

These discoveries opened the door to deeper questions: What happens to memories once they leave the hippocampus, and what molecular processes decide whether a memory becomes lasting or disappears?

Virtual Reality Experiments Reveal Memory Persistence

To investigate these mechanisms, the team built a virtual reality setup that allowed mice to form specific memories. “Andrea Terceros, a postdoc in my lab, created an elegant behavioral model allowed us to break open this problem in a new way,” Rajasethupathy says. “By varying how often certain experiences were repeated, we were able to get the mice to remember some things better than others, and then look into the brain to see what mechanisms were correlated with memory persistence.”

Correlation alone could not answer the key questions, so co-lead Celine Chen created a CRISPR-based screening platform to alter gene activity in the thalamus and cortex. This approach showed that removing certain molecules changed how long memories lasted, and each molecule operated on its own timescale.

Timed Programs Guide Memory Stability

The results indicate that long-term memory relies not on a single on/off switch, but on a sequence of gene-regulating programs that unfold like molecular timers across the brain.

Early timers activate quickly but fade fast, allowing memories to disappear. Later timers turn on more gradually, giving important experiences the structural support needed to persist. In this study, repetition served as a stand-in for importance, letting researchers compare frequently repeated contexts with those seen only occasionally.

The team identified three transcriptional regulators essential for maintaining memories: Camta1 and Tcf4 in the thalamus, and Ash1l in the anterior cingulate cortex. These molecules are not required to form the initial memory but are crucial for preserving it. Disrupting Camta1 and Tcf4 weakened connections between the thalamus and cortex and caused memory loss.

According to the model, memory formation begins in the hippocampus. Camta1 and its downstream targets help keep that early memory intact. Over time, Tcf4 and its targets activate to strengthen cell adhesion and structural support. Finally, Ash1l promotes chromatin remodeling programs that reinforce memory stability.

“Unless you promote memories onto these timers, we believe you’re primed to forget it quickly,” Rajasethupathy says.

Shared Memory Mechanisms Across Biology

Ash1l is part of a protein family known as histone methyltransferases, which help maintain memory-like functions in other systems. “In the immune system, these molecules help the body remember past infections; during development, those same molecules help cells remember that they’ve become a neuron or muscle and maintain that identity long-term,” Rajasethupathy says. “The brain may be repurposing these ubiquitous forms of cellular memory to support cognitive memories.”

These discoveries may eventually help researchers address memory-related diseases. Rajasethupathy suggests that, by understanding the gene programs that preserve memory, scientists may be able to redirect memory pathways around damaged brain regions in conditions such as Alzheimer’s. “If we know the second and third areas that are important for memory consolidation, and we have neurons dying in the first area, perhaps we can bypass the damaged region and let healthy parts of the brain take over,” she says.

Next Steps: Decoding the Memory Timer System

Rajasethupathy’s team now aims to uncover how these molecular timers are activated and what determines their duration. This includes investigating how the brain evaluates the importance of a memory and decides how long it should last. Their work continues to point toward the thalamus as a central hub in this decision-making process.

“We’re interested in understanding the life of a memory beyond its initial formation in the hippocampus,” Rajasethupathy says. “We think the thalamus, and its parallel streams of communication with cortex, are central in this process.”

Thyroid hormones supplied by the mother play an important role in fetal neurodevelopment. When these hormones become disrupted during pregnancy, previous work has linked the imbalance to atypical brain development and a higher likelihood of autism spectrum disorder (ASD). Autism is a multifaceted condition that shapes how an individual communicates, interacts socially and interprets the world.

Untreated Multi-Trimester Imbalance Carries Higher Risk

“We found that while adequately treated chronic thyroid dysfunction was not associated with increased autism risk in offspring, ongoing imbalance across multiple trimesters was,” said Idan Menashe, Ph.D., of the Ben-Gurion University of the Negev in Beer Sheva, Israel. “These findings underscore the need for routine monitoring and timely adjustment of therapy to maintain normal thyroid hormone levels throughout pregnancy.”

Large Birth Cohort Shows Clear Pattern

The research tracked more than 51,000 births and reported that mothers with persistent thyroid hormone imbalance across pregnancy had an increased likelihood of having children with autism.

The authors also documented a dose-response pattern, meaning the risk rose as the number of affected trimesters increased.

Research Team and Publication Information

Other contributors to the study include Leena Elbedour of the Ben-Gurion University of the Negev; May Weinberg of the Meir Medical Center in Kfar Saba, Israel, and Tel Aviv University in Tel Aviv, Israel; Gal Meiri of the Soroka University Medical Center in Beer-Sheva, Israel, and the Ben-Gurion University of the Negev; and Analya Michaelovski of the Soroka University Medical Center.

No funding was received for this research.

“Maternal Thyroid Hormone Imbalance and Risk of Autism Spectrum Disorder,” was published online, ahead of print.

Dark matter has remained one of astronomy’s biggest unknowns since it was first suggested. Until now, scientists have only been able to study it indirectly by observing how it affects ordinary matter, such as the way it produces enough gravity to hold galaxies together. Direct detection has not been possible because dark matter particles do not interact with electromagnetic force — meaning they do not absorb, reflect or emit light.

The WIMP Hypothesis and Predicted Gamma Rays

Many researchers believe that dark matter is made of weakly interacting massive particles, or WIMPs. These particles are thought to be heavier than protons and interact so weakly with normal matter that they are extremely difficult to detect. However, theory suggests that when two WIMPs collide, they annihilate each other and release energetic particles, including gamma ray photons.

Scientists have spent years examining regions where dark matter should be concentrated, especially the center of the Milky Way, searching for these specific gamma rays. Using new data from the Fermi Gamma-ray Space Telescope, Professor Tomonori Totani of the University of Tokyo now believes he has identified the predicted gamma ray signal associated with dark matter particle annihilation.

Totani’s findings appear in the Journal of Cosmology and Astroparticle Physics.

A 20-GeV Gamma Ray Halo Near the Milky Way Center

“We detected gamma rays with a photon energy of 20 gigaelectronvolts (or 20 billion electronvolts, an extremely large amount of energy) extending in a halolike structure toward the center of the Milky Way galaxy. The gamma-ray emission component closely matches the shape expected from the dark matter halo,” said Totani.

The measured gamma ray energy spectrum, which describes how the intensity of the emission varies, closely matches model predictions for the annihilation of hypothetical WIMPs with masses roughly 500 times that of a proton. The estimated frequency of these annihilation events based on the observed gamma ray intensity also fits within expected theoretical ranges.

Evaluating the Possibility of a Major Breakthrough

Totani explains that the gamma ray pattern cannot be easily matched to other known sources or more common astrophysical processes. Because of this, he views the data as a strong candidate for long-sought gamma ray emission from dark matter.

“If this is correct, to the extent of my knowledge, it would mark the first time humanity has ‘seen’ dark matter. And it turns out that dark matter is a new particle not included in the current standard model of particle physics. This signifies a major development in astronomy and physics,” said Totani.

Next Steps and Independent Verification

Although Totani is confident in his analysis, he emphasizes that independent confirmation is essential. Other researchers will need to review the data to verify that the halolike radiation truly results from dark matter annihilation rather than another astrophysical source.

Further support could come from finding the same gamma ray signature in other regions rich in dark matter. Dwarf galaxies orbiting within the Milky Way halo are considered especially promising. “This may be achieved once more data is accumulated, and if so, it would provide even stronger evidence that the gamma rays originate from dark matter,” said Totani.

Funding: This work was supported by JSPS/MEXT KAKENHI Grant Number 18K03692.

They must make those decisions by December 7, for coverage beginning January 1, 2026, which makes this time, known as Medicare Open Enrollment, a very important time.

And yet, University of Michigan research has shown that many people covered by Medicare don’t take key steps during Open Enrollment that could save them money, headaches and worry.

Based on that research, here are five tips for everyone who has Medicare – and the family members and friends who can help them with their choices.

Use the tools

The official Medicare website has a lot of easy-to-understand and straightforward tools to help anyone understand their Medicare coverage options, and explore the options open to them or their loved ones.

But only 33% of people with Medicare used the Internet at all to explore their options, according to a recent U-M study.

That’s even though the choices can be dizzying: many people have dozens of options. Nearly all people have more than 10 Medicare Advantage plans to choose from, as well as multiple Part D prescription drug and Medigap supplemental plans to choose from if they opt for traditional Medicare.

The Medicare Plan Compare site is the place to start, and you can start on the Your Medicare Options page.

It’s available even during the government shutdown, because the plan-navigation tools on it were built before the shutdown began.

Using the Plan Compare site, you can see which Medicare Advantage and Part D prescription drug plans serve your area, what services or drugs they cover, what they charge for monthly premiums and for copays and other costs when you get health care or fill a prescription, and what the plan’s overall star rating is.

If you have a Medicare Advantage plan now, using the Plan Compare tool will also show you if your current plan will still be available next year.

Some plans are ending or combining with others.

You can also enter your prescription drug names and doses to see what they will cost you on different Part D plans, and whether pharmacies near you are in-network.

This includes the Part D drug coverage in many Medicare Advantage plans, as well as standalone Part D plans for people who choose traditional Medicare.

U-M researchers showed that using the prescription drug tool to compare estimated costs could save people a lot of money.

They did the study before the annual cap on Medicare prescription costs took effect in 2025, but still feel it’s important for everyone with Medicare drug coverage to use the tool.

If you need help navigating the Plan Finder site, or signing up for an account that will help you get the most use out of it, don’t be afraid to ask a friend, family member or neighbor. Or use the independent help described in Tip 2, below.

“Given changing clinical circumstances and the fact that insurance plan costs and benefits are often modified from year to year, it is very important that people with Medicare coverage use the available tools during Open Enrollment to identify a plan that best meets their medical needs and fits their financial situation,” said A. Mark Fendrick, M.D., director of U-M’s center for Value Based Insurance Design.

Get independent help

Half of people with Medicare get their coverage through Medicare Advantage plans run by insurance companies.

And of the other half, who choose traditional Medicare, nearly half get Part D prescription drug plans and “Medigap” add-on plans from private insurance companies.

Those insurance companies send out a lot of mail and email at this time of year, trying to persuade people to choose their plans.

They make phone calls, pay for advertising and even hold events where participants get a free meal in exchange for listening to the sales pitch for that plan.

They do all this because they make money on enrollees who are healthier and don’t use their insurance a lot.

Then there are insurance brokers and agents – people who do one-on-one consultations, but are paid for every person they sign up for a particular company’s plan.

While all of this can inform your decision, these aren’t independent sources of information. However, there is an independent source: your State Health Insurance Assistance Program, or SHIP.

Each state has one, with paid staff and trained volunteers who don’t have a financial stake in which plan you choose.

You can find your state’s SHIP program here.

“With the overwhelming number of plans and the vast amount of information available, it’s essential to remember that free help is available,” said Lianlian Lei, Ph.D., who has studied Medicare enrollment by older adults and is an assistant professor in the U-M Medical School’s Department of Psychiatry.

“Seeking independent, unbiased assistance is crucial to making the best choice,” she added.

Because SHIP programs don’t have the marketing dollars that insurance companies and brokers do, many people don’t know about them.

In fact, a recent U-M poll showed that 75% of older adults have never heard of SHIP, and another 21% have heard of it but haven’t used it.

Only 4% of older adults had used SHIP services, even though they’re available for free to anyone eligible for Medicare.

In Michigan, anyone can reach the state SHIP program by calling 1-800-803-7174 from 8 a.m. to 8 p.m., Monday through Friday.

You’ll speak with an agent who can schedule an appointment or provide a referral to a trained, certified counselor in their community.

Not only that, the staff at this help line, called MiOptions, can also help older adults and their caregivers find out what other assistance they might qualify for.

You may also find trained SHIP volunteers offering free in-person counseling sessions at your local public library or senior center; check the events listings to see if any are coming up and how to make an appointment.

Interested in learning how to offer this kind of independent help to others as a SHIP volunteer? Visit this page.

Look at the total package, not just the monthly premiums

When choosing any insurance, a lot of people focus on the monthly premium, and not on the total package of coverage.

This is true for Medicare too.

When you use the Medicare Plan Compare tool, you can see monthly premiums for different Medicare Advantage plans side-by-side.

But you can also see things like co-pays and other costs, which can vary a lot depending on how much health care a person actually uses.

The Plan Compare tool does not allow you to compare Medicare Advantage to traditional Medicare plus any add-on plans you choose.

So, you’ll want to note these costs for traditional Medicare, and then explore the Part D prescription drug plans and Medigap plans available in your area.

And remember, even if a Medicare Advantage plan says it has a $0 premium, that’s just for the coverage it provides beyond Part B.

Unless the plan includes a Part B premium reduction, which most don’t, you will still need to pay a monthly premium of at least $185, or more if you have a higher income.

Sometimes a plan with a higher monthly premium has lower out-of-pocket costs due at the time of care, or a lower cap on total out-of-pocket costs that you could owe each year.

The National Council on Aging has a great guide to all of these kinds of costs.

When choosing a Part D prescription drug plan or a Medigap plan to go with traditional Medicare coverage, it’s also important to compare options, based on the medications you take or whether you travel a lot or live in a second location during part of the year.

But surprisingly, U-M research shows it isn’t cost but access to care providers, and dissatisfaction with quality of care, that drive most people to switch Medicare Advantage plans.

Access to care is also the biggest driver for people leaving Medicare Advantage to switch to traditional Medicare, the study found.

That’s why it’s important to look at the star ratings that Medicare Advantage and Part D prescription plans have earned from past members’ opinions of them.

It’s also important to look at the networks of hospitals, doctors and other providers that each Medicare Advantage plan will allow you to go to, or the restrictions on specific drug classes that Part D plans might impose.

This kind of information is only available on each plan’s website.

The same research team has also looked at Medicare’s “revolving door” and the patterns of switching to and from the different forms of Medicare.

One item they note: Most states do not require insurers to ensure that people have the right to purchase Medigap plans regardless of their health status, except for an initial period after they enroll in Medicare for the first time.

This can result in Medicare Advantage “lock-in” for individuals with costly care needs, meaning they are unable to obtain Medigap coverage to help offset high out-of-pocket costs in traditional Medicare.

So, if you have significant health issues and have been in a Medicare Advantage plan, but you are thinking of switching to traditional Medicare, it’s important to understand if you’ll be able to get an affordable Medigap plan to cover costs that traditional Medicare doesn’t cover.

If you have a low income, see if you’re eligible for extra assistance

For older adults and people with disabilities who have limited incomes, there are new programs and supports available for 2026, on top of the ones already in place in 2025.

Some of them are automatic, but some require you to apply for them.

You can get help understanding all of the options open to you by contacting the SHIP program for your state (see above).

But here are some major ones to be aware of:

• Medicaid and Medicare together: Certain people are what’s called “dually eligible” because they are old or disabled enough to qualify for Medicare, and have incomes low enough or disabilities serious enough to qualify for Medicaid. Each state has its own rules for qualifying for Medicaid; visit this page to learn more and use this page to find your state’s Medicaid agency contact information.
  If you do qualify for both Medicare and Medicaid, the Medicaid program may help pay some of your Medicare costs. Your state’s Medicaid agency can tell you more. Also, if you have Medicaid coverage, with or without Medicare, it’s important to know that you have to re-qualify every year; U-M research shows that many people don’t know this.
• Medicare Savings Programs: There are four different programs available to people with limited resources and incomes. Visit this page to learn more; contact your state’s agency to learn how to enroll.
• Help with drug costs through the Extra Help program: This program for Part D drug programs gives people with limited incomes and assets coverage for their medications with no monthly premium, no deductibles and low costs for drugs they get at pharmacies. Some people get enrolled automatically, but others may apply.
• Help with drug costs through the Medicare Prescription Payment Program: This program, open to anyone who has Part D prescription drug coverage through Medicare, allows you to smooth out your prescription costs over the year, so you don’t get a “spike” that might not be affordable. Learn more here. It’s important to note that this program is one that you have to enroll in yourself, through your Part D drug plan provider, and you need to renew it every year; you do not get enrolled automatically.
• PACE program: The Program of All-inclusive Care for the Elderly, or PACE, aims to support home-based living for adults age 55 and older who are eligible for both Medicare and Medicaid and who need nursing-home level care. It covers the cost of services beyond what Medicare and Medicaid cover. Find out if it’s available in your area here.
• Special needs plans: These are special Medicare plans for people who are dually eligible for Medicare and Medicaid; people with certain major health conditions including cancer, heart failure, dementia, diabetes, disabling mental health conditions, stroke, and others; and people who need nursing-home-level care for any reason.

You can find out if there’s one serving your area, and whether you might qualify, using the Plan Compare tool or by contacting your state’s SHIP program.

Don’t assume you and your spouse or partner should have the same plan

If you are married or live with a partner, your instinct might be to enroll in the same plan as them for convenience.

But that’s not always the best choice.

Your health needs, and your spouse’s or partner’s needs, may be very different. One of you might be retired, the other working.

Or maybe you have different coverage related to your past employment or military service.

If one of you has dementia, for instance, there may be special plans and programs that could cover more services.

But U-M research showed that people with and without dementia make very similar Medicare Advantage choices, which may mean they aren’t examining all their options.

No matter what your health status, and your spouse or partner’s health status, it’s still important to make individual choices when it comes to Medicare Open Enrollment.

U-M research has shown, though, that many people with Medicare Advantage coverage are making changes to their coverage in sync with their spouse or partner.

The Medicare online tools don’t have a “couples” setting, so each person should go through the process by inputting their information.

You could seek SHIP counseling together, but you may have to make two appointments depending on the program in your area.

Bonus tip about Medicare enrollment

Even if you make a choice during Medicare Open Enrollment, you may not be stuck with that choice for all of 2026.

For instance, if you choose a Medicare Advantage plan, but then realize in early 2026 that it’s not right for you, you will have until March 31 to choose a different Medicare Advantage Plan or move to traditional Medicare.

And if you have a major change in your income, employment, address, or living situation during 2026, you may become eligible for a Special Enrollment Period that will allow you to change plans.

This article contains information based on research by, and expertise from, experts who are part of the U-M Institute for Healthcare Policy and Innovation, including Lianlian Lei, Ph.D., U-M Medical School Department of Psychiatry; Geoffrey Hoffman, Ph.D., U-M School of Nursing; Kristian Stensland, M.D., M.P.H., M.S., U-M Medical School Department of Urology; and A. Mark Fendrick, M.D., and Renuka Tipirneni, M.D., M.Sc., U-M Medical School Department of Internal Medicine, Division of General Medicine. Data on awareness of SHIP comes from the National Poll on Healthy Aging, based at IHPI.