Making your annual Medicare plan review count

As a Medicare beneficiary, you have a unique opportunity each fall: the Annual Enrollment Period (AEP). This is when you can make changes to your Medicare Advantage (Part C) plan and prescription drug (Part D) plan for the coming year. While it might seem easier to let your current plan roll over, taking a proactive approach during this time can make a significant difference in your healthcare and finances.

Why Annual Review Matters

Medicare plans are not static. Insurance companies often adjust their offerings, and this includes changes to premiums, deductibles, copayments, and formularies (the list of covered drugs). A plan that was perfect for you last year might no longer be the best fit due to these changes, or because your own health needs have evolved. For instance, a new diagnosis might mean you need different specialists or medications. Failing to review your options could leave you paying more for prescriptions, encountering unexpected costs for services, or even losing access to preferred doctors.

What to Look For

When reviewing your current plan and comparing it with others, here are key areas to focus on:

• Drug Coverage (Formulary): This is often the biggest cost driver for many beneficiaries. Check if your current medications are still covered, and if so, at what tier and cost. Are there new restrictions or prior authorization requirements? If you've started new medications, ensure they are covered by any plan you consider.
• Provider Network: If you have a Medicare Advantage plan, confirm your doctors, specialists, and hospitals are still in-network. Provider networks can change annually, and going out-of-network can lead to higher costs.
• Premiums, Deductibles, and Copayments: Compare the costs associated with each plan. A lower premium might come with higher deductibles or copays, and vice-versa. Consider your anticipated healthcare usage to find the right balance.
• Extra Benefits (Medicare Advantage): Medicare Advantage plans often include additional benefits like dental, vision, hearing, gym memberships, or transportation. Evaluate if these benefits are useful to you and compare them across plans.

How to Review Your Options

Medicare.gov is your primary, unbiased resource for comparing plans. It allows you to enter your current medications and dosage to get personalized cost estimates for Part D plans. For Medicare Advantage plans, you can check if your doctors are in-network. You'll also receive an "Annual Notice of Change" (ANOC) from your current plan each September. This document details all the changes for the upcoming year. Read it carefully.

If navigating these options feels overwhelming, remember that help is available. State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling to Medicare beneficiaries. These counselors can help you understand your options and compare plans. You can find your local SHIP through Medicare.gov or by calling 1-800-MEDICARE.

Making the Decision

Once you've done your research, you can make an informed decision about whether to stay with your current plan or switch to a new one. The Annual Enrollment Period typically runs from October 15 to December 7 each year. Any changes you make during this time will become effective on January 1 of the following year. Taking the time to evaluate your options can help you save money, maintain access to your preferred providers, and ensure your healthcare needs are met in the year ahead.