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One of the biggest misconceptions I hear about Medicare is, “I like my plan, so I don’t need to review anything during the Annual Enrollment Period. I'm just going to keep it.”
And you absolutely can.
You don't have to change your Medicare Advantage or Part D plan every year. Sometimes after reviewing everything, the best decision is to leave your coverage exactly where it is.
But there is an important difference between keeping your plan and knowing your plan is still a good fit.
Your current plan can change from one year to the next. Your healthcare needs can change. And new plans or benefits may become available that weren't an option when you originally chose your coverage.
Here are five things worth checking each year.
1. Your Copays and Other Medical Costs Can Change
Maybe you currently pay $0 to see your primary care doctor, $35 to see a specialist or a certain amount for an MRI or hospital stay.
Those amounts can change for the following year.
Medicare Advantage plans can change premiums, deductibles, copays, coinsurance and maximum out-of-pocket amounts. One small increase may not make much difference, but several changes can add up—especially if you use your healthcare frequently.
This is also why I don't like looking at a plan based only on its monthly premium. What matters is how the plan works for the healthcare you actually use.
2. Your Prescription Costs Can Change
This is an area where I see some of the biggest surprises.
Your medication may still be covered next year, but that doesn't necessarily mean you'll pay the same amount for it. Plans can make changes to their formularies, which are the lists of medications they cover, as well as the cost-sharing tiers medications are placed in.
Your pharmacy can make a difference too. The same prescription may cost less at one pharmacy than another depending on your plan.
That's why I ask my clients to keep their medications and preferred pharmacy updated before we review coverage. It allows me to check how those prescriptions will be covered for the coming year rather than simply looking at whether the overall plan changed.
3. Your Doctors and Hospitals Can Change
If you have a Medicare Advantage plan, your provider network matters.
A doctor or hospital that participates with your plan today may not necessarily participate with it forever. Networks can change, and providers can also change which plans they accept.
But sometimes it's not your plan that changed—it's you.
Maybe you started seeing a new cardiologist, orthopedic doctor or other specialist this year. That's why keeping your provider list updated is just as important as keeping your medications current.
If there is a doctor or hospital that is especially important to you, that's something we want to know when reviewing your coverage.
4. Benefits Can Change — And New Ones May Become Available
Dental, vision, hearing, fitness, over-the-counter allowances and other additional benefits can change from year to year. The amount of a benefit may change, the way you use it may change, or it may disappear altogether.
But annual changes aren't always bad.
New plans and benefits may also become available that weren't offered to you last year.
Your current plan might add something useful, or another plan available in your area may offer something that wasn't previously an option.
This is one reason simply reading the changes to your current plan doesn't tell the whole story. During an annual review, I'm not only looking at what changed with the plan you already have. I'm also looking at what else will be available for the coming year.
That doesn't mean a new benefit automatically makes another plan better. Your doctors, prescriptions and medical coverage still come first.
5. Your Plan Can Change, But So Can You
This one is easy to overlook.
Even if your plan changes very little, your healthcare may have changed quite a bit.
Maybe you started a new medication, added a specialist, received a new diagnosis or started using your healthcare more frequently.
An annual review isn't only about asking, “What changed with my plan?”
It's also about asking, “What changed for me?”
What Happens Next?
If you have a Medicare Advantage or Part D plan, you'll receive an Annual Notice of Change (ANOC) each fall explaining what will change with your plan on January 1.
If you're one of my clients, don't worry about trying to interpret everything on your own. I have access to the ANOCs for the plans my clients have and will review the changes with you. If yours accidentally ends up in the recycling bin, that's okay too. You can call me rather than calling the insurance company just to find out what changed.
The most helpful thing you can do for me is make sure I have your current doctors and medications before we review your coverage. That gives me the information I need to look at how your current plan will work for you next year and whether there is anything else we should consider.
The Medicare Annual Enrollment Period runs from October 15 through December 7, but that doesn't mean you need to change plans every year.
Sometimes we'll find something that works better. Sometimes there will be a new option worth considering. And sometimes we'll review everything and find that your current plan still works really well for you.
I'm completely happy with any of those outcomes.
What matters is that we looked, so there aren't unnecessary surprises waiting for you in January.
