When Should You Review or Change Medicare Plans?

With so much information out there, it’s hard to know when you should review or change Medicare plans. You may wonder if it’s worth making a switch to a new plan or adding additional coverage to fill the gaps. No matter what your current situation is, it’s important to review your existing Medicare coverage before the next open enrollment period sneaks up on you.

Most older adults know when to sign up for Medicare. Your 65th birthday gets marked on the mental calendar. Advertisements for the different Medicare plans begin arriving a year or two before that date. You evaluate your options and select a plan.

But what if you already have a Medicare plan in place? When is the best time to review and/or change your current plan? The short answer is that you can review your Medicare coverage at any time, but there’s a specific window of opportunity to make changes.

Like most employer-sponsored healthcare plans, Medicare has an annual enrollment period where you may update, change or cancel your coverage. The Medicare Annual Enrollment Period for parts A, B and C runs from October 15th through December 7th each year. Miss that window and you’ll have to wait until the next year’s enrollment period comes around — unless you have a qualifying life event such as loss of current insurance coverage. With enrollment opening in early October, you should be reviewing your Medicare plan by late summer.

Medicare supplemental plans have their own unique enrollment period — check with your insurer for details.

Medicare Plans: A Quick Overview

Medicare Part A (hospital insurance) and Part B (medical insurance) are commonly known as “Original Medicare” and are administered by the federal government. Medicare Advantage, also called Medicare Part C, is an alternate option offered by private insurers.

There are also supplemental coverage plans (Medigap) and prescription drug coverage plans offered by private insurance companies. Supplemental plans help pay for medical costs that Original Medicare doesn’t fully cover. Prescription drug coverage is not offered as part of Original Medicare and is provided by private insurers as Medicare Part D. These additional plans may be added to your Original Medicare coverage.

Note that prescription drug coverage is required if you have Original Medicare. You would potentially incur a premium penalty if you do not have a prescription plan.

Changing Your Plan During Open Enrollment

From October 15th through December 7th, you can add, drop or change any part of your Medicare plans. You may switch from Original Medicare to Medicare Advantage during the enrollment period without notifying your Medicare provider. However, if you choose to switch from Medicare Advantage to Original Medicare during open enrollment, you’ll need to notify the insurance company that provides your current Medicare Part C coverage.

Ask yourself these three questions when reviewing your Medicare plan:

1. Do I have the coverage I need?

  • If you’re already enrolled in a Medicare plan, you should receive your Plan Annual Notice of Change by mail in the fall. This required notice lets you know about any upcoming changes in cost, coverage or service area for the following year. Read this notice to see if the changes will affect your current coverage.
  • As a reminder, Medicare Part D provides prescription drug coverage to complement Medicare Part A and Part B. If you have Medicare Advantage, your plan may include prescription drug coverage. Check your existing prescription plan to ensure that any regular medications you take will still be available and to see if their price tier has changed.

2. Can I still use my favorite doctors, hospitals and pharmacies?

  • If you have Original Medicare, you can use any doctor or hospital in the U.S. that accepts Medicare.
  • Because Medicare Advantage plans are offered through private insurers, you will have an in-network list of providers. Check with your insurance company to ensure that your doctors and hospitals are still in their network. If not, you’ll need to pay out-of-network charges, find a new physician/facility or select a different Medicare plan.
  • Prescription drug plans also typically have a network of pharmacies and providers they work with. Review your Medicare Part D coverage (or Medicare Advantage drug coverage) to ensure your preferred pharmacy is still on the list.

3. Do my plan premiums and other costs still work for my current financial situation?

  • First look at your coverage costs for the current year. Were you able to easily cover the cost of your plan plus any out-of-pocket expenses that may have come up?
  • Next, see if there are cost increases in your current plan. If you’re already struggling to keep up with payments or you’re not getting the coverage you need, start weighing other options before open enrollment happens.
  • Estimate your medical needs over the coming year. This includes any regular medical care, prescriptions, planned surgeries or hospital visits, home care and other necessities. Look at what might be covered by your current plan and see if there are any coverage gaps you need to fill.
  • Examine your Medicare health plans and any prescription drug coverage you have. Are your copays and deductibles reasonable for you to afford? If not, it may be time to look for lower-cost alternatives.

If you’re not satisfied with your current Medicare coverage, there’s no need to stick with it. From Original Medicare to Medicare Advantage, prescription drug plans and Medigap, there are plenty of options to get the insurance coverage and care you need.

Contact a Senior Market Insurance advisor today with your Medicare questions or set up a complimentary appointment to discuss your options. We’re dedicated to taking the mystery out of Medicare and making it a smoother experience for you and your loved ones!

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The material presented here is for educational purposes only, and is not intended to be used as financial, investment, or legal advice.