When Should I Change My Medicare Plan?

Changing your health insurance coverage, particularly with Medicare, can seem overwhelming due to the variety of plan types available. These range from Original Medicare to Medicare Advantage and Medicare Supplement, each with distinct costs, benefits, and coverage levels. However, if you’re thinking of switching your Medicare plan, there are several key factors to consider before making a decision.

Health Care Coverage Needs

Each year, it’s important to assess whether your current plan continues to meet your healthcare needs, both for present and potential future conditions. If you’re enrolled in Medicare Part D or a Medicare Advantage (Part C) plan, be aware that your insurance company may alter the benefits and services they provide in your plan. 

The Annual Notice of Change (ANOC) letter, which usually arrives in your mailbox in September, details any changes to your plan. This document is crucial in assessing how such changes might affect your coverage and costs. It’s particularly important to review the following areas:

• Prescription Drug Tier Changes: These are called formulary changes, and drugs moving from lower tiers to higher tiers could increase the price you pay.
• Plan Benefits and Features: Medicare Advantage plans are popular for the added benefits they may include, such as dental, vision and/or hearing coverage. However, insurance providers will sometimes modify the benefits offered in certain plans. You’ll want to make sure your coverage for the year ahead includes the benefits that are important to you. (Benefits can also be added to a plan, which may be valuable to you as well.)

Plan Premiums & Costs

Just like other aspects of life, healthcare costs can fluctuate year-to-year. It’s important to note that Medicare plan costs — premiums, deductibles, and co-pays — have the potential to change annually. Ensuring that these increased costs align with your budget is a crucial step in determining whether you should explore other healthcare options.

One significant advantage of Medicare Advantage plans, despite possible changes, is their ability to cap out-of-pocket costs for the coverage year. This feature can provide a level of financial security and predictability.

Even if your current plan costs aren’t increasing, it’s always beneficial to investigate if more cost-effective options are available. Stay proactive in your healthcare decisions to ensure you’re receiving the best value for your needs.

Network Provider Changes

Keep in mind that Medicare Advantage plans can alter their provider and pharmacy networks. It’s important to check if your preferred doctors and pharmacies remain in your plan’s network. If they are no longer in-network and you still choose to visit them, be prepared for potential higher out-of-network costs.

Key Takeaway

Deciding to switch your Medicare plan is a personal decision, but the areas we mention above are important indicators if a change may be necessary. These include changes to your plan coverage and benefits, increases in plan premiums and costs, and any network provider changes that would cause your preferred providers to become out-of-network.