Should You Change Your Medicare Plan? Here's What You Need to Know
Medicare plans can be confusing, especially when it comes to deciding whether to change your coverage. Many people wonder, "Can I change my Medicare plan at any time?" The short answer is no, but the good news is that there's a specific window of time when you can make changes to ensure your coverage fits your needs. Let's break down the essential details to help you navigate this process confidently.
What Is the Medicare Open Enrollment Period?
Open Enrollment Period
The Medicare Open Enrollment Period is your annual opportunity to review your coverage and make changes. It runs from October 15 to December 7 each year. During this time, anyone with Medicare can evaluate their current plan and compare it to others on the market. If your needs have changed, or if you find a better plan that fits your budget, this is the time to switch.
For example, if you enroll in a new Medicare or Part D plan during open enrollment, that coverage will begin on January 1 of the following year. So, a switch made in November 2024 will take effect on January 1, 2025.
Why Consider Changing Your Medicare Plan?
It's essential to re-evaluate your Medicare coverage every year. Insurance companies often make changes to plans, which could impact your premiums, deductibles, drug costs, and even which doctors or pharmacies are considered "in-network." This means that a plan that worked for you last year may not be the best fit for the upcoming year.
Here are a few reasons you might want to consider making a switch:
Lower out-of-pocket costs: If you find a Medicare Part D prescription drug plan that better meets your needs, you could save money.
Doctor network changes: If your doctor is no longer in-network, it might be worth switching plans to ensure your preferred healthcare providers remain covered.
More comprehensive coverage: During open enrollment, you may find a more comprehensive plan at a price similar to what you're already paying.
What Can You Do During Open Enrollment?
During the Medicare Open Enrollment Period, you have several options:
Join or switch between Medicare Advantage (Part C) plans.
Enroll in or change Medicare Part D prescription drug plans.
Switch from Original Medicare (Parts A and B) to a Medicare Advantage plan.
Move from a Medicare Advantage plan back to Original Medicare (but you need to carefully evaluate if you can obtain Medigap insurance).
Switch between different Medicare Advantage plans or Medicare Part D plans.
By reviewing your current plan and comparing it to others, you can ensure you're getting the right coverage for your health and budget.
Key Questions to Ask During Open Enrollment
As you navigate open enrollment, keep these questions in mind to ensure you're making the right choice for your healthcare needs:
Are my doctors still in-network?
Are my prescription drugs covered?
Will I still be able to use my preferred pharmacy?
Are my premiums, deductibles, and co-pays changing?
Do I still have coverage for essential services like vision, dental, and hearing?
Your plan should send you a "Plan Annual Notice of Change" (ANOC) in September. This document outlines any upcoming changes to your plan, including costs and coverage. Review it carefully to ensure your plan still meets your needs.
Medicare Advantage vs. Original Medicare: Should You Switch?
One of the big decisions during open enrollment is whether to stick with Original Medicare or switch to a Medicare Advantage plan.
Original Medicare (Parts A and B) covers hospital and medical services, but it doesn't cap out-of-pocket costs. For example, Medicare may cover 80% of a $25,000 surgery, but you're responsible for the remaining 20%. This can add up, especially if you need multiple surgeries or extensive care.
Medicare Advantage (Part C) plans typically include prescription drug coverage and cap your out-of-pocket expenses. Some also offer additional benefits like dental, vision, and hearing coverage. However, they often come with network restrictions—meaning you may need to use specific doctors, hospitals, and pharmacies.
Switching to a Medicare Advantage plan could be a smart move if you're looking for more predictable healthcare costs and added benefits, but it's important to weigh the potential trade-offs, such as limited provider networks. You should also understand the issues with obtain medigap (or Medicare Supplemental) coverage.
Do You Understand Medicare Part D: Prescription Drug Coverage?
Medicare Part D provides coverage for prescription drugs, and premiums vary depending on the policy and provider. It's crucial to enroll in a Part D plan when you're first eligible for Medicare, as failing to do so could result in a late enrollment penalty.
Even if you're already enrolled in Part D, it's wise to review your plan during open enrollment. Insurance companies often update their formulary (list of covered drugs) each year, and your out-of-pocket costs for medications may change. If you take multiple prescriptions, switching to a plan that covers your medications at a lower cost could save you hundreds of dollars annually.
Changes Coming in 2025: What You Need to Know
Thanks to the Inflation Reduction Act, a few key changes will take effect in 2025 that could significantly impact your Medicare coverage:
A new $2,000 cap on out-of-pocket prescription drug costs will be implemented for Medicare Part D.
You'll have the option to spread the cost of prescriptions throughout the year rather than making one large payment at the pharmacy.
Medicare drug price negotiations will help lower the cost of some of the most expensive brand-name drugs.
Insulin will be capped at $35 per month for covered prescriptions, helping millions of Americans better manage their healthcare expenses.
These changes are designed to make healthcare more affordable and accessible for Medicare beneficiaries. Be sure to evaluate whether your current plan will cover your prescription needs under these new rules.
How to Navigate the Process
Navigating the Medicare Open Enrollment Period doesn't have to be overwhelming. Here are some simple steps to follow:
Assess your current plan: Review the ANOC sent by your insurer to understand changes in costs, coverage, and network providers.
Compare plans: Use the Medicare Plan Finder tool at Medicare.gov to compare options. You can also consult your local State Health Insurance Assistance Program (SHIP) for personalized advice.
Decide whether to switch or stay: If your current plan still meets your needs, you don't have to do anything—your plan will automatically renew. If not, make a change during open enrollment.
Reevaluate in the new year: If you've switched to a Medicare Advantage plan, use the trial period (January 1 to March 31) to ensure it's the right fit. If it's not, you can switch back to Original Medicare during this time.
Need Help? You Have Options
If you're unsure about which plan is right for you, there are plenty of resources available. You can reach out to Medicare directly at 1-800-MEDICARE or visit Medicare.gov for plan comparisons. For unbiased, personalized advice, contact your local SHIP or speak with a trusted Medicare broker.
Bottom Line
Choosing the right Medicare plan is an important decision that can have a big impact on your healthcare costs and access to services. Use the Medicare Open Enrollment Period to assess your needs, compare plans, and make sure you're getting the best coverage for your situation.
Don’t wait—mark October 15 to December 7 on your calendar and take advantage of this opportunity to improve your Medicare coverage.
By taking the time to review your options, you can ensure that your Medicare plan works for you in the coming year, helping you stay healthy and save money.
Reference
Schwab. (n.d.). 4 Steps to Navigate Medicare Open Enrollment. Retrieved from https://www.schwab.com/learn/story/4-steps-to-navigate-medicare-open-enrollment
Centers for Medicare & Medicaid Services. (n.d.). Medicare Open Enrollment Partner Resources. Retrieved from https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources
Centers for Medicare & Medicaid Services. (n.d.). Inflation Reduction Act and Medicare. Retrieved from https://www.cms.gov/inflation-reduction-act-and-medicare
National Council on Aging. (n.d.). A Complete Guide to Medicare Open Enrollment. Retrieved from https://www.ncoa.org/article/a-complete-guide-to-medicare-open-enrollment/