Key Takeaways

• Annual Medicare reviews can help you avoid unexpected costs and ensure your coverage aligns with your current healthcare needs.
• Medicare plans change every year, so staying updated can maximize your benefits and potentially save money.

Don’t Let Your Medicare Coverage Stay on Auto-Pilot

When was the last time you gave your Medicare plan a good, hard look? If it’s been a while—or never—it’s time to change that habit. Medicare plans are not one-size-fits-all, and what worked for you last year may not be the best fit now. Reviewing your Medicare coverage annually is a crucial step to avoid overspending and missing out on essential benefits.

Medicare Coverage: A Living, Breathing Plan

Your health needs and Medicare plans are constantly evolving. As you get older or face new health challenges, the treatments, prescriptions, and services you require may shift. Similarly, Medicare providers often adjust their plan offerings, premiums, deductibles, and drug formularies every year.

If you’re not checking for updates during the Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7, you could miss important changes. Some updates might leave you paying more out-of-pocket than necessary, while others might provide better benefits at a lower cost.

The Risks of Sticking With Last Year’s Plan

Failing to review your Medicare coverage annually could lead to several problems, including:

• Unexpected Costs: Plans often change their premiums, deductibles, or out-of-pocket maximums. A plan that was affordable last year may have increased its costs.
• Limited Access to Providers: Some networks shrink or change, meaning your preferred doctor or hospital may no longer accept your plan.
• Prescription Coverage Gaps: Medicare Part D plans update their drug formularies, potentially removing medications you rely on. If your prescriptions are no longer covered, you could face steep expenses.
• Missed Opportunities: You might miss out on new benefits or supplemental options that better meet your needs.

How Medicare Changes Annually

Let’s break down how Medicare plans evolve each year:

Premiums and Deductibles

Medicare Parts A and B typically see annual adjustments in premiums and deductibles. For example, the standard Medicare Part B premium is $174.70 in 2024, but it’s projected to rise in 2025. These changes may impact your budget significantly, especially if you’re on a fixed income.

Medicare Advantage and Part D Plans

Private insurers offering Medicare Advantage and Part D plans have the flexibility to alter plan details each year. They may change:

• Monthly premiums
• Deductibles
• Co-payments and coinsurance
• Covered services and drugs
• Maximum out-of-pocket limits

Provider Networks

Medicare Advantage plans often operate within specific provider networks. These networks are reviewed and updated annually, and your preferred doctors or facilities might not be included next year.

How to Approach Your Annual Medicare Review

Now that you know why it’s critical, here’s how to take control of your Medicare coverage during the AEP:

1. Review Your Health Needs

Start by assessing your current health status. Has your doctor prescribed new medications or suggested specialist care? Are there upcoming surgeries or treatments you expect to need? Make a list of your healthcare priorities.

2. Check for Plan Changes

Carefully review the Annual Notice of Change (ANOC) letter from your current plan. This document outlines any changes to costs, benefits, and provider networks for the upcoming year.

3. Evaluate Part D Coverage

If you have a standalone Part D plan, check its updated formulary to ensure your prescriptions are covered. Pay close attention to any new restrictions like prior authorizations or quantity limits.

4. Compare Plan Options

Use the Medicare Plan Finder tool or consult with a licensed professional to explore other options. Compare plans based on your specific needs and budget. Remember, switching plans doesn’t always mean higher costs—it could save you money.

5. Consider Supplemental Coverage

If you’re enrolled in Original Medicare, review your supplemental (Medigap) policy. Ensure it still provides adequate coverage for potential gaps like deductibles or coinsurance.

Why the Annual Enrollment Period (AEP) Matters

The AEP is your golden opportunity to make changes to your Medicare coverage. During this time, you can:

• Switch from Original Medicare to a Medicare Advantage plan or vice versa.
• Change from one Medicare Advantage plan to another.
• Enroll in, drop, or change your Medicare Part D prescription drug plan.

Keep in mind that any changes you make during the AEP will take effect on January 1 of the following year.

Common Mistakes to Avoid

Even the most diligent individuals can overlook crucial aspects of their Medicare review. Watch out for these common pitfalls:

• Ignoring the ANOC: This document is your first clue about whether your current plan will still meet your needs.
• Procrastinating: Waiting until the last minute to review your options can lead to rushed decisions.
• Focusing Only on Costs: While affordability is important, make sure the plan you choose provides the coverage you need.

Pro Tips for a Smooth Review

Here are some additional tips to make your Medicare review a breeze:

• Stay Organized: Keep all Medicare-related documents in one place for easy reference.
• Ask Questions: Don’t hesitate to reach out to Medicare representatives or a trusted advisor if you’re unsure about something.
• Plan Ahead: Start your review early in the AEP to avoid the year-end rush.

Medicare Coverage Is Not Set It and Forget It

By now, it should be clear that Medicare isn’t a static program. Treating it like a one-and-done decision could cost you in the long run. An annual review helps you stay in control, ensuring your coverage aligns with your health needs and budget.

Make Annual Medicare Reviews a Habit

Making time for an annual Medicare review might seem like a hassle, but it’s a small effort compared to the potential savings and peace of mind you’ll gain. Remember, healthcare isn’t just about finding the lowest cost; it’s about making sure you’re prepared for whatever comes next.​​​​​​​