Key Takeaways

• Reviewing your Medicare plan annually helps ensure you have the right coverage for your healthcare needs and budget.

• Plan costs, benefits, and rules change every year, so staying informed can help you avoid unexpected expenses.

Your Medicare Plan Isn’t Set in Stone

If you think your Medicare plan is a one-and-done decision, think again. Every year, plans change—premiums shift, benefits adjust, and rules evolve. Reviewing your plan annually can help you stay on top of these changes and make sure you’re still getting the best coverage for your needs. Waiting too long to reevaluate your options could mean missing out on cost-saving opportunities or important coverage updates.

Annual Notice of Change: Your First Wake-Up Call

Every fall, Medicare plans send out an Annual Notice of Change (ANOC), outlining updates to your coverage, costs, and network. If you toss it aside without reading, you might miss key changes that impact your healthcare. Some reasons to pay close attention include:

• Premium Increases: Your monthly costs could go up, affecting your budget.

• Deductibles and Copayments: Adjustments to these out-of-pocket costs could mean you pay more at the doctor’s office or pharmacy.

• Coverage Changes: Some medications, treatments, or services you rely on may no longer be covered.

• Provider Network Updates: Your doctor or preferred hospital might leave the plan’s network, forcing you to find new healthcare providers.

• New Plan Benefits: Some plans add new benefits each year, such as wellness programs, transportation services, or enhanced prescription drug coverage.

Open Enrollment: The Time to Make a Change

From October 15 to December 7, you have the opportunity to adjust your Medicare coverage during the Annual Enrollment Period (AEP). This is the time to:

• Switch between Original Medicare and Medicare Advantage

• Enroll in or change a Medicare Part D prescription drug plan

• Move to a different Medicare Advantage plan if yours no longer meets your needs

• Drop or add supplemental coverage if necessary

Even if you’re happy with your plan, comparing options could reveal a more cost-effective or beneficial choice. Plans evolve each year, and a better fit for your needs might be available.

Prescription Drug Costs Can Shift

If you rely on medications, your Medicare Part D coverage deserves an annual check-up. Drug formularies—the list of covered medications—change every year. A prescription that was affordable last year may now be more expensive or no longer covered. Key things to review:

• Drug Tier Changes: Some medications move to a higher-cost tier.

• Coverage Restrictions: Your plan may now require prior authorization or step therapy.

• Preferred Pharmacies: Using an out-of-network pharmacy could cost you more.

• New Generics or Alternatives: A lower-cost option for your medication may now be available.

With the $2,000 annual out-of-pocket cap on Medicare Part D prescription costs in 2025, reviewing your plan can help you maximize your savings and ensure your medications are covered affordably.

Your Healthcare Needs May Have Changed

Your health isn’t static, and neither should your Medicare coverage be. As the years go by, you may need different treatments, specialists, or prescriptions. Reviewing your plan allows you to:

• Ensure your coverage aligns with new diagnoses or conditions.

• Make sure your doctors and specialists are still in-network.

• Adjust your plan to include extra benefits that support your health.

• Consider a plan with lower out-of-pocket costs if you require more frequent medical care.

Ignoring these changes could mean higher out-of-pocket expenses or limited access to necessary care.

Medicare Advantage Plans Offer New Benefits

If you have a Medicare Advantage (Part C) plan, benefits can vary significantly from year to year. Some plans introduce or remove coverage options like:

• Vision, dental, and hearing services

• Fitness programs

• Over-the-counter allowances

• Telehealth access

• Meal delivery services

With these benefits fluctuating annually, reviewing your plan ensures you’re not missing out on valuable services that could improve your quality of life.

Income Adjustments Could Affect Your Premiums

Medicare Income-Related Monthly Adjustment Amounts (IRMAA) apply if your income exceeds a certain threshold. These extra charges for Medicare Part B and Part D are based on your tax return from two years ago. If your income has decreased due to retirement or other life changes, you might be eligible for a reduction. Reviewing your Medicare costs and appealing IRMAA adjustments could help lower your premiums and save you money over time.

Special Enrollment Periods: When Life Changes Happen

Even outside of the Annual Enrollment Period, certain life events trigger Special Enrollment Periods (SEPs). You may qualify for a plan change if:

• You move to a new area where your current plan isn’t available.

• You lose employer-sponsored coverage.

• You qualify for Medicaid or Extra Help.

• You enter or leave a skilled nursing facility.

• You experience a significant income change that impacts your eligibility for certain programs.

Reviewing your options when life changes occur ensures you’re not left without proper coverage or financial assistance.

Medicare Supplement Plans: Are They Still Worth It?

If you have a Medicare Supplement (Medigap) plan, you might want to reassess whether it still makes financial sense. Premiums for these plans increase over time, and your healthcare needs might have changed. Evaluating your Medigap plan annually helps determine if:

• The cost is still justified based on your expected medical expenses.

• Your coverage is adequate for hospital stays and doctor visits.

• You should explore other coverage options that better fit your needs.

Out-of-Pocket Maximums Matter

Medicare Advantage plans have an annual out-of-pocket maximum, which limits how much you pay for covered services each year. In 2025, this limit is $9,350 for in-network services and $14,000 for combined in-network and out-of-network care. Reviewing this number annually helps you anticipate potential costs and avoid financial surprises. Knowing your financial limits can also help you decide if switching plans is a good move.

Plan Ratings: Are You in a High-Quality Plan?

Each year, Medicare rates plans based on quality and customer satisfaction. If your current plan’s rating has dropped, it might be a sign that other enrollees are experiencing issues with costs, access to care, or customer service. Checking the Medicare Star Ratings can help you decide if it’s time to switch to a higher-rated plan.

Get the Most Out of Your Medicare Plan

Medicare isn’t something you set and forget. Reviewing your plan every year ensures you’re getting the best possible coverage, minimizing out-of-pocket expenses, and making informed decisions about your healthcare. Take the time to compare options, understand changes, and seek professional guidance if needed. For expert advice on selecting the right plan, speak with a licensed agent listed on this website today.