Medicare is an essential healthcare program that benefits elderly people 65 years or older and those having some kind of disability. Your healthcare needs, your economic situation, and how you live your life can all change, so you may want to review or change your Medicare plan from time to time. Whether you’re interested in reducing costs, adding benefits, or preserving access to providers you want, this guide can help you determine when and how to make changes to your Medicare plan.
Why Should You Review Your Medicare Plan?
Medicare plans are not static—they evolve annually, and so do your personal circumstances. Here are some key reasons why reviewing your plan is important:
- Health Changes: If you’ve been diagnosed with a chronic condition or require specialized care, your current plan may not provide adequate coverage.
- Prescription Needs: Changes in medications might mean your current plan no longer offers the best coverage or value for your prescriptions.
- Financial Adjustments: Shifts in income could affect your ability to pay premiums or out-of-pocket costs, making it necessary to explore more affordable options.
- Provider Networks: Your preferred doctors or hospitals might no longer be included in your plan’s network.
- Annual Plan Changes: Medicare Advantage and Part D plans change their premiums, deductibles, and coverage annually, which can change your costs and benefits.
Reviewing your Medicare plan annually will ensure that it aligns with your health and financial priorities.
Medicare Plans
Before making any changes, it is important to understand the different types of Medicare coverage:
- Original Medicare (Part A and Part B): Dismantles hospitalization as well as outpatient care, but excludes medications or supplementary benefits like dental or vision.
- Medicare Advantage (Part C): The program typically incorporates Part A, Part B, and in some cases, Part D, into an all-in-one product with supplementary benefits such as gym memberships or hearing aids.
- Prescription Drug Plans (Part D): Separate plans dedicated to providing medication coverage.
- Medigap (Supplemental Insurance): Supplements Original Medicare by paying for some deductibles, copayments, and other out-of-pocket expenses.
Each of these options has different strengths, so it is important to understand the details to make a good decision.
When May You Change Your Plan?
Medicare gives you designated enrollment periods when you can change your plan:
Annual Enrollment Period (AEP)
When: October 15 to December 7
What You Can Do:
- Switch between Original Medicare and Medicare Advantage.
- Change your Medicare Advantage plans.
- Sign up for, change, or disenroll from a Part D prescription drug plan.
Medicare Advantage Open Enrollment Period (MA-OEP):
When: January 1 to March 31.
What You Can Do:
- Change your Medicare Advantage plan.
- Go back to Original Medicare and join a standalone Part D plan.
Special Enrollment Period (SEP)
You qualify based on certain life events like moving to a new place, losing other coverage, or becoming eligible for Medicaid.
General Enrollment Period (GEP)
When: January 1 to March 31.
What You Can Do:
- Enroll in Medicare if you miss your Initial Enrollment Period. Coverage starts on July 1.
- Knowing these windows makes sure you do not lose your opportunity to maximize your coverage.
Steps to Change Your Medicare Plan
Review Your Current Plan
Take the time to review your Annual Notice of Change. They will detail what changes are being made to your plan for the coming year. See whether the plan still serves your medical and financial needs for your current health level.
Compare Plans
Use the Medicare Plan Finder tool on the Medicare website to compare options in your area. Look at premiums, deductibles, co-payments, and coverage details.
Talk to a Medicare Expert
If you are unsure about your options, call a Medicare representative or a licensed insurance agent. Organizations like SHIP (State Health Insurance Assistance Programs) offer free, unbiased guidance.
Check Eligibility
Make sure you are within the correct enrollment period to make the changes you want.
Sign up for the New Plan
You can sign up online at Medicare.gov, by phone, or directly with the plan provider. Be sure to save a copy of your confirmation.
Important Things to Consider Before Changing Plans
Before making a final decision on a new plan, consider these things:
- Cost: Don’t just look at premiums. Look at the overall cost, including deductibles, co-payments, and out-of-pocket maximums.
- Coverage: Make sure that the plan covers your doctors, hospitals, and prescription drugs.
- Flexibility: If you travel a lot, ensure that your policy covers you outside the local area or even internationally.
- Provider Networks: See if your current doctors are in the network of this new insurance plan.
An action list of your requirements will guide you in selecting a well-suited plan for your needs.
Common Mistakes to Avoid
- Annual Review: Not reviewing it may lead to unwanted expenses or lack of cover.
- Failure to Read the Fine Print: Unforeseen costs or restrictions may result from not reading the fine print.
- Missing Enrollment Deadlines: Be sure you know the key dates to avoid delays or penalties.
- Choosing Based on Cost: Affordability is important, but make sure that you have the right coverage for your healthcare needs.
Resources for Help
There are several resources to help you navigate Medicare changes:
- gov: The official Medicare website offers tools to compare plans and manage your coverage.
- Medicare Helpline: Call 1-800-MEDICARE for one-on-one help.
- Local SHIP Office: State Health Insurance Assistance Programs offer free, objective counseling.
Reviewing your Medicare plan changes is important for aligning the coverage with any changes in your needs. Being informed of your options, reviewing your existing plan, and using available resources help make more-informed decisions that give peace of mind and financial security. Regular reviews and adjustments of your Medicare plan let you stay ahead of changes and have optimal coverage for health and lifestyle.