Happy With Your Medicare Plan? Why an Annual Review Still Makes Sense
If you are satisfied with your current Medicare coverage, that is great news. Having doctors you trust and predictable healthcare costs brings genuine peace of mind.
Because of that satisfaction, many Arizona beneficiaries assume they can simply overlook Medicare Open Enrollment, which runs from October 15 through December 7 each year with changes taking effect on January 1. The thinking is understandable: if your coverage worked well this year, why look at anything else?
While keeping your existing coverage may turn out to be your best choice, reviewing upcoming plan changes helps you avoid unexpected surprises in January. Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans can change their costs, covered drugs, benefits and, where applicable, provider or pharmacy networks from year to year.
If you have a Medicare Advantage or Part D plan, start with your Annual Notice of Change (ANOC). Your plan provides this notice each fall, in print or electronically, to describe changes taking effect in January.
A brief review can help you determine whether your coverage still fits your healthcare needs and budget for the year ahead.
What Can Change from Year to Year?
Even if your plan retains the same name, specific plan terms and coverage features can shift. Here are key areas to review each fall:
1. Prescriptions and Formularies (Part D)
Prescription drug formularies (the list of medications covered by your plan) can change from year to year. A medication you take regularly might move to a different copay tier, require new prior authorization or no longer be listed on the formulary. Checking your current medication list against next year's formulary helps prevent unexpected pharmacy costs.
2. Doctor and Hospital Networks (Medicare Advantage)
If you have a Medicare Advantage plan, check your doctors, specialists and hospitals against the plan's directory for the upcoming coverage year, and confirm important appointments with the provider and plan. Provider networks can update throughout the year, so verifying continued in-network status is a sensible precaution.
3. Out-of-Pocket Costs and Premiums
Premiums, deductibles, copayments and coinsurance can change. If you have Medicare Advantage, check its medical out-of-pocket limit. If you have Part D coverage, review your prescription costs and the separate annual limit for covered drugs.
4. Supplemental Benefits
Many Medicare Advantage plans offer supplemental benefits such as routine dental, vision, hearing or allowance benefits for over-the-counter items. Benefit allowances, vendor rules and eligible items frequently update annually.
5. Your Personal Health Needs
Your own health situation may have changed over the past twelve months. A new health condition, a change in prescriptions or upcoming treatments may mean that your current coverage structure is worth re-evaluating.
When Keeping Your Current Plan Is the Right Move
An annual review does not mean you have to switch plans. In fact, if your current Medicare health or prescription drug plan is still offered and continues to meet your medical and budgetary needs next year, you generally do not need to make any change during Open Enrollment.
For some people, the review confirms that keeping their current coverage is a good choice. Going through the review gives you confidence that you have looked at the details and know what to expect on January 1.
Medicare Open Enrollment is not an annual guaranteed-issue enrollment period for Medigap policies. Different rules apply if you are considering a Medicare Supplement.
James Little
Concierge Licensed Health & Life Insurance Agent with Esra Health
Schedule Your Complimentary Annual Plan Review: https://www.esra-health.com/jameslittle
Areas Served: East Valley - Chandler, Gilbert, Mesa, Tempe, South Scottsdale, Ahwatukee and communities statewide across Arizona.
Reviewing plan notices and formulary charts does not need to be complicated. As an independent licensed agent, I help you review your ANOC, check your doctors and prescriptions against upcoming plan details, and explain your options clearly with zero pressure and zero obligation.
Disclaimer:
We do not offer every plan available in your area. Currently, we represent 13 organizations which offer 133 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Esra Health is an independent insurance agency and is not affiliated with, endorsed by or connected to Medicare.gov, CMS or the federal Medicare program. Plan availability and benefits vary by ZIP code and county. This material is designed for general educational purposes only and is not a substitute for a personal consultation about your individual coverage needs, healthcare providers, prescription drugs and budget. Agents are compensated by insurance carriers when a client enrolls in an eligible plan.