Situation Analysis

Why It’s Important to Check Your Medicare Plans During Open Enrollment

Why It’s Important to Check Your Medicare Plans During Open Enrollment

If you’re a Medicare recipient, by now, you have probably received some sort of notice regarding the Medicare open enrollment period, suggesting that you review your coverage so you can make any necessary changes. And, if you’re like most, you’ve probably dismissed it as unnecessary reading. While you might be thinking, "If it isn’t broke, it doesn’t need fixing," it is always worth your time to check your plan to see if it is still your best option.

It may very well be that there will not be any significant changes to your plan coverage for 2022. But there are almost always some changes. You can learn about that through the information packet your Advantage Plan or prescription drug plan sent to you explaining upcoming changes.

Typically, you will see adjustments to monthly premiums, copays, deductibles, coinsurance, or out-of-pocket limits. You could also see changes to prescription coverage. You’ll certainly want to know whether your plan is reducing coverage or increasing premiums or copays.

Why the Open Enrollment Period Matters

Even if the changes in your plan aren’t significant, it would be essential to compare your plan with others that might now offer better value or coverage for your current needs. It’s also an opportunity to review your coverage to see if you need to add or drop parts. If you have Original Medicare, you may want to consider a Medicare Advantage plan or vice versa. You could change your Medicare Advantage plan if you find one that offers better coverage or lower costs. If you have a Medicare prescription plan, you could pick a new one or drop it altogether.

If you decide to change your Advantage Plan during the enrollment period and then realize it’s not the right one for you, you’ll have an opportunity to change your coverage again between January 1 and March 31. That is the Medicare Advantage Open Enrollment Period, during which you can change to another Advantage Plan or switch to Original Medicare, with or without the Part D Prescription plan. The new coverage will take effect the month following the change.

What to Watch for When Reviewing Your Plan Changes

  • Watch for changes in costs—i.e., higher co-payments, deductibles, out-of-pocket costs for medications, and hospitalization.
  • Watch for changes in the plan’s provider network. Check to see that all your preferred providers are still in the network.
  • Watch for changes in prescription coverage to ensure yours are still covered.
  • Watch for changes in drug tiers. Check to see if any of your drugs have been moved to a more expensive tier.
  • Watch out for discontinuation of your Part D plan. Part D plans are often discontinued by the insurer and replaced with another plan. Check to see if your premium or prescription costs are going to be higher or lower.

What to Consider as You Review Plan Changes

While increased costs shouldn’t be your only consideration in deciding whether to change coverage, it’s easy to compare Advantage and Part D with similar coverage to determine if you could get a better value elsewhere. If other plans are lowering premiums or other costs while yours is raising them, it would be important to know why. If your plan’s coverage is no better than a lower-cost plan, you should consider switching plans.

If you are covered by a low deductible, high premium plan and don’t foresee hospitalizations in your future, you could consider switching to a high-deductible, low-premium plan. Some Advantage plans don’t charge a premium in exchange for a high deductible.

Very often, changes in an insurer’s provider’s network can be a deal-breaker. If your preferred providers no longer participate in your plan’s network, you may have no choice but to select a different plan.

The same goes if you take expensive prescribed medications. If yours have been moved into a higher tier, or your plan places restrictions on them, you may have no other choice than to switch plans. It’s easy to shop Part D plans using Medicare’s Plan Finder tool that helps you compare plans based on your medications and different local pharmacies.

If you decide to join a Medicare Advantage Plan or change to another Advantage Plan, you can call 1-800-MEDICARE to learn which plans operate in your area. You can then check out the plans on their website. Before making any final decisions, you should call the plan provider to confirm what you find on the website, especially concerning your preferred providers and drug coverage. Your State Health Insurance Assistance Program (SHIP) is also an excellent resource for better understanding your options.


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