Reviewing Your Medicare Coverage Before Annual Enrollment

With Annual Enrollment just around the corner, seniors everywhere are reviewing their Medicare plans to see if they need to make changes to their health care coverage. If you’re new to Medicare, you may be wondering where to start, and how to make sure you are enrolled in the right plan to fit your needs and your budget.

While there are many things to learn as a new Medicare recipient, here’s some help reviewing your coverage before Annual Enrollment.

With Original Medicare, Review Costs and Benefits for Next Year 

As a recipient of Original Medicare (Part A and Part B), you should take the time to look over next year’s costs and benefits to see if Original Medicare will still work for you. Review your Annual Notice of Change, which should arrive by mail in October.

If you are not happy with what you see, Annual Enrollment (October 15-December 7) is the time to make changes. Remember, any changes you make during Annual Enrollment will take effect on January 1 of next year.

Remember to Check You Prescription Drug Formulary 

If prescription medication is a significant part of your medical care, be sure to check the formulary for next year to make sure your needs will still be met. Many times, the formulary (list of covered drugs) changes from year to year.

You need to know if your drug is no longer available or will change tiers and become more expensive. This applies to Medicare Part D, as well as prescription drug coverage you may have with a Medicare Advantage plan.

With a Medicare Advantage Plan, Don’t Forget to Review Changes in Networks 

Many times, benefits and costs stay the same with Medicare Advantage, but networks change from year to year. Be sure to confirm that your doctor is still part of your plan’s care network and any hospitals you use are still available under the plan.

Of course, it’s smart to review a few new plans in your area to see if the same coverage is available at a lower cost to you. If your Medicare Advantage plan includes prescription drug coverage, don’t forget to look over next year’s formulary for changes to drugs, dosage amounts and pharmacy availability.

Annual Enrollment Does Not Apply to Medicare Supplement Insurance 

If you have Medicare Supplement insurance (a Medigap policy), Annual Enrollment does not apply. Any changes you wish to make to your Medicare Supplement insurance plan are best made during your unique Medicare Supplement Open Enrollment period.

Medicare Supplement Open Enrollment is not Annual Enrollment.

Medicare Supplement insurance Open Enrollment begins the first month you turn 65 and enroll in Part B. During this six-month period of time, you have a guaranteed issue right, meaning no insurance company can turn you down or charge you more for a Medicare Supplement Insurance Plan.

After your Medicare Supplement insurance Open Enrollment period ends, insurance companies may refuse to sell you a policy, and can charge you more for the same policy. If you have a pre-existing health condition, make changes to your policy during your Medicare Supplement Open Enrollment, as you may not be able to get a plan after it ends.

Luckily, if you miss your enrollment period for Medicare Supplement insurance, there are a few exceptions and you may have a guaranteed issue right in some situations. If, for instance, you move out of your plan’s service area or you have Original Medicare and your employer coverage is ending, you will likely have a guaranteed issue right to buy a new policy. 

The good news is, if you are happy with your current Medicare coverage, whether it’s a Part D plan, Original Medicare or a Medicare Advantage plan, you usually are not required to do anything at all. But, it’s always a good idea to take a look, and avoid being surprised on January 1.