Medicare Open Enrollment is nearly here. That means it’s time to review your current Medicare plan to determine whether it still meets your needs.
To help you manage the process, your Medicare plan sends you two documents each September: The Annual Notice of Change (ANOC) and Evidence of Coverage (EOC). Medicare also gives you eight weeks – from October 15 through December 7 – to review your current coverage and compare your plan options. The changes you make during Open Enrollment take effect on January 1.
Determine Current and Projected Healthcare Needs
If you don’t know your current healthcare needs, it’s impossible to know whether your Medicare plan will meet them. That’s why reviewing your options begins with examining your current healthcare needs, plus any changes you expect to occur over the coming year.
Create a list of all of your providers, including primary care physician, specialists, nurse practitioners, hospitals, labs, and any other healthcare facility or provider you use. In addition, list all of the prescriptions you currently take. This is the only way to determine whether your current plan – or any other plan – will meet your needs next year.
Review the ANOC and EOC
Medicare plans must send members the Annual Notice of Change every year by September 30. This is to help you understand what changes your plan will implement next year, and plans nearly always have changes from year to year. It may be a change to your deductible, co-pays, the drug formulary, the provider network, or something similar.
Plans typically send out the Evidence of Coverage at the same time as the ANOC. This document details both your coverage and costs under your plan. Paired with the ANOC and the list you made of your current healthcare needs, you have all of the information you need to determine whether your current coverage will meet your needs next year.
For more information about these documents, please see our recent post about what to expect from the ANOC and EOC.
What if You’re Happy with Your Current Coverage?
If you have anything other than Original Medicare and a Medigap plan, we highly recommend reviewing the ANOC and EOC, as well as any other plan you’re eligible for (use Medicare’s Plan Finder tool). Plans nearly always have at least minor changes from year to year. And a change that’s minor to someone else could have major consequences for you. For example, drug formularies nearly always change from year to year. If those changes include any of your prescriptions, you could find yourself paying substantially more next year.
It’s also important to note that your plan isn’t the only one that changes from year to year. All of the plans undergo changes to their provider network, formulary, cost structure, and more. That means that a plan that didn’t meet your needs this year could very well be your ideal plan next year.
Questions to Answer about Your Plan Options
Whether you’re considering switching from Original Medicare to a Medicare Advantage (MA) plan, switch to a new MA plan, change back to Original Medicare, or look at your Part D Drug Plan options, you should answer some basic questions.
Are you in the plan’s service area? Most Medicare Advantage plans have a service area in addition to a provider network. If you don’t live within the plan’s service area, you likely don’t qualify for that plan. It’s important to note that a plan’s service area may change from year to year.
Are your providers included in the plan’s network? This includes all of your healthcare providers, including your preferred pharmacy. If the network doesn’t include your providers, any services you have done may not be covered. Or, you’ll have to change doctors.
Does the drug formulary cover your prescriptions? You can talk to your doctor about alternatives for the same drugs, particularly if plan options in your area are severely limited. However, the better option is looking for a Part D plan that covers your prescriptions.
What extra services does the plan cover? Many Medicare Advantage plans cover services above and beyond what Medicare Part B covers. The most common are prescription, dental, vision, and hearing, but you may find some with additional services.
What is the yearly out-of-pocket maximum? Original Medicare does not have an out-of-pocket, but all MA plans do.
What are your costs in the plan? Although cost shouldn’t be the only factor when choosing a plan, there’s no denying that it plays a large role. Consider the full costs of the plan, including co-pays, co-insurance, and yearly deductibles, not just the monthly premium.
What happens if you visit an out-of-network provider? Most plans have provisions for out-of-network providers. For example, HMOs rarely cover these services. However, if it’s emergency care, your plan should cover treatment.
What are the guidelines for visiting a specialist? If you have a condition that requires regular visits with a specialist, this can be more important to your decision than even the cost.
What are your costs during the coverage gap? If you enter the donut hole during the year, it’s important to know how your plan handles this event (and how you leave the coverage gap).
Do You Need Help Comparing Your Medicare Options?
Saying that this whole process can be confusing is a bit of an understatement. If you need help wading through your options, the licensed agents at Medicare Solutions are ready and waiting to help. Just call us toll-free at 855-350-8101 to get started.
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