Already on Medicare? Review your plan every year

Why review your plan every year

Medicare Advantage and Part D plans can change on January 1 each year. Your plan sends an Annual Notice of Change by September 30 that lists what’s changing. Things that often change:

• Monthly premium, deductible and copays
• Which drugs are covered (the formulary) and what tier they’re on
• Which doctors, hospitals and pharmacies are in the network
• Extra benefits, like dental, vision or hearing

Even if nothing about your health has changed, a different plan may cover your prescriptions or doctors for less.

When you can make changes

• Medicare Open Enrollment (October 15 – December 7): Anyone with Medicare can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join, switch or drop a Part D plan. Changes start January 1.
• Medicare Advantage Open Enrollment (January 1 – March 31): If you’re in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or go back to Original Medicare (and join a Part D plan) one time.
• Special Enrollment Periods: Some events let you change at other times, such as moving out of your plan’s area, losing other coverage, or qualifying for Extra Help or Medicaid.

These Medicare dates are different from the Marketplace’s Open Enrollment, which is for people who don’t have Medicare.

What to check in a plan review

• Your prescriptions: Are they all covered, on which tier, and with any prior authorization or quantity limits?
• Your doctors and hospitals: Are they in the plan’s network for next year?
• Your total yearly costs: Premiums plus deductibles, copays and drug costs, not just the monthly premium.
• Your pharmacy: Is it preferred in the plan’s network?
• Extra benefits: Do the dental, vision or hearing benefits match what you actually use?
• Help with costs: Could you qualify for Extra Help or a Medicare Savings Program?

If you have Original Medicare and Medigap

You can change your Part D plan during Medicare Open Enrollment. Medigap is different: there’s no yearly enrollment period for Medigap. Outside your one-time Medigap Open Enrollment Period, in most states an insurer can use your health to decide whether to sell you a new policy and what to charge, although some states give extra rights. Talk it through before you drop a Medigap policy.

How a licensed agent can help

A licensed agent can compare the plans available in your area with your current plan, check your doctors and prescriptions, and explain the differences in plain language. You can also compare plans yourself at Medicare.gov, call 1-800-MEDICARE (TTY 1-877-486-2048, 24 hours a day, 7 days a week), or get free counseling from your State Health Insurance Assistance Program.

More Medicare topics

Medicare and Marketplace rules can change. Check Medicare.gov, SSA.gov or HealthCare.gov for the latest rules.

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