As you approach the end of each year, it's essential to review your Medicare plan to ensure it still meets your needs. Whether you're new to Medicare or have been enrolled for years, an annual review can save you money, help you avoid unexpected costs, and ensure you have the coverage you need for the year ahead

5-Step Annual Medicare Plan Review Checklist

1. Review Your Current Coverage

Begin by thoroughly reviewing your current Medicare coverage, including Parts A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage). Understanding what each part covers, your out-of-pocket costs, and any coverage gaps is crucial.

  • Annual Notice of Change (ANOC): Review this document to understand any changes in your plan’s benefits or costs for the upcoming year. This will help you identify if your plan still meets your needs.
  • Coverage and Costs: Assess your current plan's premiums, deductibles, copayments, and coinsurance. Consider whether these costs align with your budget and healthcare needs.
  • Self-Assessment: Ask yourself:
  • Have your health needs changed over the past year?
  • Have you started taking new medications or received new diagnoses?
  • Did you find any part of your plan confusing or difficult to use?

Your answers will guide you in deciding if you need to make changes to your coverage. Learn more about why you should review your coverage each year. 

2. Compare Medicare Plans

Each year, Medicare plans can change their costs, coverage, and provider networks. Even if you were satisfied with your plan last year, it's worth comparing your options during the Medicare Open Enrollment Period, which runs from October 15 to December 7.

Here’s what to compare:

  • Premiums and Out-of-Pocket Costs: Check if the monthly premium for your plan has changed. Compare deductibles, copayments, and coinsurance amounts.
  • Coverage: Ensure that the services and medications you need are still covered. Look out for any changes in covered medications under Part D plans or any adjustments in Medicare Advantage plan services.
  • Provider Networks: Verify that your preferred doctors, hospitals, and pharmacies are still in-network. If they are no longer covered, you might need to switch plans or risk higher costs.
  • Quality Ratings: Medicare rates plans on a 5-star scale. Higher-rated plans often provide better service and customer satisfaction. These ratings can help you choose a plan that offers the best care.

3. Evaluate Prescription Drug Coverage

If you have Medicare Part D or a Medicare Advantage plan with drug coverage, review your prescription needs:

  • Formulary Check: Ensure your medications are still covered under your plan’s formulary. Pay attention to any changes in drug tiers, as this can affect your out-of-pocket costs.
  • Preferred Pharmacies: Some plans offer lower costs if you use specific pharmacies. Check if your preferred pharmacy is still included.
  • Mail-Order Options: Consider mail-order options for convenience and potential cost savings.

4. Consider Your Overall Health and Budget

Think about your health status and how it may change in the upcoming year. If you expect increased healthcare needs, consider a plan with more comprehensive coverage, even if it has a higher premium. On the other hand, if you're in good health and rarely see a doctor, you might prefer a plan with lower premiums and higher cost-sharing when you do need care.

Additionally, set a budget for your healthcare expenses. Factor in premiums, deductibles, copayments, and the cost of medications. Understanding your financial situation will help you choose a plan that balances cost and coverage.

5. Plan for Future Needs

  • Travel Plans: If you plan to travel frequently, ensure that your Medicare plan provides coverage in different geographic areas. Original Medicare offers nationwide coverage, but Medicare Advantage plans may have network restrictions.
  • Additional Benefits: Consider whether you need supplemental coverage, such as a Medigap policy, or additional benefits like dental, vision, or hearing care.

Seek Help if Needed

Medicare can be complex, and it's okay to ask for help. Consider reaching out to a State Health Insurance Assistance Program (SHIP) counselor. These experts provide free, unbiased advice and can help you understand your options.

You can also take advantage of online resources, including classes offered by GetSetUp, to guide you through your Medicare plan review. These classes are designed to help you make informed decisions about your healthcare coverage.

An annual Medicare plan review is a proactive way to ensure that your healthcare coverage aligns with your needs and budget. 

By following this checklist, you can avoid surprises, potentially save money, and feel confident in your healthcare decisions for the coming year.

Reviewed By: Keith Gilbert