Navigating all the Medicare options can feel overwhelming—should you stick with what you already have or make a change during the Annual Enrollment Period from October 15 to December 7? Like all important decisions, this one requires some careful thought and planning.
The extra effort will be worth it: You can help determine that you have the right coverage for your health needs now and in the year to come. To get started, take this quick quiz, which can help you pinpoint your priorities so you know what to look for in a plan. Jot down your answers on a piece of paper.
This quiz won’t provide a definitive answer because everyone’s situation is unique. But it should get you thinking and help you collect the necessary information for the next step.
- Were your deductibles, copays, and coinsurance unmanageable for the past year? Did you have numerous out-of-pocket costs?
- Do you anticipate higher medical costs in the next year, such as a medically necessary surgery (a knee replacement, for example) that a specialist has recommended? Or perhaps you need more intensive treatment—such as more regular visits to a heart specialist—for a chronic heart condition?
- Are you moving out of state or to a different area in your state within the next year?
- During September, your current Medicare plan should have sent you a list of changes to your policy for the upcoming year: the Annual Notice of Change letter (ANOC). Is there coverage you use that looks like it’s being cut or increasing in cost? Are there drugs you rely on being dropped from coverage?
- Are you unsatisfied with the care you’re currently receiving? Perhaps you don’t have coverage for preferred doctors, or one or more of your providers has stopped taking Medicare as payment. Are you unhappy about how far you must travel for your care?
- Do you anticipate changes in your medications?Perhaps a medication you’ve relied on in the past to manage a chronic condition, like diabetes, isn’t working as well and your doctor has recommended a switch.
If you answered yes to most or all: Consider a change.
Your plan may have been what you needed when you first signed up, but if you find yourself answering yes to all or most of the questions above, you may want to consider switching plans.
“You probably wouldn’t stay with the same unreliable car for years that you’re not really satisfied with, so you shouldn’t feel you have to settle for a health plan you’re not happy with either,” says Michelle Katz, MSN, a healthcare consumer advocate based in Washington, D.C., and author of Health Care Made Easy.
A good starting point: Speak with one of our licensed insurance agents who can help you understand all your options. Call (800) 488-7621.
Here are some of the top reasons people switch:
Out-of-pocket costs. This is often a significant reason for someone to change plans. Ask yourself if you’d be better off paying a higher monthly premium so you’d have lower out-of-pocket costs throughout the year.
Medication changes. Recent medication changes or a newly diagnosed condition that may require new, higher-priced medication might benefit from a different drug plan. Review your current prescription drug coverage and determine whether it will meet your needs for next year. If your current plan falls short, you may need to make a switch. (And again, check that ANOC letter for any changes in your plan’s drug formulary for the upcoming year.)
Selection of healthcare providers. If you’re not pleased with the quality of your care, you can start by talking to friends and colleagues with the same health condition as you to find out if they like their providers, suggests Katz. “Not all plans cover the same conditions equally, so understanding what the plan offers for your specific health needs is key.”
Coverage for anticipated procedures, tests, and treatments. You may want to choose a plan that provides more comprehensive coverage for outpatient procedures, hospital stays, and post-operative therapies such as rehabilitation and physical therapy.
Coverage for unexpected—but not unlikely—medical events. Not all plans will cover home healthcare after a surgery or provide full coverage for health devices like walkers or wheelchairs after an unexpected accident or serious diagnosis, says Katz. It’s impossible to predict most serious medical events, but they become more common as we age, so it’s important to consider them.
If you answered no to most or all: Your current plan might be the best fit.
If you don’t pay much out of pocket, you generally like your care, and you don’t foresee higher medical expenses next year, your current plan may be working.
There might be other issues at play, however, so it’s still a good idea to sit down and think about what worked for you and what didn’t. Make a list of what’s most important to you in a health plan to be sure your current plan still checks those boxes.
If there’s one specific thing that’s the top priority—say, visiting a particular specialist or having surgery at a nearby hospital that specializes in geriatric care—Katz recommends working backward to figure out if your current plan still fits the bill.
“Start by calling the doctor or hospital or care center that you want to use and find out what plans they accept and what providers they partner with,” says Katz.
Another consideration: If you’re planning a move, even to a nearby county within your state, your current plan may not cover doctors or specialists you’d like to see in your new location. (And know that if you do move, you automatically qualify for a Special Enrollment Period, or SEP, for at least two months from the date you notify your plan of your move.)
If you’re hoping to travel a lot (that’s one of the big appeals of retirement, right?), you might consider a plan that is accepted at most hospitals or doctors’ practices in the U.S.
Bottom line: It doesn’t hurt to shop around and compare plans.
You can compare quotes online to find one that fits your needs and budget.
If your answers were a mix of yes and no: Talk to your provider and an insurance agent.
Doing your own research is important and can give you confidence when searching for a new plan. But it can also be useful to talk with your provider about whether their practice is anticipating changes in coverage for plans for the upcoming year. And you might ask your doctor about potential procedures, tests, and medications you may need to consider based on your health.
It can also help to speak with a licensed insurance agent at (800) 488-7621. They can help you drill down to the details, consider issues you may not have thought of, and narrow your choices even more. You can also compare plans and get quotes online.