Your Medicare Coverage—A Mid-Year Check-upPosted by Medicare Made Clear
You’ve done your research and have enrolled in a Medicare plan. It’s a good idea to look at your needs throughout the year—even if you’re happy with your current coverage. Ask yourself whether or not your needs have changed. Pay attention to any changes to your plan that might happen in the next year. Make notes to keep track of questions you might have. Your plan’s Annual Notice of Changes (ANOC)—which is mailed out in October—can help answer some of these questions. The answers to others will depend on your specific needs. Here are some topics to get you started.
Who You See – Doctors, Hospitals and Healthcare Providers
You’ve probably already gotten a few doctors and providers you usually see. There may also be a hospital or other healthcare facility you like to use. When you’re looking at who you see for your healthcare needs, think about:
- Your plan’s network of doctors and healthcare providers. Original Medicare lets you go to any doctor who sees Medicare patients. If you have other coverage—like a Medicare Advantage plan—there is usually a network of doctors and healthcare providers you have to choose from. This can change each year.
- Your plan’s out-of-network coverage. What happens if you choose healthcare providers or facilities that aren’t in your plan’s network? Will your plan still cover visits, or will you have to pay costs out of your own pocket?
How You Feel – Looking at Your Health
It’s important to take an honest look at your health over the past year. Have your health needs changed? Here are some ways this might affect the coverage you need:
- Do you need more from your healthcare coverage? A person’s health can change a lot in a year. For example, you might have been diagnosed with a chronic illness. Or maybe you need to go to the doctor more than you used to.
- Has your health improved? This can be just as important. Maybe you need a different type of plan now. You may also have benefits you’re not using.
What You Want – Thinking about Benefits
Speaking of benefits, it’s important to review what exactly you want from your plan. Consider the following:
- Which benefits do you want? You might find you need a plan with benefits like dental coverage or help paying for hearing aids. The same is true in reverse. If you find you have benefits you’re not using, you could save money by looking for a plan with only the benefits you need.
- Are my plan’s benefits changing? Covered services will often change from year to year. Make sure the benefits you want will still be available next year.
What You Take – Prescription Drugs
It’s a good idea to get to know your plan’s drug formulary—the list of drugs your plan will cover. Since both your coverage needs and your plan’s formulary can change each year, it’s good to know:
- Are my drugs in my plan’s formulary? Have you added any new prescriptions in the past year? Is your plan’s formulary going to change? If a certain drug isn’t covered, are there others available that will work just as well? What happens if you choose a drug that isn’t in the formulary?
- Will I be able to use my pharmacy? This is especially important if you have a plan with a network of pharmacies you have to choose from. Even if your pharmacy isn’t in your plan’s current or future network, some plans let you get your drugs through mail order.
What You Pay – Considering Cost
Look at how healthcare fits into your budget. Has this changed over the past year, or will it need to for next year? Compare your plan costs with your budget needs.
- Your plan. Are costs for your current plan going up next year? Look at the big picture: premiums, deductibles, coinsurance rates, copays and out-of-pocket expenses/limits.
- Your budget. Has your budget for healthcare changed? Can you afford your current plan, or do you need to scale back? If you think you might need help paying for healthcare, look at what’s out there for your specific situation.
Where You Are – Your Plan’s Service Area
If you’re planning on moving to a different city or state, make sure you’ll have the Medicare plan you need in your new home. Even if you’re not moving, maybe you plan to travel more than you did last year.
- If you’re moving. Will your plan cover you in your new home, or will you need to look for another? Medicare might offer you a special enrollment period if your current plan won’t be available where you’re moving.
- If you’re traveling. Does your plan offer coverage for medical services if you travel outside its service area? How about prescriptions?
Now you’ve thought about your healthcare needs. Do you need to learn more or change plans? If you’d like general information about plan types, take a look at the MMC Plan Type Comparison chart. If you’re ready to compare specific plans side-by-side, check out the Medicare.gov Plan Finder tool. This is a helpful resource that shows you all types of plans available in your area. You can compare benefits, costs and other important plan features. Reviewing your needs throughout the year and comparing your plan options can ensure you’re well-prepared for the Medicare Annual Enrollment Period: October 15 – December 7.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
MedicareMadeClear: 10 Key Medicare Facts
MedicareMadeClear: Plan Type Comparison chart
Medicare.gov: Plan Finder tool
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