How to Decide Whether to Switch Medicare PlansPosted by Medicare Made Clear
Picking a Medicare plan is my favorite thing to do,” says pretty much no one. So the decision to switch plans is a big one. It means you’ll shop and compare, and pick again.
You can pick a new plan, if you decide to, during Medicare annual enrollment, which runs from Oct. 15 to Dec. 7 every year. Coverage changes go into effect on Jan. 1.
You really only have to answer three questions about your current plan to decide whether to keep it or to switch. If you answer “no” to one or more of the three, then you’ll probably want to explore other plan options.
1. Will I have the coverage I need?
To answer this question you need to learn how your plan is changing for next year, if at all. Insurance companies review – and may change – their Part D and Medicare Advantage plans every year.
Your plan will notify you about plan coverage and cost changes in a document called the Annual Notice of Changes, or ANOC for short. Be sure to read it and pay attention to coverage changes that may affect you. Most plans send ANOCs out in September.
Look for Part D formulary changes, such as certain medications moving from one formulary tier to another. Low-tier drugs generally cost you less than high-tier drugs.
Also check to see if there are any new prior authorization or step therapy requirements. Plans may use them as cost-saving measures, which could be helpful to you. But, if you’re affected, you’ll want to be sure you know what to expect come January.
2. Am I comfortable with the plan premium and other costs?
Premiums are a familiar cost to most people, and that cost is usually the first thing you see when looking at insurance materials. You want to know what you’ll have to pay every month.
Medicare and private Medicare plans may change their premiums, and that cost is worth noting. But you also need to pay attention to other costs, like deductibles, copays and coinsurance. All of these costs are explained, along with other plan details, in your plan’s Explanation of Benefits. Make sure you’re looking at plan details for correct year.
If you have a plan with a deductible, then you’re responsible for the cost of your care up to that amount. After that, your plan coverage starts to kick in. Check for any changes to your plan deductible and how that will affect your budget.
Copays and coinsurance can be harder to grasp. These are costs that are charged when you receive a service. You might pay $20, for example, when you go to the doctor. Or you could pay a set percentage of your plan’s cost – coinsurance – for a test or exam.
Think about the health care services you’re likely to use next year and use your plan’s quoted costs to estimate what you may have to pay next year. Factor in any planned procedures or services related to new or changing health conditions.
You’ll need to add your estimated costs (deductibles, copays and coinsurance) to your annual premium cost (monthly premium x 12). This gives you a pretty good estimate of your costs for the year so you can decide how that amount works with your budget.
3. Can I get covered services from the doctors, hospitals and pharmacies I like?
Plans may also change their provider and pharmacy networks from year to year. You need to check your plan details to make sure that your doctor and other providers are still in network.
You can usually get the full network list on the plan web site. Otherwise call your plan using the number on the back of your member card.
The Bottom Line
Picking a Medicare plan may not top your list of fun fall activities. But you owe it to yourself to shop if you find that your current plan falls short of your needs. Use our Medicare Plan Review Worksheet for help deciding.
For more information, explore MedicareMadeClear.com or 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.