Navigating Medicare can be tricky. So once you’ve locked in your plan, you might be tempted to just call it a day forever. But every fall offers you a chance to review your Medicare insurance and make sure it’s still working for you.
The Annual Enrollment Period (AEP) takes place yearly from Oct. 15 through Dec. 7. During this time, anyone with an existing Medicare Advantage or Medicare Part D plan can review their insurance and prescription drug coverage, read about upcoming changes and make adjustments.
During the AEP, you can:
- Leave an Original Medicare plan to join a Medicare Advantage plan. These plans are run by private insurers who contract with the government to offer Medicare benefits.
- Leave a Medicare Advantage plan to switch back to an Original Medicare plan (Parts A and B).
- Switch from one Medicare Advantage plan to another.
- Sign up for a stand-alone Medicare Part D prescription drug plan, switch to a different Part D plan or drop Part D coverage.
(Even if you have Part D, medications can be expensive. Get your free discount prescription card to see how much you could save.)
If you don’t want to change anything, don’t worry — in most cases, your plan will automatically renew. Otherwise, any changes you make will go into effect on Jan. 1, 2022.
Should you make a Medicare change?
To decide whether you want to change your Medicare plan, it’s important to read the Annual Notice of Change (ANOC) letter from your insurance provider that arrives in September. The letter spells out any changes to your plan or prescription drug coverage for the year ahead.
“That can include new amounts for premiums, deductibles, copays/coinsurance, benefits and provider network changes. Some plans go away or new plans might be available,” says Danielle Roberts. She’s a Medicare expert and co-founder of the insurance agency Boomer Benefits, which helps people understand Medicare and pick the best plan for their situation. She is also the author of 10 Costly Medicare Mistakes You Can’t Afford to Make.
Read the letter carefully and ensure that your prescription medications are still covered by your plan — and that your doctors are still in your plan’s network. That’s especially important: Some plans cover only out-of-network medical costs at a reduced rate — or not at all.
“You might want to change your plan if your favorite doctor no longer accepts it or your prescriptions are no longer covered,” Roberts says.
If you have Medicare Part D, you can search here to see if your prescription medication is still covered in your plan. If you have a Medicare Advantage plan, contact your insurer to ask for your plan’s formulary, which is the list of medications it covers. Many companies provide these lists on their websites. Here is a sample list for United Healthcare.
(Are you leaving policy freebies on the table? Here are some common health care perks and where to find them.)
Other considerations to help you decide whether to change your existing coverage include:
- Premiums: The payments you make (usually monthly) for your health insurance plan.
Keep in mind that the plan with the cheapest premium isn’t always the best option, says Nathan Rubenstein. He’s the owner of Midwest Medicare Advisors insurance agency. “It might save you money every month but could cost you a lot more in out-of-pocket costs in the long run,” he says.
- Coinsurance: The percentage of your health care costs that you’re responsible for after you meet your deductible up until the point you hit your out-of-pocket maximum.
Medicare Part B covers 80% of your Part B (doctor visits, preventive care) costs. But that remaining 20% could climb into an unaffordable expense. That’s why many people with Original Medicare also have supplemental insurance plans called Medigap policies.
- Out-of-pocket maximum: A limit to how much of your own money you might be responsible for spending.
Medicare Advantage has out-of-pocket maximums, but Medicare doesn’t. Which, again, is why many people have supplemental Medigap coverage.
You can find and compare Medicare insurance plans and prescription drug plans on the Medicare site.
How to make a change to your Medicare plan
If you don’t have an account on Medicare.gov, you can create one and make any changes during the AEP. You can also call 1-800-MEDICARE. If you have a Medicare Advantage plan, you can also work directly with your insurance company or an insurance broker to make changes or enroll in a new plan. Your new coverage will begin on Jan. 1.
If you want help choosing a new plan or making changes to an existing plan, many states offer free help through the State Health Insurance Assistance Program (SHIP).
Need another chance to make a change? If you have a Medicare Advantage plan, you’re in luck. These plans offer an Open Enrollment Period (OEP) from Jan. 1 to March 31 each year. During this OEP, you can switch to a different Medicare Advantage plan or join Original Medicare (with a Medicare drug plan, if you choose).
What’s new for Medicare in 2022?
Reading your ANOC letter will give you a good idea of changes to your Medicare plan for the next policy year. Other changes, such as the exact amount of Medicare Part B premiums, are usually announced in October before the AEP begins, Roberts says.
However, the Centers for Medicare and Medicaid Services (CMS) has already announced a few changes to the Part D prescription drug program for 2022, including:
- A requirement for Part D plans to offer real-time medication comparison tools. These allow enrollees to see how much they would pay out of pocket for different prescription medications.
- The addition of a second specialty tier for medications to allow for lower cost sharing for enrollees.
- An increase in the Part D deductible from $445 in 2021 to $480 in 2022.
Sifting through insurance information isn’t particularly fun. But it’s a very worthwhile annual task to make sure you’re getting the most from your Medicare plan.
No matter what prescription drug coverage you have, use Optum Perks to make sure you’re getting the best possible price. Download our app to see how much you could save today.
How to join a health or prescription plan: Medicare.gov
Medicare Advantage and Part D changes for 2022: Centers for Medicare and Medicaid Services
The increase in the Part D deductible for 2022: Centers for Medicare and Medicaid Services