Every fall, most people with Medicare Advantage or a Part D drug plan do the same thing: nothing. Their coverage rolls into the new year automatically, and for many of them that works out fine.
The trouble is that plans change every year, and staying put only works if the plan you are staying in still fits. The Annual Enrollment Period is your yearly chance to check.
The Dates
The Medicare Annual Enrollment Period runs from October 15 through December 7. During that window you can switch Medicare Advantage plans, move between Original Medicare and Medicare Advantage, or join, switch, or drop a Part D drug plan.
Changes you make generally take effect January 1. After December 7 your options narrow considerably, so the useful time to review is now — before the window opens, not in its final week.
Step One: Read the Annual Notice of Change
If you are in a Medicare Advantage or Part D plan, your plan is required to send you an Annual Notice of Change each fall, generally by the end of September. It lists what is changing for the coming year.
This document is easy to set aside because it looks like routine plan mail. It is the single most useful thing you will receive all year.
Look specifically for changes to premiums, deductibles, and copays; changes to which drugs are covered and at what tier; and changes to the provider or pharmacy network. If you cannot find your notice, contact your plan and ask for it.
Step Two: Check Your Doctors
Medicare Advantage plans generally use provider networks, and those networks can change from one year to the next. A doctor who was in network this year is not guaranteed to be in network next year.
Make a short list of the doctors, specialists, and hospitals you actually use, and confirm each one against the plan’s network for the coming year. Your plan’s provider directory is a starting point, but calling the doctor’s office to confirm directly is worth the extra few minutes.
Step Three: Check Your Prescriptions
Drug plans publish a formulary — the list of covered drugs — and it can change each year. A medication can be dropped, moved to a different cost tier, or given new requirements such as prior authorization.
Write down every prescription you take, including dosage, and check each one against next year’s formulary. Confirm that your usual pharmacy remains in the plan’s preferred network as well, since that can affect what you pay.
The Medicare Plan Finder at Medicare.gov lets you enter your medications and compare how different plans would cover them.
If Nothing Changed For You
If your doctors are still in network, your prescriptions are still covered on similar terms, and your costs are reasonable, staying in your current plan may be exactly the right answer.
The point is not to change plans. The point is for staying put to be a choice you made rather than one that was made for you.
A Familiar Scenario
Someone has taken the same medication for years with a predictable copay. Their Annual Notice of Change arrives in September and goes into a drawer. In January, the first refill costs several times what it did in December — the drug moved to a higher tier.
The information was in the notice all along. It simply was not read until it was too late to act on it.
We’re Here To Help!
If you would like help working through your Annual Notice of Change, or checking your doctors and prescriptions before December 7, give us a call. Reviewing it early leaves time to act on what you find.
This article is general information about the Medicare Annual Enrollment Period. Plan details, costs, and networks vary and change each year; confirm current information with your plan, at Medicare.gov, or by calling 1-800-MEDICARE.
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 35 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.