Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7 annually, is the period people on a Medicare plan can switch or adjust their plan based on their needs [1]. But how exactly do you evaluate whether your current plan has all you need or if you need to switch to a different plan? Medicare plans can change their coverage, costs, co-pays, and in-network providers [2, 3], which is why it’s vital to assess whether your plan still works for you. In this blog, we will highlight 5 important questions to ask yourself or a support representative of your current Medicare plan during AEP to ensure you make the best decision for your healthcare needs.
Have My Health Needs Changed This Year?
Above all else, you must analyze your current health and what Medicare plans are tailored to your needs. By asking yourself whether your health status is the same as or different from last year, you can better understand whether your current Medicare plan still works for you or if you need to switch to a plan with more/less services covered. For example, if you received one or more new diagnoses, prescriptions, or specialist recommendations this year, you may need to adjust your plan to avoid paying excess out-of-pocket fees. On the other hand, if you switched off a prescription or no longer see a certain specialist, you may want to switch to a more basic plan. It all depends on your current state of health and what you anticipate your needs being this upcoming year.
In general, it’s better to play it safe when choosing a plan, especially if the one you’re considering does not cover as much as your current plan. For instance, if your condition is currently under control and there’s a chance your doctor will wean you off a certain medication, but you’re not sure it’s definite, it’s better to stick with a plan that covers this medication so you don’t risk paying large out-of-pocket fees.
Are My Current Doctors and Pharmacies Still In-Network?
If you are satisfied with the doctors and specialists you are currently seeing, as well as the pharmacy you currently use for prescriptions, it is well worth checking if they are considered “in-network” in your plan. “In-network” providers are a group of healthcare professionals that work with Medicare to provide discounted service rates to those in specific plans [4]. Never assume just because a healthcare provider or pharmacy was in your plan’s network last year that they will continue to be in your plan this year. As previously mentioned, Medicare plans change coverage details and in-network providers often, so you’ll need to verify this during AEP. To check if a healthcare provider or pharmacy is in-network, simply visit the specific Medicare plan’s online directory and enter the name of the provider or pharmacy you want to verify. Or you can also call their customer service phone line (listed on the back of the insurance card) and tell the representative the provider or pharmacy name to verify this way. Likewise, you can compare multiple plans against one another by using Medicare’s “Plan Compare” online feature.
What Does My Annual Notice of Change Say?
In September, preceding AEP, you will receive an Annual Notice of Change (ANOC) letter [5]. The ANOC explains the changes being made by your current plan. It is important to review your ANOC carefully so you know what to expect from your current plan if you choose to stick with it. Key things to look out for include changes to costs, coverage, and in-network providers. Your plan may not make any changes to these, but if it does, it’s worth noting and assessing whether the changes work for your needs and budget.
What Will This Actually Cost Me Next Year?
It is helpful to note the costs for each part of your Medicare plan, including premiums, deductibles, and out-of-pocket maximums, so you have an estimate of what you’ll be paying for your plan next year.
Who Can I Ask If I’m Not Sure?
When it comes to choosing a Medicare plan, you are never alone. Don’t hesitate to reach out for support if you ever have any questions or concerns, or just feel confused with the whole process. Although there are online tools to help you choose the appropriate plan, some individuals benefit from speaking to a representative over the phone who can help them on a more personal level. You can contact a representative from your plan’s support line, call Medicare’s 24-hour support line at 1-800-MEDICARE (1-800-633-4227), or visit Greater Good Health for further assistance.
You Have Time to Get This Right
Carefully assessing your current plan against your healthcare needs and reaching out for support can take time. Don’t rush this process. Choosing a health insurance plan is an integral part of your health journey, which is why taking it seriously is a must. Again, there is no shame in reaching out for additional support throughout the process, and no question is a silly question. There are many individuals ready to help you navigate this process and address your concerns.
Frequently Asked Questions
Want the abridged version of this information? No problem! Check out these frequently asked questions (and answers):
Q: How do I know if my Medicare plan still fits my needs?
- A: You can better understand if your plan fits your needs by reviewing your ANOC against your current health status.
Q: What is an Annual Notice of Change (ANOC) letter?
- A: The ANOC is a letter that addresses the changes being made by your current plan, including changes to costs, coverage, in-network providers, and more.
Q: Are my doctors still covered if I switch plans?
- A: This all depends on the plan you switch to and what doctors are considered “in-network.” To check the providers in a plan’s network, visit the plan’s online directory, call the support phone number, or use Medicare’s “Plan Compare” online feature.
Q: Who can help me review my Medicare options?
- A: Representatives from the plan’s support line and Medicare’s 24-hour support line (1-800-MEDICARE (1-800-633-4227)) can help you review your options and answer any questions.
References:
- https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources
- https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost
- https://www.kff.org/medicare/changes-to-the-medicare-advantage-program-enhance-some-consumer-protections-but-roll-back-others/
- https://www.cigna.com/knowledge-center/in-network-vs-out-of-network
- https://www.medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/upcoming-plan-changes
Greater Good Health accepts Medicare Advantage patients and is contracted with select Medicare Advantage plans by clinic location. This communication complies with federal regulations including the Anti-Kickback Statute and Stark Law. It is intended for informational purposes only and does not promote or endorse any specific plan. For a complete list of plans we participate in, please contact our office or visit Medicare.gov.