Each fall, Medicare beneficiaries get a chance to switch their insurance plans.<\/p>\n
During Medicare open enrollment, Oct. 15 to Dec. 7 each year, fewer than 1 in 5 actually changed their coverage in 2024, according to a poll by online publication SeniorLiving<\/p>\n
That\u2019s better than the previous year, when fewer than 1 in 10 made a change, according to the poll of 931 older adults on Medicare. But by forgoing the chance to compare and switch their Medicare coverage, millions of people are potentially missing out on thousands of dollars of savings and leaving themselves open to nasty surprises about their benefits or health care choices.\u200b\u200b<\/p>\n
\u201cPeople\u2019s medical needs change as they grow older, and their plans [and what they cover] may change from year to year,\u201d says Tricia Neuman, KFF senior vice president and executive director of the nonpartisan nonprofit\u2019s Program on Medicare Policy. \u201cReviewing the options each year makes a lot of sense.\u201d<\/p>\n
Last year, fewer than two-thirds of older adults checked out the possibilities, according to the SeniorLiving poll.\u200b\u200b\u200b\u2018People\u2019s medical needs change \u2026 and their plans [and what they cover] may change from year to year. Reviewing the options each year makes a lot of sense.\u2019<\/p>\n
Here are some situations that might cause you to consider a change during the annual open enrollment. Answers are based on interviews with several Medicare experts and guidance from Medicare itself.<\/p>\n
\u200b\u200bAnd a reminder: Switching from a Medicare Advantage plan to original Medicare carries a big risk if you intend to buy a Medigap policy, which covers out-of-pocket expenses. In most states, Medigap insurers can turn you down because of your preexisting health conditions or charge you more based on your health or age if you\u2019ve had Medicare Part B for more than six months. Factor that into your decision-making.<\/p>\n
1. My prescription costs have jumped \u200b
\nThat happens usually in one of three scenarios, Neuman says:<\/p>\n
Your Part D policy\u2019s monthly premiums have increased.
\nYou\u2019ve been prescribed a new drug your Part D policy doesn\u2019t cover.
\nYour current medicines have fallen off your Part D\u2019s formulary, its list of covered medicines.
\nEach September, Part D prescription plans send out a list of modifications to their drug coverage, called the Annual Notice of Change (ANOC). That gives you time to make sure your medicines are still covered.<\/p>\n
If not, you can shop around for another plan, ask your doctor to apply for an exception in covering your favored medicine or contact the plan yourself and have the doctor provide a written statement explaining why alternatives aren\u2019t as effective or could cause problems.\u200b\u200b<\/p>\n
Remember, too, that the limit on your out-of-pocket costs for prescriptions will increase to $2,100 from the $2,000 introduced in 2025. You also have the option of joining the Medicare Prescription Payment Plan, also started in 2025, which spreads your out-of-pocket costs throughout the year.<\/p>\n
But if some of your medications aren\u2019t covered in your present plan, they won\u2019t count toward the $2,100 maximum or your deductible, and they won\u2019t be able to be added to the prescription payment plan.<\/p>\n
2. I\u2019m spending extended time in a different state\u200b
\nMedicare Advantage plans typically charge more to go to doctors outside their networks. In some cases, they won\u2019t cover any charges if it\u2019s not an emergency.<\/p>\n
So a Midwestern snowbird might have to pay more to see out-of-network doctors while in Florida. Read the details of your plan or talk with a representative to know where you stand.<\/p>\n
If you\u2019ll be living a dual-residence existence for years to come, you might consider a switch to original Medicare, with the usual caveats.3. I\u2019ve been diagnosed with a chronic condition \u200b
\nA serious medical change, such as a diabetes or even a prediabetes diagnosis, should trigger a full review of your Medicare coverage. Consider the care you\u2019ll need.<\/p>\n
If you have a Medicare Advantage plan and want a gym membership or disease-specific programs, find a plan that offers them. If you anticipate needing a lot of specialists, make sure they\u2019re in your plan\u2019s network. If you need new medications, make sure your plan covers them.<\/p>\n
If you have original Medicare, make sure your Part D policy pays for any new prescriptions, or find one that does. And if you want to work out regularly, some Medigap plans that pair with original Medicare also offer free memberships or discounts. If you anticipate needing lots of specialists, 98 percent of all doctors who aren\u2019t pediatricians accept Medicare, KFF points out.<\/p>\n
Making critical changes early can \u201creally affect your pocketbook and save you money,\u201d says Gretchen Jacobson, a vice president with the New York\u2013based Commonwealth Fund foundation.<\/p>\n
4. \u200b\u200bI need surgery and prefer a specific doctor
\n\u200bOriginal Medicare allows patients to choose any doctor or hospital that accepts Medicare, and since that\u2019s all but 2 percent of physicians who don\u2019t specialize in treating children, chances are good that you\u2019ll be covered.<\/p>\n
But if you\u2019re in a Medicare Advantage plan and its surgeons don\u2019t meet your needs, you may need a different Medicare Advantage plan or to switch to original Medicare \u2014 if you can be accepted into a Medigap plan. Starting with open enrollment for 2026, the Medicare Plan Finder is listing the providers that participate in some plans.<\/p>\n
The people who really need to focus on whether doctors are in network are those who\u2019ve suffered major problems like cancer and heart attack, says Senior Fellow Emeritus Joseph Antos at the American Enterprise Institute, a Washington-based public policy think tank.<\/p>\n
\u201cA specialist may be key to their treatment,\u201d he says.<\/p>\n
5. \u200b\u200bI\u2019m super healthy and rarely need a doctor \u200b
\nIf you\u2019re in original Medicare, all should be well: As a \u201cpay-for-service\u201d arrangement, not seeing the doctor isn\u2019t costing you anything extra beyond your mandatory Part B and Part D insurance premiums.<\/p>\n
If you\u2019re in a Medicare Advantage plan and paying a monthly premium on top of your standard Part B premium, that may be for a plan that offers lots of extras, such as gym memberships. Consider switching to a lower-cost plan without services you don\u2019t plan to use in the coming year.\u200b\u200b<\/p>\n
6. My income has dropped sharply\u200b\u200b
\nIf you are in original Medicare, your Part B monthly premium is locked in, but your Part D drug plan isn\u2019t. You may be able to find a lower-cost policy that covers the medicines you are on.<\/p>\n
If you\u2019re in a Medicare Advantage plan, consider a switch to a plan with no extra payment on top of the mandatory Part B premium.<\/p>\n
If your Part B or Part D premiums include an income-related monthly adjustment amount (IRMAA), you can fill out Form SSA-44 to request a review of those additional fees.<\/p>\n
And you might qualify for help. Ask your state Medicaid office \u2014 links to state offices are on the federal Medicaid website \u2014 or State Health Insurance Assistance Program (SHIP) about Medicare Savings Programs. Or call 800-MEDICARE (800-633-4227); the SHIP help line is 877-839-2675. \u200b\u200b\u200b<\/p>\n
7. My former employer is changing its retiree benefits
\nSome companies provide retirees with supplemental insurance, which covers many health costs that original Medicare doesn\u2019t.<\/p>\n
If you have changes to your retiree benefit coverage, or for some reason that coverage no longer is offered, contact Medicare\u2019s Coordination of Benefits & Recovery Call Center at 855-798-2627. Someone can tell you whether you fall in the window in which Medigap insurers cannot deny you coverage based on preexisting \u200bconditions.<\/p>\n
8. My regular doctor is no longer in network for my plan\u200b
\nIf you deeply want to stay with a doctor, ask directly whether he or she is moving to a different Medicare Advantage plan, accepting original Medicare patients or dropping out of Medicare completely.<\/p>\n
If you decide to make a change, make sure a short-term decision won\u2019t affect your long-term coverage \u2014 for example, switching to original Medicare to temporarily stay with one doctor but sacrificing Medigap coverage for the long term. It might be safer to ask your doctor to recommend a colleague in your current plan.\u200b\u200b<\/p>\n
9. I\u2019m in need of serious dental care\u200b
\nOriginal Medicare doesn\u2019t cover routine dental care costs, but many Medicare Advantage plans do.<\/p>\n
If you don\u2019t have your own dental insurance and can\u2019t afford dentistry costs out of pocket, you can buy a stand-alone dental policy. Some Medigap insurers also offer discounts on dental services if you choose from their list of in-network dentists.<\/p>\n
If you have Medicare Advantage, you can consider finding a plan that will cover a portion of the costs of your needed work. But Antos warns that figuring out what portion of your dental bills a Medicare Advantage plan will cover is complicated \u2014 some plans cover little more than routine cleanings \u2014 so it helps to know what services you will use in the coming year.\u200b\u200b<\/p>\n
This story, originally published Oct. 12, 2021, has been updated with information for the 2026 Medicare plan year.<\/p>\n","protected":false},"excerpt":{"rendered":"
Each fall, Medicare beneficiaries get a chance to switch their insurance plans. During Medicare open enrollment, Oct. 15 to Dec. 7 each year, fewer than 1 in 5 actually changed their coverage in 2024, according to a poll by online publication SeniorLiving That\u2019s better than the previous year, when fewer than 1 in 10 made … Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":47,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-46","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/posts\/46","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=46"}],"version-history":[{"count":1,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/posts\/46\/revisions"}],"predecessor-version":[{"id":48,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/posts\/46\/revisions\/48"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=\/wp\/v2\/media\/47"}],"wp:attachment":[{"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=46"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=46"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/americanfreshnews1.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=46"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}