One of the most common misconceptions about Medicare is that once you pick a plan, you are done. You made your choice, you enrolled, and now you can move on with your life. If only it were that simple.
The truth is that Medicare plans change every single year. And those changes can have a real impact on your costs, your coverage, and your access to the doctors and medications you rely on. That is why an annual coverage review with a dedicated Medicare agent is not optional. It is essential.
What Changes Every Year
On January 1 of each year, Medicare Advantage plans, Medicare Supplement plans, and Part D prescription drug plans can all make changes. Here are the most common changes that affect beneficiaries:
Formulary changes
The list of medications covered by your plan, called the formulary, is updated annually. A drug that was on Tier 2 this year might move to Tier 3 or Tier 4 next year, significantly increasing your out-of-pocket cost. In some cases, a medication may be removed from the formulary entirely, requiring you to seek a prior authorization, a tier exception, or a switch to a different medication.
Network changes
If you have a Medicare Advantage plan, your plan has a provider network. Doctors, specialists, and hospitals can enter or leave that network each year. If your primary care physician or a specialist you see regularly leaves the network, you may face higher costs to continue seeing them, or you may need to find a new provider.
Premium changes
Monthly premiums can increase, decrease, or stay the same. Even $0-premium Medicare Advantage plans can introduce a premium from one year to the next. Part D plan premiums also fluctuate. A plan that was the best value last year may not be the best value this year.
Copay and coinsurance changes
The amount you pay out of pocket for doctor visits, hospital stays, lab work, and other services can change. A $20 specialist copay might become $40. A 20% coinsurance might become 25%. These changes add up over the course of a year.
Extra benefits changes
Many Medicare Advantage plans offer extra benefits like dental, vision, hearing, fitness memberships, and over-the-counter allowances. These benefits can be reduced, expanded, or eliminated from year to year.
How I Conduct an Annual Review
Each fall, before the Annual Enrollment Period opens on October 15, I reach out to each of my clients to schedule an annual coverage review. Here is what that process looks like:
- Review the ANOC: Every September, your plan sends an Annual Notice of Change. I review this document and identify any changes that could affect you.
- Update your medication list: Medications change throughout the year. I ask you to bring your current list of prescriptions so we can check each one against the formulary for your current plan and any potential alternatives.
- Verify your providers: We confirm that your doctors, specialists, and preferred facilities are still in your plan's network for the coming year.
- Assess your health needs: If your health has changed over the past year, such as a new diagnosis, a surgery, or a change in mobility, we factor that into the plan comparison.
- Compare plans: Using all of this information, I compare your current plan against other available options. I look at total cost of care, not just premium. That includes premiums, deductibles, copays, drug costs, and out-of-pocket maximums.
- Make a recommendation: If your current plan remains the best fit, I tell you so. If a different plan would serve you better, I explain the differences and help you enroll before the December 7 deadline.
Why Most People Skip This and What It Costs Them
According to research from the Kaiser Family Foundation, most Medicare beneficiaries do not switch plans during the Annual Enrollment Period. Many assume their plan is still working for them without actually checking. Others find the process too confusing or time-consuming to navigate on their own.
The cost of inertia can be substantial. A single formulary change on one medication can increase your annual drug cost by $300 to $1,000 or more. A network change that forces you to see an out-of-network specialist can cost hundreds in unexpected copays. These are real dollars that could be avoided with a 30-minute annual review.
Medicare plans are not static. They change every year, and your plan should evolve with you. An annual review is not about switching for the sake of switching. It is about making sure your plan still fits your life.
If you have not had your coverage reviewed this year, or if you are not sure whether your current plan still makes sense, I am here to help. My annual reviews are no-cost, thorough, and completely without pressure.
When Was Your Last Coverage Review?
An annual review can save you hundreds. Schedule yours today.
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