Key Takeaways
- Medicare plans change their benefits, costs, and provider networks annually, making yearly reviews essential to avoid unexpected expenses.
- Your prescription drug coverage can shift dramatically as medications move between tiers or get dropped from formularies altogether.
- Health needs evolve over time, requiring different coverage options as you develop new conditions or treatments.
- New Medicare benefits and plan options emerge each year that could save you thousands of dollars in healthcare costs.
- CHRISTUS Health Medicare Advantage plans offer comprehensive coverage options worth considering during your annual plan review.
Letting your Medicare plan automatically renew without reviewing it first could be costing you thousands of dollars each year.
Many Medicare beneficiaries simply stay with the same plan year after year, missing opportunities for better coverage and potential savings. While automatic renewal might seem convenient, your health needs, plan benefits, and costs can change significantly over just 12 months. Taking time during the Annual Enrollment Period (October 15-December 7) to review your options is one of the smartest healthcare decisions you can make.
CHRISTUS Health’s Medicare specialists understand that navigating these annual changes can feel overwhelming, but evaluating your current coverage is critical to managing your healthcare costs and ensuring you have access to the care you need. Let’s explore why an annual review of your Medicare plan should be part of your healthcare routine.
1. Your Prescription Drug Coverage Can Change Dramatically
Prescription drug coverage often undergoes substantial changes each year that can directly impact your wallet. Whether you have a standalone Part D prescription drug plan or drug coverage through a Medicare Advantage plan, these changes can significantly affect your out-of-pocket costs.
How Drug Formularies Shift Each Year
Medicare drug plans modify their formularies (lists of covered medications) annually, and these changes can be substantial. Plans can add or remove medications from their formulary entirely, potentially leaving you without coverage for medications you rely on. Even if a drug remains on the formulary, its coverage level may change, placing it in a different pricing tier that affects how much you’ll pay at the pharmacy.
For example, a medication that was previously on a preferred tier with a $10 copay might move to a non-preferred tier with a $45 copay or higher. These shifts aren’t minor tweaks—they represent real dollars coming out of your pocket each month. Without reviewing these changes carefully, you might face unexpected and substantial price increases at the pharmacy counter.
What Happens When Your Medication Changes Tiers
When medications change tiers, the financial impact can be immediate and significant. Consider a scenario where three of your regular prescriptions each move up just one tier in your plan’s formulary. With an average increase of $25-$35 per prescription, you could suddenly face an additional $75-$105 in monthly out-of-pocket costs—translating to $900-$1,260 annually for the exact same medications you were taking before.
Real-World Impact: Medication Tier Changes
Medication moving from Tier 1 to Tier 2: $5 → $20 copay
Medication moving from Tier 2 to Tier 3: $20 → $47 copay
Medication moving from Tier 3 to Tier 4: $47 → 25% coinsurance (≈$100 for a $400 drug)
Potential Annual Impact: $1,704 in additional out-of-pocket costs
The Financial Impact of Ignoring Formulary Updates
Failing to review formulary changes can lead to significant financial strain. Beyond higher copays and coinsurance amounts, you might find yourself paying full price for medications that are no longer covered at all. During your annual review, check whether your current medications remain on your plan’s formulary and in which pricing tier they’ll be placed for the coming year.
If you discover that your medications have been dropped or moved to higher-cost tiers, comparing alternative plans becomes essential. Many Medicare beneficiaries find that switching to a different plan can save them hundreds or even thousands of dollars annually just on prescription costs alone. These savings opportunities make your annual review a potentially high-value financial decision.
2. Premium and Out-of-Pocket Costs Often Increase
Medicare plans frequently adjust their cost structures annually, which can significantly impact your healthcare budget. These changes affect everything from your monthly premiums to what you pay when you visit the doctor or pick up prescriptions.
Understanding Your Annual Notice of Change Letter
Every fall, Medicare beneficiaries receive an Annual Notice of Change (ANOC) letter from their current plan. This important document outlines all the changes coming to your plan in the next calendar year. Unfortunately, many people set this letter aside or glance at it briefly without understanding its significance. The ANOC provides critical information about premium increases, deductible changes, copayment adjustments, and modifications to your plan’s maximum out-of-pocket limits.
Take time to carefully review this document and highlight any cost increases that will affect your budget. Pay particular attention to the summary chart that compares this year’s benefits to next year’s. This side-by-side comparison makes it easier to identify significant changes that might warrant switching plans.
How Small Premium Increases Add Up Over Time
Even modest premium increases can substantially impact your finances over time. A $20 monthly premium increase might seem manageable at first glance, but it translates to $240 in additional annual costs. If your plan has raised premiums by small amounts for several consecutive years, you might be paying significantly more than necessary compared to other available options.
Remember that premium increases don’t happen in isolation—they often occur alongside other cost changes like higher deductibles or increased copayments. The cumulative effect of these changes can dramatically alter the overall value of your plan. What was once an affordable option might gradually become one of the more expensive choices in your area.
Comparing Deductibles and Copays Across Plans
While premiums are the most visible cost, they’re just one component of your total healthcare spending. Your annual deductible—the amount you pay before your coverage kicks in—can vary dramatically between plans and change from year to year. Similarly, copayments for doctor visits, specialists, emergency care, and hospital stays frequently increase, sometimes by substantial amounts. For those with specific medication needs, understanding how to talk to your pharmacist about these changes can be crucial in managing healthcare costs effectively.
During your annual review, calculate your potential total annual costs based on your typical healthcare utilization patterns. A plan with a lower premium but higher copays might actually cost more for someone who visits specialists frequently. Conversely, someone who rarely sees doctors might benefit from a higher-deductible plan with lower monthly premiums. For more insights on maintaining your health, explore these health & wellness tips.
3. Your Doctor and Hospital Network Might Change
Network changes are among the most disruptive shifts that can occur with Medicare Advantage plans. Even if you’re completely satisfied with your current doctors and hospitals, there’s no guarantee they’ll remain in your plan’s network next year.
When Providers Leave Your Plan’s Network
Provider networks can change substantially from year to year as insurance companies renegotiate contracts with doctors, specialists, hospitals, and other facilities. When healthcare providers and plans can’t agree on reimbursement rates, providers may leave the network entirely. You might discover that the primary care physician you’ve trusted for years or the specialist managing your chronic condition is no longer considered in-network under your current plan. For those with rare diseases, compounded medications might be an option when providers leave the network.
These network disruptions often happen with little warning beyond the information in your ANOC. While plans are required to maintain adequate networks, there’s no requirement that specific providers remain available. This reality makes reviewing your plan’s provider directory an essential part of your annual Medicare checkup.
How Network Changes Impact Your Access to Care
When your trusted providers leave your network, you face difficult choices. You might need to find new doctors who participate in your plan, potentially disrupting the continuity of your care. Alternatively, you can continue seeing your preferred providers but pay substantially higher out-of-network costs, which can quickly become unaffordable. For many Medicare beneficiaries with established doctor relationships, particularly those managing complex health conditions, maintaining access to their current healthcare team is a top priority.
Network disruptions can be especially problematic if you live in a rural area with limited provider options or if you rely on specialists who are scarce in your region. In these situations, finding a replacement provider who participates in your plan might involve significant travel or extended waiting periods for appointments. For more insights, consider reading about reasons to shop for a new Medicare plan.
Finding Plans That Include Your Preferred Doctors
During your annual review, verify whether your current doctors, specialists, and hospitals will remain in-network for the coming year. This research involves checking your plan’s updated provider directory or calling your providers directly to confirm their network participation. If you discover that key providers are leaving your network, the Annual Enrollment Period gives you the opportunity to switch to a plan that includes them.
Medicare’s Plan Finder tool allows you to search for plans that include specific doctors and hospitals, making it easier to identify options that preserve your important healthcare relationships. Taking the time to verify network participation can prevent the stress and potential care disruptions that come with losing access to your preferred providers.
4. Your Health Needs Evolve Over Time
Your healthcare needs rarely remain static. As we age, health conditions develop or change, requiring different types of care and coverage. The plan that perfectly suited your needs last year might be inadequate for addressing your current health situation.
Why Last Year’s Perfect Plan Might Not Fit Today
Think about how your health has changed in the past year. Have you developed a new chronic condition? Undergone surgery? Started seeing a specialist? Each of these changes affects what you need from your Medicare coverage. For instance, if you’ve recently been diagnosed with diabetes, you might benefit from a plan that offers lower cost-sharing for endocrinologist visits and diabetes supplies. Similarly, if you’ve developed hearing problems, you might want a Medicare Advantage plan that includes hearing benefits not covered by Original Medicare. For additional health and wellness tips, you can explore this resource.
Even positive health changes might warrant a plan switch. If you’ve successfully managed a condition and no longer need certain medications or frequent specialist visits, you might save money with a different coverage structure. The plan that made sense when you were managing an acute condition might not be cost-effective now that your health has stabilized.
Key Questions to Assess Your Changing Health Needs
During your annual Medicare review, ask yourself these essential questions about your current health status and consider the impact of nutrition on your overall wellness:
- What medical services did I use most frequently in the past year?
- Have I been diagnosed with any new conditions?
- Did I start taking any new medications?
- Are there treatments or services I anticipate needing in the coming year?
- Did I experience any unexpected healthcare costs that better coverage might have reduced?
The answers to these questions can help determine whether your current plan still aligns with your healthcare needs or if you’d be better served by different coverage. Evaluating these factors annually ensures your Medicare plan evolves alongside your health.
Matching New Health Conditions to Better Coverage Options
Different Medicare plans excel at covering different health scenarios. If you’ve developed arthritis and might need physical therapy, look for plans with lower copays for therapy services. If you’re planning an elective surgery, compare plans based on their hospital coverage and post-surgical care benefits. For those newly managing chronic conditions, prescription drug coverage becomes increasingly important, as does access to relevant specialists.
By evaluating your health trajectory during your annual review, you can select coverage that anticipates your likely needs rather than simply reacting to past conditions. This proactive approach can lead to better care coordination and potentially lower out-of-pocket costs throughout the year. For more insights on personalized healthcare strategies, consider exploring why personalized medicine is the future of healthcare.
5. New Medicare Benefits and Plan Options Emerge Yearly
The Medicare landscape isn’t static. Each year brings new plans, expanded benefits, and innovative coverage options that weren’t available before. Without an annual review, you might miss opportunities to take advantage of these improvements.
Recent Medicare Advantage Benefit Expansions
Medicare Advantage plans have significantly expanded their supplemental benefits in recent years. Many now cover services that traditional Medicare doesn’t, including dental care, vision exams and glasses, hearing aids, fitness memberships, transportation to medical appointments, meal delivery after hospitalizations, and even in-home support. These additions can provide substantial value beyond the core medical and hospital coverage.
The competition among insurance companies has led to continuous innovation in benefit design. Plans regularly introduce new perks to attract and retain members. Without reviewing what’s available each year, you might miss out on newly added benefits that address your specific needs and could improve your quality of life while reducing your healthcare spending.
Supplemental Benefits Worth Exploring
When reviewing Medicare options, pay particular attention to these high-value supplemental benefits that vary widely between plans:
- Comprehensive dental coverage (including major services like crowns and dentures)
- Vision benefits with allowances for frames and lenses
- Hearing exam coverage and hearing aid allowances
- Over-the-counter (OTC) product allowances
- Fitness benefits and gym memberships
- Telehealth services with reduced or waived copays
- Transportation to medical appointments
- Post-hospital meal delivery
- In-home support services
These benefits can provide thousands of dollars in additional value beyond traditional medical coverage. During your annual review, calculate the potential savings from these extras based on services you’re likely to use in the coming year.
How Competition Creates Better Options for Seniors
The competitive Medicare marketplace benefits consumers through continuous improvement in plan offerings. Insurance companies frequently adjust their coverage to remain competitive, sometimes resulting in better values year over year. In many regions, entirely new plans enter the market annually, bringing fresh options and innovative benefit structures.
This dynamic environment means the best plan this year might not have even existed last year. Without reviewing what’s available, you might remain in an outdated plan while missing newer, more comprehensive options at similar or even lower costs. The introduction of new plans often forces existing ones to improve their offerings or reduce their premiums, creating a more favorable market for informed consumers who take the time to compare their options.
When and How to Review Your Medicare Coverage
Timing is crucial when reviewing and changing Medicare plans. The Annual Enrollment Period (AEP) from October 15 to December 7 is your primary opportunity to make changes for the following calendar year. During this window, you can switch between Original Medicare and Medicare Advantage plans, change from one Medicare Advantage plan to another, or select a different Part D prescription drug plan.
Mark These Important Medicare Dates on Your Calendar
Several key dates structure the Medicare review and enrollment process. In September, you’ll receive your Annual Notice of Change letter outlining how your current plan will change in the coming year. October 1st is when updated plan information becomes available for the following year, giving you two weeks to research before AEP begins on October 15th. The December 7th deadline is firm—decisions must be made by this date for coverage that begins January 1st.
For those enrolled in Medicare Advantage plans, the Medicare Advantage Open Enrollment Period from January 1 to March 31 provides an additional opportunity to make a one-time plan change if you discover your selected plan isn’t meeting your needs. However, this period offers fewer options than the fall AEP, making your annual fall review particularly important.
Using Medicare’s Plan Finder Tool Effectively
Medicare’s Plan Finder tool at Medicare.gov is your primary resource for comparing available plans in your area. This online tool allows you to enter your specific medications, preferred pharmacies, and healthcare providers to generate personalized comparisons of available plans. The system calculates estimated annual costs based on your typical usage, making it easier to identify the most cost-effective options for your situation.
For the most accurate results, create a Medicare.gov account that saves your information from year to year. Enter all prescription medications with their exact dosages and frequency, and include any doctors or hospitals you want to continue using. The tool will then show you which plans cover your needs and estimate your total costs under each option, including premiums, deductibles, and cost-sharing for the services you’re likely to use.
Getting Free Expert Help With Your Medicare Review
You don’t have to navigate Medicare decisions alone. Free, unbiased assistance is available through several resources. The State Health Insurance Assistance Program (SHIP) provides one-on-one counseling in every state. These trained counselors can help you understand your options and make informed decisions based on your specific situation.
Medicare brokers and local insurance agents can also provide valuable guidance at no cost to you. These professionals work with multiple insurance companies and can help identify plans that match your needs. Many senior centers and community organizations also host Medicare workshops during the enrollment period where you can get personalized help with your plan comparison.
For personalized assistance with complex Medicare decisions, consider scheduling a consultation with a Medicare specialist who can analyze your specific healthcare usage patterns and recommend appropriate coverage options.
Take Action: Your Medicare Review Checklist
To conduct a thorough Medicare plan review, follow this practical checklist to ensure you’re making a fully informed decision:
- Gather your current plan information, including your ANOC letter and benefits summary
- Make a list of all prescription medications with dosages and frequency
- Compile names of your doctors, specialists, and preferred hospitals
- Review your healthcare usage from the past year (medical visits, hospitalizations, procedures)
- Consider any anticipated healthcare needs for the coming year
- Identify your priorities (low premiums, comprehensive drug coverage, specific benefits)
- Use Medicare’s Plan Finder to compare available options
- Narrow down to 2-3 plans that best meet your needs
- Call those plans directly to verify your medications and providers are covered
- Make your selection before the December 7 deadline
Frequently Asked Questions
The Medicare review process raises many common questions. Here are answers to some of the most frequently asked concerns about evaluating and changing your coverage.
How much money can I typically save by reviewing my Medicare plan annually?
Savings vary widely depending on your specific situation, but many beneficiaries save hundreds or even thousands of dollars annually by switching to more suitable plans. According to Medicare research, beneficiaries who review their prescription drug coverage and switch to the plan that best meets their needs can save an average of $300-$400 per year. Those with multiple chronic conditions or who take several medications often save significantly more—sometimes $1,000+ annually.
The potential savings increase if you’re currently in a plan that doesn’t align well with your healthcare needs. For example, if you’re in a high-premium plan but rarely use medical services, switching to a lower-premium option could save substantial money. Similarly, if your current plan charges high copays for services you use frequently, finding a plan with more favorable cost-sharing for those specific services can dramatically reduce your out-of-pocket expenses.
Beyond direct financial savings, choosing a plan with benefits that match your needs can improve your overall healthcare experience and potentially your health outcomes—a value that extends beyond dollars and cents. For instance, understanding the impact of nutrition on medication effectiveness can further enhance your health management strategy.
What happens if I miss the Annual Enrollment Period but need to change my plan?
If you miss the Annual Enrollment Period but have qualifying circumstances, you may be eligible for a Special Enrollment Period (SEP) that allows you to make changes outside the standard enrollment windows. Qualifying events include moving to a new address outside your plan’s service area, losing other health coverage, qualifying for Extra Help with Medicare costs, or having both Medicare and Medicaid. In these situations, you typically have two months from the qualifying event to make plan changes.
Will switching Medicare plans affect my existing doctor relationships?
If you switch between Medicare Advantage plans, your provider network will change, potentially affecting your ability to see your current doctors at in-network rates. Before switching plans, verify that your preferred healthcare providers participate in the new plan’s network by checking the plan’s provider directory or calling your doctors’ offices directly. If you switch from Medicare Advantage to Original Medicare with a Medigap policy, you’ll gain access to any provider who accepts Medicare, which includes most doctors nationwide.
How do I know if a lower premium plan is actually a better deal?
A lower premium plan is only a better deal if the total annual costs—including premiums, deductibles, copays, and coinsurance—are lower based on your expected healthcare usage. To determine the true value, estimate how often you’ll visit doctors, what prescriptions you’ll take, and what procedures you might need in the coming year. Then calculate the total costs under each plan considering these factors, and consider the impact of nutrition on medication effectiveness as it can influence your healthcare needs.
Look beyond the premium to evaluate these critical cost components:
- Annual deductibles for medical services and prescriptions
- Copayment and coinsurance amounts for the services you use most
- Maximum out-of-pocket limits that cap your annual spending
- Coverage for your specific medications and their tier placement
- Network restrictions that might result in higher costs for out-of-network care
A plan with a $20 higher monthly premium might actually save you money if it offers lower copays for services you use regularly or places your medications in more favorable tiers.
Can my Medicare plan be canceled if I don’t review it each year?
Your Medicare plan typically won’t be canceled simply because you don’t review it. Most plans automatically renew each year unless you make a change or the plan itself is discontinued. However, if your plan is being discontinued, you’ll receive a non-renewal notice by October 2, giving you time to select a new plan during the Annual Enrollment Period.
While your coverage won’t be canceled for lack of review, failing to evaluate your options annually may mean you remain in a plan that no longer serves your needs well or costs more than alternatives. The real risk isn’t cancellation but rather missing opportunities for better coverage, additional benefits, or cost savings through more suitable options. For example, understanding the impact of nutrition on medication effectiveness could be a factor in choosing the right plan.
Annual plan reviews are about optimizing your coverage rather than preventing cancellation. By staying informed about your options, you maintain control over your healthcare decisions and ensure your Medicare coverage continues to support your changing needs.