Do Not Wait Until October: Your 5-Step Medicare Review Checklist

Your Medicare plan may not stay the same from one year to the next.

Premiums, copays, prescriptions, provider networks, pharmacies, and extra benefits can change. These changes can affect you even when you decide to remain enrolled in the same plan.

Medicare Open Enrollment runs from October 15 through December 7 each year. During this period, eligible Medicare beneficiaries can make certain changes to Medicare Advantage and Medicare prescription drug coverage. Changes generally take effect on January 1. Don't wait until October 15 to begin preparing.

Here are five things to review before Medicare Open Enrollment begins.

1. Read Your Annual Notice of Change

If you are enrolled in a Medicare Advantage or Medicare prescription drug plan, your plan will send you an Annual Notice of Change, commonly called the ANOC.

This notice usually arrives in September. It explains changes that will take effect in January, including possible changes to:

• Monthly premiums

• Medical copays

• Prescription costs

• Deductibles

• Covered services

• Provider networks

• Pharmacy networks

• Extra benefits

• The plan’s service area

Medicare also provides an Evidence of Coverage document. This document gives more complete information about what the plan covers, what you may pay, and how the plan operates.

Look for the words Annual Notice of Change on the cover. Read the summary of changes and mark anything that affects the services you use.

2. Check Your Doctors and Hospitals

Your doctors are one of the most important parts of your Medicare review.

Make a list of every provider you want to continue seeing, including your:

• Primary care physician

• Cardiologist

• Oncologist

• Orthopedic doctor

• Neurologist

• Eye doctor

• Preferred hospital

• Outpatient clinic

• Medical group

• Laboratory

A provider may accept Medicare but not accept every Medicare Advantage plan.

There is also a difference between a doctor accepting your insurance and a doctor being considered in-network. Using an out-of-network provider may result in higher costs or no coverage, depending on your plan.

Check the plan’s current provider directory, but do not stop there. Call the provider’s office and ask whether the provider expects to remain in the plan’s network during the coming year.

When speaking with the office, provide the complete name of the plan—not just the insurance company’s name.

3. Review Every Prescription

Do not compare Medicare drug coverage without entering your complete medication list.

For every prescription, write down:

• The medication name

• The dosage

• How often you take it

• The quantity you receive

• Whether you prefer a 30-day or 90-day supply

• Your preferred pharmacies

A plan’s covered-drug list is called a formulary. Formularies can differ from one plan to another.

A prescription may be:

• Covered by one plan but not another

• Placed on a different drug tier

• Subject to prior authorization

• Subject to quantity limits

• Subject to step therapy

• Less expensive at a preferred pharmacy

• Less expensive through mail order

Do not choose coverage based only on the monthly premium.

A plan with a low premium could cost more during the year if it charges more for the prescriptions you take.

4. Compare Your Total Costs

The monthly premium is only one part of your Medicare expenses.

Depending on your coverage, you may also pay:

• Medical deductibles

• Prescription deductibles

• Primary care copays

• Specialist copays

• Urgent care copays

• Emergency room copays

• Hospital copays

• Outpatient surgery costs

• Diagnostic testing costs

• Prescription copays or coinsurance

• Out-of-network costs

Medicare Advantage plans also have an annual maximum out-of-pocket limit for covered Part A and Part B services. However, the amount can vary by plan, and prescription drug spending is generally tracked separately.

Think about the services you are most likely to use.

Someone who rarely visits a doctor may evaluate costs differently from someone who regularly sees several specialists or receives frequent treatments.

The goal is not simply to find the lowest premium. The goal is to understand what the coverage could cost based on your health needs.

5. Decide Which Benefits Matter to You

Some Medicare Advantage plans may include additional benefits that Original Medicare generally does not cover.

Depending on the plan and your eligibility, these may include:

• Routine dental care

• Vision services

• Hearing benefits

• Over-the-counter allowances

• Transportation

• Fitness programs

• Meal benefits

• In-home support

• Telehealth services

Do not select a plan based only on an advertisement or one attractive benefit.

Ask these questions:

• What exactly is covered?

• Is there an annual allowance?

• Which providers can I use?

• Is prior approval required?

• Are there limits or exclusions?

• Do I qualify for the advertised benefit?

• Will I realistically use it?

Supplemental benefits vary by plan, service area, and eligibility. Some benefits shown in advertisements may not be available to every Medicare beneficiary.

Your Medicare Review Timeline

July and August

Begin gathering your information:

• Doctors

• Hospitals

• Prescriptions

• Pharmacies

• Recent medical bills

• Current insurance cards

• Questions about your coverage

September

Watch for your Annual Notice of Change and Evidence of Coverage.

Read the summary of changes and note anything that concerns you.

Beginning in October

Information about plans for the coming year becomes available. You can begin comparing costs, provider networks, drug coverage, and benefits. CMS states that information about next year’s plans becomes available beginning in October. 5 Through December 7

Medicare Open Enrollment is the period when eligible beneficiaries can make certain changes to Medicare Advantage and Medicare drug coverage.

A change submitted by December 7 generally becomes effective January 1.

You do not have to change your coverage simply because Medicare Open Enrollment has arrived.

The purpose of an annual review is to verify that your existing coverage still meets your needs.

After comparing your options, you may decide that your current plan remains suitable. The important point is to make that decision after reviewing the facts—not because you assumed nothing changed.

Important Medigap Reminder

Medicare Open Enrollment does not automatically give everyone a guaranteed right to purchase or change a Medicare Supplement, also called Medigap.

Depending on your situation and state, changing Medigap coverage may involve medical underwriting. Do not cancel an existing Medigap policy until you understand whether a replacement policy has been approved and when it will become effective. Before October 15

A proper Medicare review should consider more than premiums and extra benefits.

It should examine your:

• Doctors

• Hospitals

• Prescriptions

• Pharmacies

• Medical costs

• Drug costs

• Travel needs

• Preferred type of coverage

Preparing early gives you time to ask questions and compare your choices without feeling rushed.

Request Your Medicare Review

Whether you are already a client or are looking for Medicare guidance, our office can help you organize your information and understand the available choices.

Call Senior Help And You, LLC at 520-252-5275.

Schedule your Medicare review with me HERE

Albert Ferrin, RSSA®
Your Medicare Coach
Senior Help And You, LLC
Trusted and Referred by Seniors and Retirees
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