Top Reasons to Review Your Medicare Plan and Drug Coverage Each Year

• by David Levine
• January 12, 2024
• Reviewed by John Krahnert

While No one claims that understanding Medicare is easy. Researching and enrolling in the right plan for you can be a daunting challenge. You might think that once you’re in, you’re done. But that’s not the case!

If you want to ensure that your coverage still fits your needs from year to year, then you should read this guide on what you should review about your Medicare plan and your Medicare drug coverage every year.

That’s because the Centers for Medicare & Medicaid Services (CMS) changes the rules and regulations for coverage every year.

If you have a private Medicare Advantage (Medicare Part C) plan and/or Medicare Part D prescription drug coverage, your plan carrier may also change aspects of your plan for the upcoming year. This can be true for your basic medical coverage and, often most important, for your prescription drug coverage.

For these reasons, it’s important to review your plan every year to ensure it meets your coverage needs.

How to review your Medicare prescription drug coverage

Some of the most important changes to your Medicare plan coverage from one year to the next can affect your prescription drug coverage.

Every year, Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage review the drugs they choose to cover (which are listed in the plan formulary) and how they are priced (which tier they’re on in your plan formulary).

For example, a drug you take may be moved from tier 1 of your plan – typically the formulary tier with the lowest drug costs for you – to tier 2 or 3, which may typically require a higher copayment requirement.

In addition, rules for prior authorization from your doctor may change. Or your plan may enter into an agreement with a particular pharmacy for better pricing. If that pharmacy isn’t an option for you, you may end up paying more than you have to. 

Also, new Medicare plans may enter the marketplace in your area that feature different formularies and different tiers than your current plan. These changes could potentially significantly impact what drugs are covered and how much they cost you if you were to switch to the new plan.

Is Your Plan Still Right for You?

If you don’t like some of the changes to your Medicare plan this year, you can consider comparing coverage options and shopping for plans. When you do, you may find plans in your area that:

• Cost less
• Cover your prescription drugs
• Include your doctors and pharmacy in the plan
• Offer extra benefits that Original Medicare (Medicare Part A and Part B) doesn’t cover, like vision and/or hearing, dental or others

Keep in mind that Medicare Advantage plans that offer additional benefits may not be available in all areas.

Comparing plans online or by calling to speak with a licensed insurance agent also allows you to get:

• An estimate of your out-of-pocket costs
• Quality and customer service ratings from current plan members

When reviewing your Medicare plan coverage, have the full list of all your prescription drugs and dosages handy. Check to see that your medications are on the formulary of any new plans you’re considering, and compare the costs at more than one pharmacy.

Remember to compare not only the monthly premium for different plans, but also monthly copayments and whether there are any other restrictions, like step therapy or quantity limits.

Important Medicare enrollment dates

 CMS recommends you mark your calendar with these important Medicare enrollment dates and tasks:

• September and October – review and compare plans
  Carefully look over any notices from your plan about changes for next year. These notices will come to you in the mail in the “Annual Notice of Change (ANOC)” letter. Find and compare plans available where you live that meet your needs for the coming year.
  
  
• October 15 – Open Enrollment begins
  The fall Medicare Open Enrollment Period (also called the Annual Election Period, or AEP) is the one time every year when most Medicare beneficiaries are allowed to make changes to their health and drug plans for the next year (unless they qualify for a Special Enrollment Period). October 15 is the first day you can change your Medicare coverage for next year during open enrollment.
  
  
• December 7 – Open Enrollment ends
  December 7 is the last day of the open enrollment period, and typically it’s the last day you can change your Medicare coverage for the following year. The plan has to get your enrollment application by December 7, so you need to make your decision in time to meet that deadline.
  
  
• January 1 ­– Coverage begins
  If you switch to a new plan, the new coverage begins January 1. If you remain with the same plan, any changes to coverage, benefits or costs for the new year also will begin on January 1.
  
  
• January 1-March 31 – Medicare Advantage Open Enrollment Period
  Between January 1 and March 31, a Medicare Advantage Plan member can leave that plan and switch to another Medicare Advantage Plan, with or without drug coverage, or to Original Medicare (Part A and Part B).
  
  If you switch to Original Medicare during this period, you can also join a Medicare drug plan (Part D). Your coverage will begin the first day of the month after the plan gets your enrollment form.

In certain cases, you may be able to make other changes to your coverage if you qualify for a Special Enrollment Period.

How do you change Medicare plans?

Compare plans for free online, or call today to speak with a licensed insurance agent who can help you compare Medicare plans available where you live.

We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

About the author

David Levine is an award-winning writer and editor whose work has been featured in the New York Times, New York Daily News, Sports Illustrated, American Heritage, U.S. News & World Report and others.

David has covered health, health insurance and health policy topics – among many others – since 2017. He earned a Bachelor's Degree in English from the University of Rochester and currently lives in Albany, New York.

 

LinkedIn: David Levine

 

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