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Maximize Medicare with an annual review

🕐 3 min read

Greek philosopher Heraclitus stated, “The only thing that is constant is change,” and that goes for your Medicare plan, too. While you don’t need to sign up for Medicare each year, it’s important to know whether your coverage is still the best fit for you in the rapidly changing health care landscape.

In addition to changes in your current plan, each year there are new health plan and prescription drug coverage choices. Reviewing your options annually helps you determine whether you have the right coverage to meet your needs.

A few questions to help with your annual evaluation:

Has your current policy changed?

If you have a Medicare Advantage plan or a stand-alone Part D plan, you should receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from your current providers. If you have Original Medicare, take a look at next year’s Medicare & You handbook to understand all of your Medicare costs, benefits and options for 2016.

Prices change year to year, so review your current rates and what you can expect to pay in the coming year. There may be alternative plans with lower costs available in your area.

Is your current plan still available in your area?

In some cases, your current plan may no longer be available, which means you must select a new plan – or you may default to another plan chosen by the Centers for Medicare & Medicaid Services. This is also possible if you’ve moved to a new area not covered by your current plan.

Has your health changed?

If you developed a health condition in the last 12 months, are taking new or different prescriptions, or now need ongoing visits to a specialist, you should find out whether the plan you have – or decide to purchase – will give you the coverage you need.

Are your doctors covered?

This is a key reason to check your Medicare plan annually. Physicians may retire or relocate, and medical facilities may change their terms for Medicare beneficiaries. If having access to a specific doctor or medical center is important to you, make sure they are in your plan’s network.

What about your medications?

Medicare plans can alter the drugs, procedures and conditions they cover from year to year. For example, your Medicare Part D plan may no longer cover the prescription drugs you need, or it may put restrictions on how and where you purchase them.

Even if you are satisfied with your current Medicare coverage, you should look at other Medicare options that may better suit your needs. For example, even if you are satisfied with your current Medicare Advantage or Part D plan, check to see whether there is another plan in your area that will offer better health and/or drug coverage at a more affordable price or with fewer restrictions.

Medicare annual open enrollment runs from Oct. 15 through Dec. 7 for coverage starting Jan. 1, 2016. With the busy holiday season, it’s easy for time to get away from you. Many people feel overwhelmed, so they simply select Original Medicare and then maybe pick a prescription drug plan and supplemental plans their friends or family have recommended. But since each person’s health situation is different, this strategy may end up costing you more since the coverage doesn’t fit your needs. It’s important to review your Medicare plan options to help ensure that you have the right coverage.

You can search through web sites such as or contact insurance companies directly to get information about the plans they offer. However, it’s easiest to speak with a licensed insurance agent who represents many carriers with multiple plans to provide you with a wide array of options. A licensed agent (like those with my company, HealthMarkets) provides a personalized evaluation of your needs and can make recommendations on the solution that’s best for you to help you navigate Medicare like a pro.

Michael Z. Stahl is the senior vice president and chief marketing officer of HealthMarkets Insurance Agency, an independent health insurance marketplace in North Richland Hills.

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