8 Questions to Ask Yourself Before Making Any Changes During Medicare Open Enrollment

Key Takeaways

• Asking the right questions before making Medicare Open Enrollment changes can help you avoid costly mistakes and ensure your plan fits your current healthcare needs.

• Reviewing your current coverage and comparing new options are critical steps to make informed decisions during the Open Enrollment Period.

Is Your Current Plan Meeting Your Needs?

The first question to ask yourself is whether your existing Medicare plan still works for you. Over time, your healthcare needs can change—and so can your plan’s coverage. Evaluate the following:

• Are you visiting the doctor more or less frequently than last year?

• Have your prescription drug needs changed?

• Does your plan still include your preferred doctors, specialists, or facilities?

• Are your regular healthcare providers still part of your plan’s network?

• Does your plan offer adequate access to specialized care if needed?

If your current plan doesn’t match your evolving needs, it may be time to explore alternatives. Take note of gaps or limitations that might affect your access to care in the future.

Are Your Healthcare Costs Increasing?

Review the total costs associated with your plan, not just the monthly premiums. These include deductibles, copayments, coinsurance, and out-of-pocket maximums. If you notice that:

• You’re paying more for prescriptions or doctor visits.

• Your plan’s premium or deductible has increased significantly.

• You’re nearing or exceeding your out-of-pocket maximum frequently.

• There are additional costs for services you now require more frequently, such as physical therapy or imaging tests.

It’s worth comparing other Medicare plans to find one that may better fit your budget. Even small increases in costs can add up significantly over time, impacting your financial stability.

Do You Anticipate Changes in Your Health?

Predicting your future healthcare needs is challenging but essential. Ask yourself:

• Are you managing a chronic condition that could require more frequent visits or specialized care?

• Have you scheduled surgeries, therapies, or treatments in the upcoming year?

• Are you considering enrolling in wellness programs or other supplemental care?

• Are you likely to need emergency care or hospital stays based on your current health trends?

• Is there a possibility you might require long-term care or rehabilitation services?

If the answer to any of these questions is yes, it’s a sign you should carefully review how your current plan aligns with your projected healthcare usage. Proactively planning for potential health changes can save time and reduce stress later.

Are You Taking Advantage of All Available Benefits?

Medicare plans often come with supplemental benefits, but are you using them? These may include:

• Vision, hearing, or dental coverage.

• Fitness memberships or wellness programs.

• Transportation services to medical appointments.

• Telehealth services for routine or specialty care.

• Over-the-counter allowances for health-related products.

If you’re not using these benefits or don’t find them valuable, you might want to explore plans that better match your priorities. Look for plans that focus on the benefits you’re more likely to use, ensuring you’re not paying for features that aren’t relevant to you.

Have You Reviewed Any Annual Changes to Your Plan?

Medicare plans are updated annually, and these changes can significantly impact your coverage and costs. During Open Enrollment, review your plan’s Annual Notice of Change (ANOC) to understand:

• Adjustments in premiums, deductibles, or copayments.

• Changes to covered drugs on the formulary list.

• Network modifications, such as dropped doctors or facilities.

• Revisions to supplemental benefits or services included in the plan.

• New limitations or restrictions that might affect your care.

Understanding these changes helps you avoid surprises and determine whether your current plan is still the best choice for the upcoming year. Even minor changes can influence the suitability of your coverage.

Are You Considering the Prescription Drug Costs?

Prescription drug coverage under Medicare Part D is vital for many beneficiaries. Ask yourself:

• Have your medications been added or removed from your plan’s formulary?

• Are your prescriptions still classified in the same pricing tier?

• Have drug costs pushed you into the catastrophic coverage phase or the new $2,000 cap?

• Are there alternatives or generic options that could lower your costs?

• Does your pharmacy offer preferred pricing under your plan?

If your drug costs are rising, it’s time to compare Part D plans or review options that bundle drug coverage with Medicare Advantage. Paying close attention to formulary details can prevent unexpected expenses.

Is Medicare Advantage or Original Medicare the Better Fit for You?

Medicare Advantage (Part C) and Original Medicare have distinct benefits. Evaluate your lifestyle and healthcare preferences:

• Do you need additional benefits like dental or vision that aren’t included in Original Medicare?

• Are you comfortable with the network restrictions of a Medicare Advantage plan?

• Do you prefer the flexibility of seeing any provider that accepts Medicare nationwide?

• Does the cost structure of Medicare Advantage (e.g., copayments and out-of-pocket maximums) align with your budget?

• Are you frequently traveling or living part of the year in another state, requiring broader coverage options?

Balancing these factors helps you decide whether a switch to or from Medicare Advantage makes sense for your needs. Your decision should prioritize both coverage and cost-effectiveness.

Have You Checked for Plan Availability in Your Area?

Medicare plan availability can vary by location. During Open Enrollment, check:

• Are there new plans being offered in your area?

• Has a plan you’re considering expanded its service area?

• Do you need a plan that offers nationwide coverage for frequent travel?

• Are there unique local benefits available that might enhance your coverage?

• Does your current plan have limitations specific to your region that other plans may not?

Your ZIP code plays a major role in the coverage options available to you, so researching local and regional plans is essential. Local factors, such as provider availability and regional cost structures, can significantly impact your decision.

Wrapping Up Your Medicare Open Enrollment Decisions

Taking the time to ask these eight questions ensures that you’re making informed decisions about your healthcare coverage. By evaluating your current plan, anticipating future needs, and comparing new options, you can confidently select the Medicare plan that works best for you in 2025. Remember, the effort you put into this process now can lead to better health outcomes and financial security throughout the year.