What You Should Be Doing During Medicare Open Enrollment to Get the Best Coverage

Key Takeaways

1. Medicare Open Enrollment runs from October 15 to December 7 each year, giving you an opportunity to review and make changes to your Medicare coverage.

2. Proactively reviewing your coverage and exploring options ensures you are not overpaying or missing out on benefits you need.

Understanding Medicare Open Enrollment

Medicare Open Enrollment is a yearly period when you can make changes to your Medicare plans. Whether you’re enrolled in Original Medicare, a Medicare Advantage Plan, or Part D prescription drug coverage, this window allows you to adapt your coverage to your current healthcare needs. It’s your chance to ensure you have the best plan for the upcoming year, so don’t let it slip by. It’s also an opportunity to stay informed about evolving Medicare policies that may directly impact your plan and its benefits. Taking the time to review your options annually is one of the smartest moves you can make when it comes to your healthcare.

Why This Period Matters

The plans and costs associated with Medicare can change yearly. Premiums, deductibles, and coverage details might shift, making your current plan less suitable or even more expensive. Additionally, your personal health needs may have changed over the past year. Open Enrollment gives you the power to:

• Change from Original Medicare to Medicare Advantage or vice versa.

• Switch Medicare Advantage plans.

• Update your Part D prescription drug plan.

• Drop Medicare Advantage and revert to Original Medicare.

Ignoring this window could mean sticking with a plan that no longer meets your needs or budget. Even if you’re satisfied with your current plan, reviewing it ensures there are no unexpected changes that could affect your care or finances.

Step-by-Step: Navigating Open Enrollment

1. Evaluate Your Current Coverage

Start by reviewing your current plan’s Annual Notice of Change (ANOC) letter. This document highlights any updates to your plan’s costs, benefits, and coverage. Ask yourself these key questions:

• Are your current doctors and hospitals still covered?

• Have your prescription drug needs changed?

• Are the premiums, deductibles, or copayments increasing?

Identifying gaps or concerns in your current plan is the first step to finding a better fit. Keep a list of questions or issues you encounter during this evaluation so you can address them when exploring new plans.

2. Compare Available Plans

Medicare offers tools to compare plans online. These tools help you:

• View costs for premiums, deductibles, and out-of-pocket limits.

• Compare benefits, such as dental, vision, and hearing coverage.

• Check coverage for prescription drugs.

Make sure to consider your medical history and anticipated needs when comparing options. Plans with lower premiums might have higher out-of-pocket costs, so balance your priorities carefully. Also, look for plans that offer value-added services, such as telehealth benefits, which have become increasingly important for many beneficiaries.

3. Confirm Provider Networks

If you’re considering switching plans, verify that your preferred doctors and hospitals accept the new plan. Networks can vary significantly, and you don’t want to be caught off guard by unexpected out-of-network charges. Make a quick call to your healthcare providers to confirm whether they’re in-network under your potential new plan.

4. Check Prescription Drug Coverage

Prescription drug plans (Part D) often undergo significant changes each year. Confirm whether your current medications remain covered and compare prices across plans. Pay close attention to:

• Formulary changes (the list of covered drugs).

• Tier placements, which affect costs.

• Pharmacy networks, as preferred pharmacies often have lower copayments.

If your medication needs have changed, it’s critical to ensure the plan you select offers sufficient coverage at a reasonable cost. Additionally, some plans may offer mail-order services, which can be a convenient and cost-effective option.

5. Assess Costs Beyond Premiums

While premiums are an important factor, they aren’t the only cost to consider. Look at deductibles, copayments, and out-of-pocket maximums. For 2025, Medicare Advantage plans have a maximum out-of-pocket limit of $9,350 for in-network services. Understanding these limits can help you anticipate potential expenses. Keep in mind that unexpected healthcare costs can quickly add up, so choosing a plan with predictable costs can offer peace of mind.

Common Pitfalls to Avoid

Waiting Until the Last Minute

Open Enrollment might seem like a long window, but procrastination can lead to rushed decisions. Start early to give yourself ample time to compare plans and make informed choices. A rushed decision could leave you stuck with a plan that doesn’t fully meet your needs.

Overlooking the Annual Notice of Change

Skipping the ANOC can leave you unaware of changes that impact your costs or coverage. This document is essential reading to avoid unpleasant surprises. Take note of any changes and consider whether they align with your current and future needs.

Focusing Solely on Premiums

A low premium can be tempting, but it’s not the whole picture. Look at the total cost of a plan, including deductibles and out-of-pocket expenses. A plan with a slightly higher premium but better coverage for your prescriptions or doctor visits might be a more cost-effective choice overall.

Ignoring Extra Benefits

Some plans offer additional benefits like gym memberships, transportation services, or over-the-counter allowances. While these shouldn’t be your primary deciding factor, they’re worth considering if they align with your needs. Extra benefits can add significant value to your plan, especially if they address areas where you currently spend out of pocket.

Tips for Making the Best Choice

Use Medicare’s Plan Finder Tool

Medicare provides an easy-to-use tool to compare plans based on your ZIP code, medications, and preferences. This tool simplifies decision-making by presenting key details side-by-side. Use this feature to narrow down your options efficiently.

Consult a Licensed Advisor

If you’re feeling overwhelmed, a licensed Medicare advisor can guide you through the process. They’ll help you identify plans that align with your healthcare needs and budget. Having an expert’s opinion can provide clarity and confidence in your final decision.

Involve Trusted Family Members

Making Medicare decisions can feel complex, so involving a trusted family member or caregiver can offer valuable perspective and support. Discuss your options with someone who knows your healthcare needs and financial situation well.

Important Deadlines and Timelines

Medicare Open Enrollment spans from October 15 to December 7 each year. Changes you make during this period take effect on January 1 of the following year. Missing this window means waiting until the next Open Enrollment unless you qualify for a Special Enrollment Period due to life events like moving or losing other coverage.

What Happens If You Do Nothing?

If you don’t take action during Open Enrollment, you’ll remain in your current plan. While this might seem convenient, it can lead to:

• Higher costs if your plan’s premiums, deductibles, or copayments increase.

• Gaps in coverage if your medications or healthcare needs aren’t adequately addressed.

Being proactive ensures you’re not caught off guard by changes that could impact your health or finances. Taking no action might also mean missing out on new plans that offer better coverage or lower costs.

Medicare’s Changes for 2025

This year brings several updates that could influence your decision:

• Part D Prescription Drug Coverage: An out-of-pocket cap of $2,000 has been introduced, providing significant financial relief for high-cost medications.

• Medicare Advantage: The maximum out-of-pocket limit is $9,350 for in-network services.

• Premium and Deductible Adjustments: Be aware of updated costs for Medicare Parts A, B, and D. For example, the Part B deductible is $257 this year.

Understanding these changes helps you make the most of Open Enrollment. Familiarize yourself with these updates to identify whether they improve or diminish the value of your current plan.

Final Thoughts: Maximize Open Enrollment’s Benefits

Medicare Open Enrollment is your annual opportunity to align your healthcare coverage with your current needs. By proactively reviewing your plan, comparing options, and making thoughtful changes, you can avoid overpaying and ensure your coverage supports your health and financial goals. Start early, stay informed, and don’t hesitate to seek help if you need it. Your health deserves the best care and coverage available, and Open Enrollment is the time to make it happen.