How the Medicare Drug Price Reforms Are Reshaping Part DThe annual Medicare open enrollment period runs every fall, and some enrollees will need to take action to avoid getting stuck in a plan that doesn’t meet their needs. Once you receive your Annual Notice of Change, you’ll know what’s shifting in your plan for the coming year — and if you don’t like what you see, you have options.
Key Takeaways
- Insurers sometimes discontinue Medicare plans or cut specific benefits due to financial pressure, so it’s worth reviewing your coverage every year — even if you were happy with it last year.
- Your Annual Notice of Change (ANOC), typically mailed in September, is the official document that spells out exactly what’s changing in your plan for the coming year.
- Common ANOC changes include shifts to your premium, out-of-pocket costs, extra benefits (like dental or gym memberships), prescription coverage, and provider networks.
- Losing access to your current doctor, pharmacy, or hospital is one of the most consequential changes to watch for, since switching plans may be the only way to keep them.
- The Medicare annual enrollment period runs from October 15 to December 7 every year, giving you a defined window to switch plans if your current one no longer fits.
- Working with an independent Medicare agent costs beneficiaries nothing and can help you compare options even if your plan hasn’t changed at all.
Why Medicare Enrollees Should Pay Extra Attention Each Year
In response to financial pressure, Medicare insurance companies sometimes drop certain benefits from year to year. It’s possible that your Medicare plan could be discontinued, or that it will continue to be offered with some benefits cut.
For people who depend on Medicare, this can be stressful. However, there are still options. In a recent plan year, CMS projected that 97% of Medicare beneficiaries would have access to 10 or more Medicare Advantage plan choices — a reminder that even when your specific plan changes, alternatives are almost always available.
Will Your Medicare Plan Change This Year?
To see if your Medicare Advantage or Medicare Part D plan is changing, check your Annual Notice of Change (ANOC). This is a letter that your plan sends out each September, detailing any plan changes. Any changes go into effect starting January 1.
Possible changes could impact:
- Your Premium. Your monthly premium may go up or down.
- Out-of-Pocket Costs. Look for changes to your copays (the amount you pay when you access care or buy a prescription) and your out-of-pocket maximum (the most you will be required to pay for covered care during a plan year).
- Extra Benefits. Many Medicare Advantage plans provide benefits that are not required under Medicare rules, and these benefits can change. For example, some plans offer gym memberships or dental benefits. Your plan may be adding or cutting benefits.
- Prescription Coverage. The amount you pay for certain prescriptions could be changing. There could also be changes to your deductible (the amount you pay out of pocket before your plan benefits apply).
- Provider Networks. Most plans use networks of providers, medical facilities and pharmacies. If you don’t treat within these networks, you may have to pay more, and your care may not be covered.
If you have not received your Annual Notice of Change yet, contact your plan. You will need this information to make good decisions during open enrollment.
What if You Don’t Like Your Medicare Plan Changes?
When you receive your Medicare ANOC, review the plan changes to determine how they will impact you.
- Are you losing access to your doctor, pharmacy or hospital? If a primary care and specialty doctor you see is no longer in network, you may need to decide between switching to a plan that includes them or finding a new doctor. The same goes for the pharmacy or hospital you use.
- Are your costs increasing? If your premiums or out-of-pocket costs are increasing, you need to determine whether you can budget for the increase. If you can’t, you may be able to find a more affordable plan option. (If you’re really struggling with costs, you can also see if you qualify for the Medicare Savings or Extra Help programs.)
- Are your benefits being cut? If your plan is cutting benefits, consider whether you actually used these benefits or were planning to use them in the new year. If you want the benefits that are being cut, you can look for another plan that still offers them.
- Is your plan being discontinued? If your plan will no longer be offered, you should find a new plan.
Make the Most out of Your Medicare Enrollment Period
The annual Medicare enrollment period runs from October 15 to December 7 every year. This is your opportunity to find the right plan for your needs, so don’t let it pass you by.
- If you are unhappy with your plan changes, explore your options to see if there’s another plan that suits your needs.
- Even if you are happy with your plan, consider exploring your options. It’s possible that there’s another plan that is an even better fit for you. You won’t know unless you look.
An independent agent can help you understand your plan changes and explore your plan options. Even if your plan hasn’t changed, it’s good to have a second opinion, and independent agents do not charge beneficiaries for guidance. In our experience, the people most likely to regret skipping a plan review are those who assume “no news is good news” — but if you didn’t specifically check for a discontinuation notice, it’s worth confirming your plan is still being offered at all.
Don’t Navigate Open Enrollment Alone
Do you need help with Medicare enrollment? Heffernan Insurance Brokers can guide you through the process and help you make an informed decision — and if you want a refresher on the enrollment windows themselves or how to avoid common enrollment mistakes, those guides are a good next stop too.
