When Should You Consider Changing Your Medicare Plan, Supplement, or Part D Coverage During Open Enrollment?

The Medicare Open Enrollment Period (October 15 - December 7) is the ideal time to review your coverage and make any changes to your Medicare Advantage, Medicare Supplement (Medigap), or Part D prescription drug plans. Here’s when you should consider making a switch:

1. Your health needs have changed

Health conditions and medications can change, and your prior coverage may no longer be the most cost-effective or provide access to the care you need within your network.

• Medicare Advantage: Check if your current plan covers your new healthcare needs or medications. Make sure that your preferred doctors remain in-network. If you are currently enrolled in Medicare Advantage, you can change to a new plan (adding or removing drug coverage) or return to Original Medicare during two Open Enrollment Periods: between October 15 and December 7 and between January 1 and March 31.

• Medigap: If you use Original Medicare with a supplement, in most cases, changing your Medigap policy due to a change in your healthcare needs will require medical underwriting. This means that insurers can evaluate your health history and potentially deny coverage or charge higher premiums based on any pre-existing conditions. If you are outside of your initial Medigap enrollment period or a particular enrollment period that grants you guaranteed issue rights, then this likely means you’ll need to stick with your current plan and plan accordingly.

• Part D: If your medication list has changed, compare Part D plans to see if another offers better prescription coverage or a lower deductible. You can always change Part D plans during open enrollment without medical underwriting.

2. Your plan’s coverage/costs have changed, or new plan options exist in your area.

Plans can adjust their premiums, drug formularies, and other details each year. Reviewing the “Annual Notice of Change” (ANOC) is crucial.

• Medicare Advantage: Evaluate changes in costs, coverage, or provider networks. If your plan’s expenses have increased or coverage has decreased, look at other options. Medicare Advantage plans are constantly changing, and new plans may include additional benefits like dental, vision, or hearing coverage. Even if your current plan has worked well, see if newer options offer better value.

• Medigap: Medigap plans are standardized and don’t change from year to year, but their premiums might. If costs have increased, you can shop for another supplement (requires medical underwriting in most cases) or explore a switch to Medicare Advantage (no underwriting). However, remember that you may be unable to switch back to Medigap once you leave it.

• Part D: Every year, Part D plans can change their formularies, premiums, and copays. If your current plan’s premium has increased or it no longer covers your medications affordably, it’s time to explore new options.

3. You’re moving to a new area

Relocation can impact your Medicare options, especially for region-specific plans.

• Medicare Advantage: If you’re moving, you’ll need to see if your current plan is available in your new area or if a different plan might offer better coverage. You may also be allowed to buy specific Medigap plans without underwriting. Under special situations, such as moving out of your Medicare Advantage Service Area, you can be granted guaranteed issue rights, enabling you to switch back to Original Medicare with a Medigap supplement without medical underwriting.

• Medigap: Medigap policies are portable, but premium costs vary by location, so check prices in your new area.

• Part D: Part D plans are also region-specific. If you’re moving to a new area, review the available plans to ensure access to a good network of pharmacies and drug coverage.

Use the Open Enrollment Window Wisely

Even if you’re happy with your current coverage, taking time during Open Enrollment to review your options can ensure that you’re getting the best plan for your needs. Whether you’re switching due to cost, coverage, or convenience, being proactive can help keep your healthcare secure and affordable.