Medicare changes call for coverage review

If you have Medicare, you may assume that once you’ve chosen your coverage, you can simply leave it alone. Unfortunately, that can be an expensive assumption.

Medicare costs, benefits, prescription coverage, provider networks and plan rules can change from one year to the next. And your own health, medications and financial circumstances can change.

That’s why an annual Medicare review is worth your time.

Start with Parts A and B

For Original Medicare, review the annual changes to your Part A and Part B costs, including premiums, deductibles and coinsurance.

If You Have Medicare Advantage

This is where an annual review can become especially important.

Don’t look only at the monthly premium. Check the plan’s deductible, copays, coinsurance and maximum out-of-pocket limit (MOOP). Then make sure your doctors, specialists and hospitals are still in the plan’s network.

Review the plan’s dental, vision, hearing and other supplemental benefits, but don’t let those extras overshadow the costs you could face when you actually need medical care.

A plan that looks attractive because it offers generous extras may not be the best choice if your doctors aren’t in network.

Don’t forget your prescription plan

Part D is one area where an annual review is particularly important. Your plan’s premium, deductible, drug tiers, formulary and pharmacy network can change from year to year.

For example, in 2027, the annual Part D out-of-pocket threshold is increasing from $2,100 to $2,400. This is the amount of qualifying out-of-pocket spending, known as True Out-of-Pocket (TrOOP), that generally must be reached before you enter catastrophic coverage.

Once you reach that threshold, you pay no cost-sharing for covered Part D drugs for the remainder of the year.

Of course, not everyone will spend $2,400 on prescriptions. But if you take several expensive medications, it’s important to compare not only the monthly premium, but also what your specific drugs will cost under each plan, and what Tier level they fall under. This is important because in 2027, the Part D Deductible for Tier 3 and above medications is increasing from $615 to $700.

Review every medication you take against your plan. The plan with the lowest premium isn’t necessarily the plan with the lowest overall cost.

Have a Medicare supplement / MEDIGAP?

Medicare Supplement Plans are not limited in any way by enrollment periods, so they can be reviewed any time of year. If you have a Medigap policy, your benefits generally haven’t changed—but your premium may have.

Check your current premium and any rate increase. It may be worthwhile to see how your premium compares with other companies offering the same standardized Medigap plan.

However, changing Medigap policies isn’t as simple as changing Medicare Advantage plans. Medigap policies are underwritten, meaning the company can review your health status, and approve or deny new coverage—but they can’t take away the existing coverage.

Your health can affect whether you qualify for a new policy, so don’t cancel an existing policy until you understand your options. An insurance broker can compare/contrast rates for you.

Finally, review you

Medicare isn’t the only thing that changes. Did you start taking new medications? Change doctors? Move? Retire? Have a significant change in income? Lose employer coverage? Experience a change in your health?

Any of these could affect whether your current coverage remains the best fit.

Medicare isn’t something you choose once and forget about. It’s something worth reviewing as your health, finances and Medicare itself change. The Annual Enrollment Period isn’t necessarily about changing your Medicare coverage. It’s about making sure the coverage you have still makes sense for you.

Nanette Makrauer is an independent insurance broker and Certified Medicare Advisor residing in Bluffton. nanette@health-wealth-insurance.com. www.health-wealth-insurance.com.