Each fall, Medicare patients get a chance to switch their insurance plans. But only about 10 percent actually do. And that means millions of people are potentially missing out on thousands of dollars of savings and leaving themselves open to nasty surprises about their benefits or health care choices.
“People’s medical needs change as they grow older, and their plans [and what they cover] may change from year to year,” says Tricia Neuman, senior vice president of the nonprofit Kaiser Family Foundation and director of its program on Medicare policy. “Reviewing the options each year makes a lot of sense.”
Here are some common situations that might cause you to consider a change during the annual open enrollment window, from Oct. 15 to Dec. 7. Answers are based on interviews with several Medicare experts and guidance from Medicare itself.
And a reminder: Switching from a Medicare Advantage (MA) plan to original Medicare (OM) carries a big risk if you intend to buy a Medigap policy that covers expenses Medicare doesn’t. In most states, Medigap insurers can turn you down due to preexisting conditions, or charge you more based on your health or age, if you’ve had Medicare Part B for more than six months. Factor that into your decision-making.
1. My prescription costs have jumped.
That happens usually due to one of two scenarios: You’ve been prescribed a new drug your Plan D policy doesn’t cover, or your current medicines have fallen off your Plan D’s formulary (list of covered medicines), Neuman says. Each September, Part D prescription plans will send out a list of changes to drug coverage, giving you time to make sure your medicines are still covered. If not, you can shop around for another plan or ask your doctor to apply for an exception in covering your favored medicine.