Is It Time to Switch Your Medicare Plan?

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The Medicare Annual Enrollment Period (AEP) has started — have you thought about taking this opportunity to weigh your options for Medicare coverage? If not, here are a few things to consider.


1. Are your current plan's costs or benefits changing?

Medicare Advantage and Part D prescription drug plans may change their premium costs, out-of-pocket cost limits, deductibles, networks, the list of prescription drugs they cover (formularies), and other benefits each year. These changes can affect how much you pay out of pocket for Medicare coverage in the upcoming year, so it's important to check with your plan to see what's changing. If your coverage is changing and you want to find a plan that better fits your health and financial needs, you can do so during AEP.

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2. Are you on new medications?

If you don't currently have a Medicare prescription drug plan (either through a Medicare Advantage plan or a Part D plan) and have been prescribed new medication(s), you may want to consider adding prescription drug coverage during AEP. Otherwise, you could be responsible for the full cost of your prescriptions.

If you currently have Medicare prescription drug coverage, then you know your plan's formulary determines which prescription drugs it covers. Check to make sure your plan's formulary covers your new medications. If it doesn't, you may want to consider what other plans cover.

3. Are you looking to switch doctors?

Some Medicare Advantage plans, like HMO plans, require you to go to doctors and other health care providers that are in the plan's network. If you're looking to switch to a new primary care doctor or specialist, for example, and you have a plan that requires you to stay in-network for care, then you'll want to make sure your new doctors qualify as in-network with your plan. If they don't, you may want to switch to a plan that doesn't have network restrictions or has the doctors you want to see in-network.

4. Are you traveling outside of the U.S. in the upcoming year?

You probably won't need medical care while on vacation outside of the country, but it's better to be safe than sorry. Some Medicare Advantage plans may cover health care services you receive in a foreign country, but not all. If you're planning a trip outside of the U.S., you'll want to check your plan to see if you'll be covered for health care received at your vacation spot. If you're not covered and you want overseas coverage, take advantage of AEP to find a plan that offers this benefit.

5. Do you have any surgeries or tests scheduled?

Your out-of-pocket costs for surgeries, tests, and procedures will depend on your specific plan's rules and restrictions. If you have a surgery scheduled for the upcoming year, be sure to call your plan to get an estimate of what the surgery will cost you. If that estimate is beyond your budget, you can shop for a new plan that may offer better coverage for these services.

AEP gives you the chance to choose a plan that meets your needs, so if you're not 100% satisfied with your current plan, don't miss your opportunity to enroll in a better one.

Rachel Quetti is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Rachel isn't trying out new fitness classes, she is cooking up fun, (mostly) healthy recipes in the kitchen. Rachel lives in Watertown, Massachusetts and has a degree in journalism from the University of Massachusetts, Amherst.

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