Medicare Yearly Enrollment: Do You Need to Review Your Plan Every Year?

Why should you review your Medicare plan every year?

Medicare plan review matters because your coverage needs and your plan details can both change. A plan that worked well last year may still be a good fit, but it should not be assumed without checking.

This is especially important if you have:

• Medicare Advantage, also called Part C, which is an alternative way to receive Medicare benefits through a private plan approved by Medicare.
• Medicare Part D, which helps cover prescription drugs.

Even if your health has not changed, your doctors, prescriptions, preferred pharmacy, premiums, copays, deductibles, and plan rules may be different for the next year.

What can change in a Medicare Advantage or Part D plan?

Medicare health and drug plans may change important details for the upcoming year. These changes can affect how convenient or affordable your coverage is.

During an annual review, look for changes in:

• Premiums, which are monthly amounts you pay for coverage.
• Deductibles, which are amounts you may pay before the plan starts paying.
• Copayments and coinsurance, which are your share of costs when you receive care or fill prescriptions.
• Provider networks, meaning the doctors, hospitals, and other providers that participate in the plan.
• Drug formularies, meaning the list of covered prescription drugs.
• Pharmacy networks, including whether your pharmacy is preferred or standard in the plan.
• Prior authorization, step therapy, or quantity limits for certain drugs or services.

What is the Annual Notice of Change?

If you are enrolled in a Medicare plan, the plan sends a Plan Annual Notice of Change, often called an ANOC, each fall. This notice explains changes in coverage, costs, and other plan details that take effect in January.

Do not ignore this notice. Compare it with your current use of care and prescriptions. If your drug moves to a higher cost tier, your doctor leaves the network, or your pharmacy is no longer preferred, you may want to compare other options during Open Enrollment.

When can you change Medicare plans?

Medicare Open Enrollment runs from October 15 through December 7 each year. Changes made during this period generally take effect January 1 of the next year, as long as the plan receives the enrollment request by the deadline.

During Open Enrollment, depending on your current coverage, you may be able to:

• Switch from Original Medicare to a Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan back to Original Medicare.
• Change from one Medicare Advantage Plan to another.
• Join, switch, or drop a Medicare Part D drug plan.

Some people may also qualify for a Special Enrollment Period because of certain life events, such as moving or losing other coverage. Those rules depend on the situation.

What should you check before keeping your current plan?

If you are considering staying with your current Medicare plan, review the details before deciding no action is needed.

• Make a current list of your prescription drugs, including dosage and frequency.
• Confirm whether each drug is covered and what your estimated cost may be.
• Check whether your doctors, hospitals, specialists, and pharmacy are still in the plan network.
• Review the plan premium, deductible, copays, coinsurance, and out-of-pocket limits where applicable.
• Look at coverage rules, such as referrals, prior authorization, or pharmacy restrictions.
• Consider any expected changes in your health care needs for the coming year.

Medicare.gov Plan Compare and 1-800-MEDICARE can help compare available plans. Your local State Health Insurance Assistance Program, or SHIP, may also provide free and unbiased Medicare counseling.

What if you have Original Medicare or Medigap?

If you have Original Medicare, your core Part A and Part B coverage is not selected through the same annual plan shopping process as Medicare Advantage. However, you may still need to review your Part D drug plan each year if you have one.

If you have a Medigap policy, also called Medicare Supplement Insurance, changing policies can be more limited than changing Medicare Advantage or Part D plans. In many cases, switching Medigap outside certain protected periods may involve medical underwriting or may not be available on the same terms. Rules can vary by state and situation.

For that reason, review carefully before dropping Medigap or switching from Original Medicare with Medigap to Medicare Advantage. The best choice depends on your health needs, budget, location, and access preferences.

Do you have to change your Medicare plan every year?

No. Reviewing your Medicare plan does not mean you must change it. If your current plan is still offered and still fits your needs, you may decide to keep it.

In many cases, if you keep your current Medicare health or drug coverage and the plan continues, you do not need to do anything for that coverage to continue. The key is to confirm that the plan remains suitable for the coming year before Open Enrollment ends.

Official Sources