Why a Yearly Medicare Checkup Matters

When you think about a yearly checkup, you probably think about visiting your doctor to make sure your health is on track. But there's another kind of checkup that deserves a place on your annual calendar: your Medicare checkup.

Medicare coverage isn't something you choose once and forget about. Plans can change. Prescription costs can change. Doctors and pharmacies can change networks. Your health needs can change. And your financial situation may look very different from what it did a year ago.

That's why taking a little time each year to review your Medicare coverage can be so important.

A yearly review doesn't necessarily mean you need to change your plan. Sometimes the best decision is to stay right where you are. The important thing is knowing that your coverage still fits your needs before the new year begins.

Medicare plans can change

One of the biggest reasons to review your coverage each year is that your plan can change.

Medicare Advantage and Medicare prescription drug plans send members an Annual Notice of Change, commonly called an ANOC, each fall. This notice explains changes to the plan that will take effect in January, including changes to costs, coverage and other plan details.

Those changes can include things such as:

• Monthly premiums
• Deductibles
• Copayments and coinsurance
• Prescription drug coverage
• Drug costs
• Provider networks
• Pharmacy networks
• Covered benefits
• Service areas
• Other plan rules and requirements

A plan may have been an excellent fit for you this year and still look different next year. That doesn't automatically mean the plan is bad or that you need to leave it. It simply means it is worth taking a closer look.

Think of it this way: if your insurance company is reviewing and changing the plan every year, shouldn't you be reviewing it too?

Your health can change, too

Your Medicare coverage should make sense for the person you are today, not necessarily the person you were a year ago.

Maybe your health has been stable and you haven't needed much medical care. Or maybe this year brought some unexpected changes. Perhaps you:

• Started seeing a new specialist
• Were diagnosed with a new condition
• Had surgery or another major procedure
• Started taking additional medications
• Began seeing your doctor more frequently
• Need physical therapy or other ongoing services
• Are considering a different treatment
• Started using a different pharmacy

These changes can affect what you need from your Medicare coverage.

For example, a prescription that wasn't on your medication list last year may be an important part of your healthcare today. A specialist who wasn't part of your life last year may now be someone you see regularly.

That's why a Medicare review should look beyond the monthly premium. The real question is whether your coverage still works for your healthcare needs.

Your prescriptions may have changed

Prescription coverage is another important reason to review your plan annually.

The medications you take today may not be the same medications you were taking last year. And even if your prescriptions haven't changed, the plan's formulary, pharmacy network, or your out-of-pocket costs may change.

Medicare specifically recommends reviewing your prescription coverage and comparing estimated costs when evaluating plans.

A yearly review should include questions such as:

• Are all of my prescriptions still covered?
• Is my pharmacy still preferred or in-network?
• Have my copays changed?
• Would another plan have different costs for my medications?
• Am I using a mail-order option that could save money?
• Are there other pharmacies in my area that may offer different costs?

It's easy to look at a plan and see "$0 premium" and assume you've found a great deal. But the monthly premium is only one piece of the puzzle. What matters is the overall cost of your healthcare, not just what you pay each month to have the plan.

Your doctors and specialists matter

One of the most important parts of a Medicare review is checking your healthcare providers.

If you've built a relationship with your primary care doctor, cardiologist, oncologist, orthopedic doctor, dermatologist, or another specialist, you probably don't want to discover after January 1 that something about your network or coverage has changed. Medicare recommends checking whether your doctors and pharmacies are included in a plan's network when comparing Medicare coverage.

This is particularly important for people who see several specialists or receive ongoing treatment.

Your healthcare team is part of your coverage decision. A plan shouldn't just look good on paper. It needs to work in the real world, with the doctors, prescriptions and healthcare services you actually use.

Your financial situation can change

Life changes, and so can your budget.

Maybe your income has changed. Maybe you've retired completely. Maybe you've experienced an increase in living expenses. Maybe your Social Security income is different. Or perhaps you're simply trying to find ways to make your healthcare dollars stretch a little further.

These changes are worth discussing during your annual Medicare review.

Medicare plan costs can vary significantly depending on the type of coverage, the services you use, deductibles, copayments, coinsurance and premiums.

That's why I encourage people not to make Medicare decisions based on one number. A plan with a $0 monthly premium isn't necessarily the least expensive option once you consider the healthcare services and prescriptions you actually use. On the other hand, paying a higher premium doesn't automatically mean you're getting better coverage.

The goal is to find coverage that makes sense for your individual situation.

Don't ignore the mail from your Medicare plan

Every fall, Medicare beneficiaries receive important information about their coverage.

Two documents to pay particular attention to are the Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC).

The ANOC outlines changes coming for the new plan year, while the Evidence of Coverage provides details about what the plan covers and what you pay. Medicare recommends reviewing these documents each year.

I know Medicare mail can sometimes feel overwhelming. You may open the mailbox and find what seems like a small mountain of envelopes, brochures and notices. It can be tempting to put them aside and think, "I'll deal with that later."

But those notices can contain information that affects your coverage and costs for the upcoming year. If you're not sure what you're looking at, don't ignore it. Ask questions.

What should you review during your Medicare checkup?

A good Medicare review should look at the whole picture. Consider reviewing:

Your doctors
Are your primary care doctor and specialists still participating with your coverage?

Your prescriptions
Are your medications covered, and what will they cost next year?

Your pharmacies
Are your preferred pharmacies still in-network?

Your healthcare needs
Have your medical needs changed since you originally selected your plan?

Your plan benefits
Are the benefits you actually use still included?

Your out-of-pocket costs
Have deductibles, copays or coinsurance changed?

Your monthly premiums
Has the amount you pay each month changed?

Your financial situation
Does your current coverage still make sense for your budget?

Your lifestyle
Are you traveling more? Spending part of the year somewhere else? Moving? These things can also affect the type of coverage that makes sense for you.

Medicare itself recommends comparing plans based on costs, prescriptions, providers and the services that matter to you.

This is where an independent Medicare agent can help

Medicare can be complicated, and you don't have to figure everything out by yourself.

Working with an independent Medicare agent can provide another resource when you're reviewing your options. An independent agent may be able to compare plans from multiple insurance companies rather than representing only one company's products. That can make it easier to look at different options based on your doctors, prescriptions, budget and priorities.

Medicare.gov itself lists a trusted agent or broker as one of the resources people can use when comparing Medicare plans.

A good agent should begin by asking questions, not by immediately telling you which plan to choose. They should want to understand:

• Which doctors you see
• Which prescriptions you take
• Which pharmacies you use
• What your healthcare needs look like
• What matters most to you
• What your budget looks like
• Whether anything has changed since your last review

And importantly, you should never feel pressured to change plans simply because you're having a review. Sometimes the right answer is to make a change. Sometimes the right answer is to stay exactly where you are. The value of a review is making that decision based on current information rather than simply assuming everything stayed the same.

Medicare also has rules that licensed agents and brokers must follow when marketing Medicare plans and meeting with beneficiaries.

A Medicare review doesn't have to be complicated

You don't need to become a Medicare expert to have a meaningful annual review. You simply need to be willing to ask a few questions:

• Has anything changed?
• Does my plan still cover what I need?
• Are my doctors and prescriptions still covered the way I expect?
• Are my costs still reasonable for my situation?
• Are there other options I should know about?

That's it. You don't have to understand every Medicare term before you start. You don't have to read every page of every plan document. And you certainly don't have to make a decision simply because someone tells you that you should. Take the time to understand your options.

Think of it as your annual Medicare checkup

We schedule appointments with our doctors because we understand that our health can change. Medicare deserves some of that same attention.

Your coverage is helping protect you from potentially significant healthcare expenses, so it makes sense to make sure that coverage continues to fit your life.

Your health can change. Your prescriptions can change. Your doctors can change. Your finances can change. And your Medicare plan can change.

That's why reviewing your Medicare coverage once a year can be so valuable. You may discover an opportunity to reduce your costs. You may find coverage that better fits your current needs. Or you may review everything and decide that your current plan is still the right fit.

Any of those outcomes can be a good result, because the goal isn't simply to change plans. The goal is to make sure you understand your coverage and that it still makes sense for you.

If you're approaching Medicare's Annual Enrollment Period or simply haven't reviewed your coverage in a while, consider putting a Medicare checkup on your calendar. Bring your plan information, your medication list and the names of your doctors. Then sit down with someone you trust and take a fresh look.

Because when it comes to Medicare, "I've had the same plan for years" isn't necessarily a reason not to review it. It may be the very reason you should.

Medicare plan availability, costs, benefits, provider networks and coverage rules vary by plan and location. Always review your plan documents and verify current information before making a coverage decision.

---

About the Author: Anna Ptak is a Medicare and health insurance agent based in Arizona. Anna got into the insurance business after helping her mom and Aunt Elsie navigate Medicare and seeing firsthand how confusing the process can be. Today, she enjoys helping individuals and families understand their Medicare options without all the insurance-speak and stress. When she's not talking Medicare, Anna is a wife and mom of seven who loves the outdoors, football, and dreaming about one day retiring somewhere warm in Puerto Rico. Anna's goal is simple: make Medicare a little easier to understand and a lot less overwhelming.