Medicare’s annual Fall Open Enrollment Period, running from October 15th to December 7th each year, is the best time for you to review and optimize your Medicare-related coverage.
This is a great opportunity for you to potentially save money, improve your benefits, and possibly both! But sadly, studies show that more than half of Medicare beneficiaries don’t take advantage of open enrollment. That means they miss out on the chance to find better, more relevant coverage and save money.
Don’t be one of them. Your needs change. Plans change. Pricing changes.
It’s a good idea to keep your Medicare strategy up to date by shopping around each year. This blog post will walk you through the process.
Why Annual Reviews Matter
Medicare plans can change from year to year, affecting costs, coverage, and provider networks.
Your health needs may also evolve, making it essential to reassess your coverage regularly. By taking a close look at your Medicare strategy every year or two, you could:
- Find plans with lower premiums or out-of-pocket costs
- Ensure your preferred healthcare providers remain in-network
- Gain access to additional benefits not covered by Original Medicare
- Optimize prescription drug coverage based on your current medications
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Your Annual Medicare Review: Step-By-Step
Step 1: Examine Your Annual Notice of Change (ANOC)
Each year in September or so, your current Medicare Advantage or Medicare Supplement carrier will send you an Annual Notice of Change (ANOC) letter in September.
This document outlines any changes to your coverage, costs, or service area for the coming year.
Pay close attention to:
- Premium changes
- Deductible and copayment adjustments
- Modifications to your plan’s drug formulary
- Changes in provider networks
Step 2: Assess Your Current Health Needs
Consider any changes in your health status or anticipated medical needs for the upcoming year. This might include:
- New diagnoses or ongoing health conditions
- Planned surgeries or treatments
- Changes in prescription medications
Step 3: Evaluate Part D Prescription Drug Plans
Even if you’re satisfied with your current drug coverage, it’s wise to review Part D plans annually.
A study by the Kaiser Family Foundation found that Medicare beneficiaries could potentially save an average of $300 per year by reviewing and optimizing their Part D coverage alone.This year it’s especially important, because there are some significant changes happening in Medicare prescription drug coverage in 2025.
For example, some plans are now authorizing Wegovy for weight loss purposes. Prior to this year it was only authorized for diabetics. However, not all Part D plans are authorizing it.
You should consider:
- your current medications and their pricing tiers
- each plan’s pharmacy network and preferred pharmacies
- the plan’s star rating for drug pricing and customer service
- step therapy requirements – the requirement to try a less expensive, lower-tier drug, such as a generic, before being authorized a more expensive drug
- prior authorization requirements
Step 4: Review Your Medicare Advantage (MA) Plan Options
Medicare beneficiaries often benefit from switching to another Medicare Advantage plan that better suits their needs.
If you’re considering a Medicare Advantage plan or want to switch to a different Medicare Advantage plan from your current one plan, you can potentially switch to another Medicare Advantage plan that may suit your needs better.
For example, if you were recently diagnosed with end stage renal disease (ESRD), you might want to join a Medicare Advantage Special Needs plan, designed specifically for people with this condition who need dialysis or special immunosuppressant drugs following a kidney transplant.
Your MediGap Advisors Personal Benefits Manager can walk you through your current plan and help you compare it to other plans available in your area, including special needs plans and plans with new and innovative supplemental benefits, as well.
You should compare alternatives based on the following parameters:
- Monthly premiums
- Out-of-pocket maximums
- Copayments and coinsurance for services you frequently use
- Provider networks
- Additional benefits like dental, vision, or hearing coverage
- Star ratings for quality and performance
- Services for patients with special needs
- Supplemental benefits such as non-medical transportation services, nutritional support, caregiver assistance, etc.
Step 5: Consider Enrolling in Medigap or Medi-Share 65+
Medicare Advantage plans are affordable: Often under $10 per month, and many plans have no monthly premium at all.
What’s not so affordable are the relatively high out-of-pocket costs you could incur in the event you need care. With Medicare Advantage plans, your out-of-pocket costs could be as high as $8,850 per year, thanks to deductibles, copays, and co-insurance costs.
That causes many people to skip or delay treatment they need, because of the cost.
If you want to limit your risk, and you can afford to pay a modest monthly premium to reduce or or limit your out-of-pocket risk to as low as $500 or less, you have two great choices:
- Enroll in a Medigap plan, such as Medigap Plan G, which limits your Medicare Part A and Part B out of pocket costs to your Part B deductible, which is just $240 as of this writing in 2024 (it may change in 2025).
- Enroll in Medi-Share 65+, an affordable, innovative alternative to Medigap plans that also limits your out-of-pocket costs –– to just $500 per household per year. It’s also available at a much lower premium compared to the higher-end Medigap plans like Plan N and Plan G.
Both of these approaches have important advantages and disadvantages.
You don’t need to enroll in these plans during Open Enrollment. They take applicants at any time. However, Medigap plans are medically underwritten after your initial enrollment period at age 65. Which means if you have pre-existing conditions, they could charge you more, or decline coverage.
Medi-Share 65+ also restricts cost sharing related to pre-existing conditions for six months after enrollment. But that waiting period is waived if you sign up during the Medicare Fall Open Enrollment Period. So again, October 15th through December 7th is the best time to enroll.
Read on for more information about the Medi-Share 65+ health sharing plan!
Introducing Medi-Share 65+
Medi-Share 65+ is a healthcare sharing program designed specifically for seniors on Medicare. While not insurance, it offers a way for Christians to share each other’s eligible medical expenses and potentially reduce out-of-pocket costs.
Here are some great reasons to consider Medi-Share 65+ as an alternative to Medigap insurance:
1. Lower monthly costs compared to traditional Medigap plans
- Medi-Share 65+ costs only $99/month for ages 65-75 and $150/month for ages 76+
- This is significantly less than the average $250+ monthly premium for Medigap Plans G and N.
2. Low out-of-pocket maximum
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- $500 annual household portion (similar to a deductible).
- After that, 100% of Medicare Part A and Part B-approved charges are shared.
3. No pre-existing condition restrictions
*If you enroll during initial Medicare open enrollment or annual enrollment period.
4. 10-year price lock guarantee
Members who enroll under age 75 get up to a 10-year price guarantee. Medi-Share will not increase your required contribution until you reach age 75.
5. No narrow care networks
You can use Medi-Share 65+ with any doctor or provider who accepts Medicare. This is similar to Medigap, and a significant advantage over Medicare Advantage plans, which are managed care plans that restrict access to non-emergency care from out-of-network providers.
6. Potential for significant savings
Especially beneficial for those in good health or in high cost-of-living areas.
7. Simple enrollment process
Takes just minutes to sign up. You can self-enroll here.
For adults 65 and older seeking to minimize monthly costs while maintaining comprehensive coverage for Medicare out-of-pocket expenses, Medi-Share 65+ offers an innovative and potentially cost-effective alternative to traditional Medigap plans.
However, it’s important to recognize that Medi-Share 65+ is designed to complement, not replace, your Medicare coverage, which should remain your primary insurance to ensure full healthcare protection.
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IMPORTANT: Do You Need a Separate Prescription Drug Plan?
Medicare Part D provides prescription drug coverage, an essential component of comprehensive healthcare for many seniors.
During Open Enrollment, it’s crucial to review your Part D plan because:
- Drug formularies can change annually, affecting which medications are covered and at what cost
- Your medication needs may have changed over the past year
- New plans may enter the market, offering better coverage or lower costs
- Your current plan’s premiums or copayments may increase
When evaluating Part D plans, consider:
- The plan’s formulary and your specific medications
- Total annual costs, including premiums, deductibles, and copayments
- Pharmacy networks and mail-order options
- Coverage during the donut hole (coverage gap)
What To Do Now
If you’re a Medicare beneficiary looking to select the best plan to complement your health insurance, the Fall Enrollment Period is the perfect time to take action.
Contact a Personal Benefits Manager for personalized assistance and a free consultation. They can help you explore your options and ensure you choose the plan that best meets your healthcare needs and budget.
For Further Reading: What To Do When You Receive Your Medicare Annual Notice of Change Letter|Does Medigap Cover Prescription Drugs?|How to Get Out of Medicare Advantage Nightmares
Mike Montes is a Personal Benefits Manager at MediGap Advisors. Mike has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Mike on his Bio page.