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Dear Connie,
I’ve had the same Medicare plan for several years. I haven’t had any major problems, but every year people tell me I should compare plans. How do I know if my current Medicare plan is still the best one for me?
Not sure what to look for,
Denise from Tampa, Florida
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Local, licensed insurance agents with 25+ years of combined experienceDear Denise,
That’s a great question to ask.
The only way to know is to compare the services covered by your current plan with your current healthcare needs. If your doctors, medications, costs, and benefits still work well for you, keeping your plan may be the right choice. This applies whether you have a Medicare Advantage plan, a stand-alone Part D plan, or Medicare Supplement insurance (Medigap). But your health, budget, and your plan can change from year to year.
Here’s a simple way to check.
Once you’re enrolled in a Medicare health plan, it’s easy to assume it will always meet your needs. But your health rarely stays the same from one year to the next. You might start a new medication, see a new specialist, have surgery, or manage a new chronic condition. Besides your health, you may have even moved to a new city or county.
A plan that was a great fit two years ago may not be one today. Your review should start with your health, not with plan names or advertising.
Ask yourself these five questions each year, even if you expect to keep your current coverage.
Insurance companies update their provider networks– their network of doctors and hospitals that accept your plan- every year. According to Medicare.gov, a doctor who accepts Medicare may still drop out of your plan’s network from one year to the next.
Check your plan’s provider directory or call your doctor’s office. If you have a PFFS plan (Private Fee-for-Service plan), a type of Medicare Advantage plan, you may be able to see any doctor who accepts Medicare and agrees to the plan’s payment terms, even if they aren’t in that network.
According to Medicare.gov, every Medicare Part D and Medicare Advantage Prescription Drug plan uses a formulary, a list of covered drugs sorted into cost tiers. Insurers can move a drug to a pricier tier or drop it from the list. One medication change can raise your yearly costs more than you’d expect.
Think about whether you’re seeing specialists more often, starting physical therapy, or beginning a costly treatment. When your care needs grow, your plan’s coverage and costs matter more than before.
Look past your monthly premium, the amount you pay each month for coverage. If you have Original Medicare, remember your Part B premium is separate from any plan premium and can change every year. Compare your deductible, copays, and other out-of-pocket costs, including your plan’s out-of-pocket maximum. The lowest premium isn’t always the lowest overall cost.
If you’re not sure how to compare these costs, call (623) 223-8884 to speak with a licensed insurance agent for a no-cost Medicare health plan review. They can help you understand whether your current plan is still the best fit for your needs.
Many plans offer extra benefits. The extra benefits Medicare Advantage plans included last year can change from one plan year to the next, so don’t assume they carried over automatically. These extras are nice to have, but they should support strong medical coverage, not replace it.
If you’re unsure whether your current coverage still fits your needs, call (623) 223-8884 to speak with a licensed insurance agent for a no-cost Medicare health plan review.
Agent tip:
“Don’t judge your plan by its name or its ads. Judge it by your own doctor list, drug list, and last year’s bills. That’s the only comparison that really matters.”
If your doctors haven’t changed, your medications are still covered, and your costs remain affordable, staying enrolled can be the right call. The same is true if you’re satisfied with your plan’s customer service and its benefits still meet your needs.
You do not need to switch Medicare plans every year. A plan that still works for your health and budget is a good plan, even if it isn’t new.
Some changes are worth a closer look, such as:
These signs mean it’s worth comparing plans. Some of these changes, such as moving to a new county or state, may also qualify you for a Special Enrollment Period, allowing you to make changes outside the usual enrollment windows. They don’t mean you have to switch. A simple comparison can confirm your plan is still your best option, or show something that fits better.
The best Medicare plan isn’t the newest or the most popular. It’s the plan that still works for your health and your budget today.
Make it a habit to review your coverage every year. According to the Kaiser Family Foundation (KFF), nearly 7 in 10 Medicare beneficiaries don’t compare their coverage options annually, even though reviewing their coverage takes only a few minutes.
Even if you decide to stay with your current plan, reviewing it first helps you enroll with confidence.
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No. If your plan is still available and covers your doctors and medications at a cost you can afford, you can keep it. Medicare health plans automatically renew each year unless you choose to make a change.
Review your coverage in the fall each year. Even a quick check can catch changes to your doctors, medications, or costs before they affect you.
Yes. Insurance companies can update provider networks, drug formularies, premiums, and benefits each year. According to Medicare.gov, your Annual Notice of Change (ANOC) letter explains what’s different for the coming year.
People often switch when a doctor leaves the network or a prescription’s cost rises significantly. Both changes can affect your care and your budget more than other plan updates.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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