Fall is here, bringing with it all things pumpkin spice — and health insurance open enrollment.
Medicare’s fall open enrollment period runs from Oct. 15 to Dec. 7, and it’s your annual opportunity to change certain aspects of your coverage. In fact, it might make sense to adjust your coverage based on your potentially changing health care needs.
As you consider changing, though, make sure you understand the potential pitfalls. For example, switching from Original Medicare to a Medicare Advantage plan can lead to the loss of any Medigap policy you have. If you drop that Medicare supplemental insurance, there is no guarantee that you’ll be able to get it back later or pay the same premium.
Let’s take a look at some reasons it might make sense to change your Medicare coverage during the fall open enrollment season.
1. You spend part of the year in another state
There are two main types of Medicare. Original Medicare, also known as traditional Medicare, is offered directly by the federal government. Medicare Advantage plans are offered by private insurance companies that contract with the government.
Medicare Advantage plans often resemble PPO and HMO plans, with in-network and out-of-network providers. If you have a Medicare Advantage plan and spend part of the year in another state, you run the risk of moving to a place where the providers you want to see are out of network. This could be more expensive in the long run.
Double-check that providers in any state where you live during the year accept your Medicare Advantage plan. It might make sense to change your plan to ensure that you get the coverage you need at a price you can afford — no matter where you are.
2. Your preferred doctor is no longer in your plan’s network
If you have a Medicare Advantage plan, you may find your preferred doctor is no longer considered in-network. If your doctor leaves the network, then you’re stuck with higher costs if you continue to see them — unless you change your plan or switch back to Original Medicare (assuming your provider accepts traditional Medicare).
With Original Medicare, there are no network requirements. As long as your doctor accepts traditional Medicare, you can see them. Be aware you’ll likely pay 20% in coinsurance after your Part B deductible, and you could pay more if your doctor doesn’t accept assignment.
3. You have a newly diagnosed chronic condition
Let’s say you recently received a new diagnosis of a chronic condition. Your current plan might require special referrals to see specialists. Perhaps the best care can only be had through providers that are out of your current plan’s network. Maybe the medications you need aren’t covered under your existing policy.
You might need to switch to a Medicare arrangement that doesn’t have referral or network restrictions.
4. You’re fit as a fiddle
Maybe you’re in the opposite situation. Perhaps you don’t have a lot of health care needs, but your plan doesn’t reflect that. Rather than continuing to pay a higher premium for your current policy, it might make sense to switch to a plan with fewer bells and whistles.
Consider, too, comparing the cost of Medicare Advantage coverage with traditional Medicare. Depending on your situation, you might be able to get a cheaper plan that meets your needs during the Medicare open enrollment period.
5. Your income is down
Perhaps your retirement income has decreased recently. Maybe you’re taking less from your nest egg to ensure it lasts longer, or you’ve quit your part-time job. In that case, use the open enrollment period to shop around for cheaper coverage.
You might also be able to access savings programs to help with your Medicare premiums and drug costs. Additionally, there are ways to use both Medicare and Medicaid, if you qualify. When you’ve taken a hit to your income, it makes sense to explore all these options.
To learn more, check out “6 Ways to Get Help With Medicare Expenses.”
6. Your drug costs are up
Every year, review your drug costs. The price of prescriptions can change. Additionally, you might have a change in dosage, which can affect the cost. Finally, your current plan might not cover the medication you use anymore. Perhaps you prefer the name brand, but now your plan will only cover the generic version.
Double-check what you qualify for and whether switching plans will give you access to better prescription coverage. You can also check to see if you qualify for government programs that help people with limited incomes pay for Medicare, including prescription drug costs.
7. You’re expecting surgery in the coming year
When you’re planning a procedure, it’s especially important to make sure you can cover the cost. If you already know which doctor and facility you’ll be using, check to see if they are in your current Medicare Advantage plan’s network.
On the other hand, if you don’t know where you’ll go, it might make sense to switch to traditional Medicare to keep your options a little more open.
No matter the situation, carefully consider your health care needs. As you move through life, they’ll likely change, and that means you might need to use Medicare open enrollment as a way to ensure you have the right coverage.
Read more about health care coverage in retirement in “6 Things Retirees Wish They Had Known About Medicare Before Signing Up.”
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