7 Signs You Should Change Your Medicare Coverage This Open Enrollment

Fall is here, bringing with it all things pumpkin spice — and health care coverage open enrollment.

Medicare open enrollment runs from Oct. 15 to Dec. 7, and it’s your annual opportunity to change plans. 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, including the fact that switching from traditional 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 some reasons it might make sense to change your Medicare coverage during open enrollment season.

1. You spend part of the year in another state

If you have a Medicare Advantage plan, you’re actually getting coverage through a private company that works with the Medicare system. These plans might operate similarly to a more traditional health insurance plan, with in-network and out-of-network providers. When you spend part of the year in another state, you run the risk of moving to a place where your Medicare Advantage plan doesn’t have in-network providers. This could be more expensive in the long run.

Double-check providers in any state where you live during the year. It might make sense to change your plan and approach to ensure that you get the coverage you need and at a price you can afford — no matter where you are.

2. Your preferred doctor is no longer in your plan’s network

Similarly, 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 enrollment.

With traditional Medicare, there are no network requirements. As long as your doctor accepts Medicare, you can see them without incurring additional costs.

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-network for your current plan. 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, network or drug 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, and your plan doesn’t reflect that. Rather than continuing to pay a higher premium for your current Medicare Advantage plan, it might make sense to switch to a new 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, including for 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.

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 to see what you qualify for and whether switching plans will give you access to better prescription coverage. You can also see if switching to traditional Medicare will provide you with financial help through government programs designed for retirees on low incomes.

7. You are 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 what doctor and facility you’ll be using, check to see if your Medicare Advantage plan considers them in-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.