Short answer: No. You do not need to change Medicare plans every year.
If your current Medicare coverage continues to meet your healthcare needs and budget, staying with your existing plan may be the right choice.
But there’s an important difference between changing your Medicare plan every year and reviewing your Medicare plan every year.
You may not need to change your plan. You should, however, take the time to make sure it still works for you.
Here’s why.
Medicare Plans Can Change From Year to Year
Medicare Advantage and Medicare Part D prescription drug plans can make changes for the upcoming plan year.
Those changes might affect:
- Monthly premiums
- Deductibles
- Copayments and coinsurance
- Prescription drug coverage
- Pharmacy networks
- Provider networks
- Maximum out-of-pocket costs
- Additional benefits
That’s why Medicare beneficiaries with these plans receive an Annual Notice of Change (ANOC) each fall.
Your ANOC explains changes to your plan that will take effect the following January.
Even if you’ve been completely satisfied with your coverage this year, it’s worth checking what will be different next year.
1. Your Medicare Plan Costs Can Change
The plan that fit your budget this year may cost more—or less—next year.
Look for changes to:
- Premiums
- Deductibles
- Primary care and specialist copays
- Hospital costs
- Prescription costs
- Coinsurance
- Maximum out-of-pocket limits
Don’t judge a Medicare plan by its premium alone.
A low-premium plan can still result in significant out-of-pocket expenses depending on how you use your healthcare.
The question isn’t simply, “What is my premium?”
A better question is, “What might this coverage actually cost me based on the healthcare I use?”
2. Your Prescription Drug Coverage Can Change
This is one of the most important reasons to review Medicare coverage every year.
Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage can change their formularies and cost-sharing arrangements.
A medication could:
- Move to a different formulary tier
- Have a different copay or coinsurance
- Require prior authorization
- Have new quantity limits
- Be subject to step therapy requirements
Your preferred pharmacy arrangement could change as well.
And there’s another possibility: your prescriptions may have changed.
Perhaps you’re taking a medication this year that you weren’t taking when you originally selected your plan.
An annual Medicare review should therefore consider both changes to your plan and changes to your medications.
3. Your Doctors and Hospitals Can Change
Provider networks are particularly important for people enrolled in Medicare Advantage plans.
Doctors, specialists, clinics, and hospitals can enter or leave plan networks.
When reviewing your coverage, consider the providers that matter most to you:
- Primary care physician
- Specialists
- Clinics
- Hospitals
- Healthcare systems
Don’t simply assume that because a provider participated in your plan this year, everything will remain the same next year.
Verify provider participation when reviewing coverage for the upcoming year.
4. Your Medicare Benefits Can Change
Some Medicare Advantage plans provide additional benefits beyond those covered by Original Medicare.
Depending on the plan, these might include benefits involving:
- Dental care
- Vision
- Hearing
- Fitness programs
- Over-the-counter products
- Transportation
- Other supplemental services
These benefits can change.
But don’t focus only on whether a plan advertises a particular benefit. Look at how the benefit actually works.
For example, if dental coverage is important to you, consider the amount of coverage, covered services, provider requirements, and your potential out-of-pocket costs.
5. Your Needs Can Change, Too
Sometimes the biggest change isn’t the Medicare plan.
It’s you.
Over the course of a year, you might:
- Start taking new medications
- Begin seeing a specialist
- Receive more frequent medical care
- Plan to travel more often
- Spend part of the year outside Minnesota
- Prefer different doctors or healthcare systems
- Find that certain benefits have become more important
A plan that was a good match when you enrolled may not always remain the best match as your circumstances change.
Does Medicare Annual Enrollment Mean You Have to Change Plans?
No.
The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7 each year.
This is an opportunity to review your coverage and, when appropriate, make certain changes for the following year.
It is not a requirement that you change plans.
If you review your current coverage and determine that it still meets your needs, keeping it may be an entirely appropriate decision.
The goal isn’t to find a new Medicare plan every year.
The goal is to make an informed decision every year.
What Should You Review Each Year?
Before Medicare Annual Enrollment, gather a few pieces of information.
Your current medications
Create an updated list that includes each medication, dosage, and frequency.
Your doctors and healthcare providers
Identify the doctors, specialists, hospitals, and healthcare systems you want to continue using.
Your healthcare usage
Think about how you’ve actually used your coverage during the past year.
Your Annual Notice of Change
When your ANOC arrives, review changes to costs, benefits, prescription coverage, and other plan provisions.
Your priorities for next year
Think about what’s most important to you—not just what was important when you originally enrolled.
Should You Automatically Switch to a Plan With More Benefits?
Not necessarily.
Medicare Advantage plans may advertise benefits that sound attractive, but those benefits should be considered as part of the entire plan.
A plan with additional benefits isn’t automatically a better plan for you.
Prescription coverage, provider access, healthcare costs, maximum out-of-pocket exposure, and other plan rules may be more important depending on your circumstances.
Compare the whole plan, not just one feature.
Should You Automatically Stay With Your Current Plan?
Not necessarily.
Automatically staying with your current plan without reviewing it can be just as problematic as automatically switching plans.
Instead, use this simple approach:
Review first. Compare if necessary. Decide second.
You might discover that another option better fits your needs.
Or you might complete your review and discover that your current plan is still exactly where you want to be.
Either outcome can be a good result.
Minnesota Medicare Plans Can Vary Depending on Where You Live
Medicare Advantage and Part D plan availability can vary by location.
A plan available to someone living in one Minnesota county may not necessarily be available to someone living elsewhere in the state.
That’s one reason recommendations from friends and relatives should be treated carefully.
The plan that’s right for someone else isn’t necessarily the plan that’s right for you.
Your prescriptions, doctors, healthcare needs, budget, and location all matter.
The Bottom Line: Review Every Year, but Change Only When It Makes Sense
So, do you need to change Medicare plans every year?
No.
But reviewing your coverage each year is a good habit.
Remember:
You don’t need a new plan every year. You need a plan that continues to work for you.
When Annual Enrollment arrives, review your current coverage, look at what’s changing, consider your healthcare needs, and then decide whether staying or changing makes the most sense.
Need Help Reviewing Your Medicare Coverage?
YourMedicareMN helps Minnesota Medicare beneficiaries understand their options and compare coverage based on their individual needs.
Medicare plan changes can be difficult to evaluate because the lowest premium isn’t always the lowest overall cost—and benefits that look attractive may not be the ones that matter most to you.
Visit Contact Us to schedule a personalized Medicare review and get answers tailored to your situation.
For official Medicare information, visit the Medicare.gov website.
YourMedicareMN is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability and benefits vary by location and plan. Contact the plan or Medicare for complete plan information.
Learn first. Decide With Confidence.