If you’re happy with your Medicare Advantage plan, you might assume that keeping the same plan means keeping the same coverage.
Not necessarily.
Medicare Advantage plans can change from one year to the next. Your premium, copays, benefits, prescription drug coverage and even your provider network may be different next year — even if you never change plans.
That’s why reviewing your Medicare Advantage coverage every fall is so important.
Here’s what can change and what Minnesota Medicare beneficiaries should look for.
Why Do Medicare Advantage Plans Change Every Year?
Private insurance companies offer Medicare Advantage plans under contracts with Medicare. Each year, insurers determine the benefits, costs and other features of the plans they’ll offer for the following year, subject to Medicare requirements and approval.
As a result, the Medicare Advantage plan you have this year may look somewhat different on January 1.
Some changes may be small. Others could have a significant effect on your healthcare or what you pay.
1. Your Medicare Advantage Premium Can Change
Your Medicare Advantage plan’s monthly premium can increase, decrease or remain the same.
Some Medicare Advantage plans have a $0 monthly plan premium, but $0 doesn’t mean your healthcare is free.
Depending on your plan and the services you use, you may still have deductibles, copayments, coinsurance and other out-of-pocket expenses.
You also generally continue paying your Medicare Part B premium.
When reviewing your plan, don’t focus on the monthly premium alone.
2. Deductibles Can Change
Your plan may change its deductibles for the coming year.
Depending on your Medicare Advantage plan, this could include a medical deductible, prescription drug deductible or deductibles applying to certain services.
Look at both whether a deductible has changed and whether the services you regularly use are affected.
3. Copays and Coinsurance Can Change
The amount you pay when receiving healthcare can also change.
Changes might affect your cost for:
- Primary care visits
- Specialist visits
- Urgent care
- Emergency room visits
- Hospital stays
- Outpatient procedures
- Diagnostic tests and imaging
- Physical therapy
- Skilled nursing care
A change that looks relatively small can become significant if it’s attached to a service you use frequently.
4. Your Maximum Out-of-Pocket Limit Can Change
Medicare Advantage plans have an annual maximum out-of-pocket limit for covered Medicare Part A and Part B services.
Your plan’s limit can change from one year to the next.
This is an important number to consider because it helps define your potential financial exposure if you experience significant healthcare needs during the year.
When comparing coverage, consider not only what you expect to spend when you’re healthy, but what you could potentially spend during a difficult health year.
5. Prescription Drug Coverage Can Change
If your Medicare Advantage plan includes Part D prescription drug coverage, don’t assume your medications will be covered exactly the same way next year.
Changes can potentially affect:
- Which medications are covered
- Drug tiers
- Your share of prescription costs
- Pharmacy networks
- Prior authorization
- Step therapy
- Quantity limits
Review the specific medications you take, including dosage and frequency, when comparing your coverage for the coming year.
A plan that works well for your prescriptions this year may work differently next year.
6. Extra Benefits Can Change
Many Medicare Advantage plans include benefits beyond those provided by Original Medicare.
Depending on the plan, these may include benefits related to:
- Dental care
- Vision care
- Hearing services
- Fitness programs
- Transportation
- Over-the-counter items
- Other supplemental benefits
These benefits aren’t necessarily identical from year to year.
A benefit might increase, decrease, be structured differently or no longer be offered.
Extra benefits can be valuable, but don’t let an attractive extra benefit overshadow the fundamentals: your doctors, hospitals, prescriptions and potential healthcare costs.
7. Provider Networks Can Change
This is particularly important for people enrolled in Medicare Advantage HMO and PPO plans.
Doctors, specialists, clinics, hospitals and other healthcare providers can enter or leave a plan’s network.
If particular providers are important to you, verify their participation rather than assuming they’ll remain in your network.
Consider checking:
Your primary care physician
Your specialists
Your preferred clinic
Your preferred hospital or health system
Provider networks are especially important when comparing Medicare Advantage plans because access can differ significantly between plans and geographic areas.
8. Your Plan’s Service Area Can Change
Medicare Advantage plans operate within defined geographic service areas.
The counties in which a plan is available can change, and an insurer can also discontinue a particular plan.
This is particularly relevant in Minnesota because Medicare Advantage availability varies by county.
A plan available in one part of Minnesota isn’t necessarily available in another.
If you’re moving — even if you’re staying within Minnesota — don’t assume your Medicare Advantage coverage will work exactly the same way at your new address.
How Do You Find Out What’s Changing?
This is where your Annual Notice of Change (ANOC) becomes important.
Your Medicare Advantage plan sends you an ANOC each fall explaining important changes to your plan for the coming year.
The changes generally take effect January 1.
When your ANOC arrives, don’t simply file it away.
Compare next year’s coverage with this year’s coverage and concentrate on the things that matter most to you.
A Simple Medicare Advantage Annual Review
You don’t need to compare every line of every Medicare document.
Start with these questions:
Costs: Are my premium, deductible, copays, coinsurance or maximum out-of-pocket limit changing?
Doctors: Are my physicians and specialists still participating?
Hospitals: Are the hospitals and healthcare systems I want available through the plan?
Prescriptions: Are my medications covered, and what should I expect to pay?
Benefits: Are the additional benefits I actually use changing?
Then ask one more important question:
Have my healthcare needs changed?
Your plan isn’t the only thing that can change from year to year.
You might have a new prescription, a new doctor, a new diagnosis or different healthcare priorities.
The right Medicare coverage needs to fit the person you are next year, not just the person you were when you originally enrolled.
Do You Need to Change Medicare Advantage Plans Every Year?
No.
An annual Medicare review does not mean an annual plan change.
If you’ve reviewed the changes and your current plan continues to work well for your doctors, prescriptions, healthcare needs and budget, keeping it may be the right decision.
The objective isn’t to find a different plan.
The objective is to make an informed decision about the plan you’ll have next year.
When Can You Make Changes?
Medicare’s Annual Enrollment Period (AEP) runs from October 15 through December 7 each year.
During AEP, Medicare beneficiaries can make certain changes to their Medicare Advantage and prescription drug coverage for the following year.
Changes made during AEP generally take effect January 1.
Your Annual Notice of Change arrives before AEP so you have time to understand what’s changing before deciding whether your current coverage still meets your needs.
Medicare Guidance for Minnesotans
Medicare Advantage plans can change from year to year — and your healthcare needs can change too.
That’s why reviewing your coverage annually is worthwhile.
At YourMedicareMN, the focus is education first. We help Minnesota Medicare beneficiaries understand Medicare, evaluate their options and make informed decisions based on their individual needs.
Review. Compare. Decide.
Changing plans isn’t the goal. Understanding your coverage is.
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.