When you start hearing more ads for Medicare, it’s a good sign we’ve entered the fall Open Enrollment season. Almost all Medicare enrollees have some decision to make each year about Medicare, and open enrollment is the opportunity to ensure your health insurance is the best fit for your needs. Don’t miss this opportunity to ensure you’re getting the health care coverage you need and expect at the best available price.

Original Medicare

If you plan on keeping Original Medicare, the good news is that it requires a lot less ongoing review. Parts A and B don’t need to be revisited, and your Medigap plan doesn’t need to be reviewed regularly. You only need to review your Part D plan annually.

Part D prescription plan: Review it annually

You should review your Part D plan each year during the Medicare Open Enrollment Period (Oct. 15 to Dec. 7). Any changes you make will become effective Jan. 1 of the following year. Part D plans can change each year, as can your prescription drug needs. Plans can change premiums, deductibles, their pharmacy networks and the costs of different medications. Your own needs can change as you start or stop certain medications. You can search plans at medicare.gov/plan-compare.

Medigap: Generally don't need to revisit 

Most people don’t need to review their Medigap plan annually. Medigap plans are standardized and don’t change their benefits each year. They do increase their premiums each year, generally at the anniversary of purchasing your policy. But if you’re comfortable with the price increase, you don’t need to do anything.

Switching to Medicare Advantage

If you’re unhappy with Original Medicare, each year you’ll have the opportunity to switch from Original Medicare to Medicare Advantage during the Medicare Open Enrollment Period (Oct. 15 to Dec. 7). There are substantial differences in how Medicare Advantage works, so it’s important to understand all of them — and not just the benefits touted on commercials and ads — before switching. 

If you end up regretting the switch to Medicare Advantage, you’ll have a single (once-in-a-lifetime) 12-month trial period in which you can easily return to your Medigap plan. After that, Medigap plans in most states require underwriting, which means they can deny coverage or charge higher premiums based on preexisting conditions.

Medicare Advantage

If you’ve selected Medicare Advantage, it’s important to review your plan annually. Plans can change who is in network, which drugs are covered (and what pricing tier they’re in), and the price of plans and cost sharing. You should review your Medicare Advantage plan each year during the Medicare Open Enrollment Period (Oct. 15 to Dec. 7). Any changes you make will become effective Jan. 1 of the following year. 

To comparison shop, you can search plans at medicare.gov/plan-compare. Advantage plans aren’t standardized, so make sure you’re taking time to consider: 

• The costs of the plan, including premiums, deductibles, copays/coinsurance and out-of-pocket maximums
• Which providers are in-network and whether the network is regional or national
• How out-of-network care is covered
• What pre-authorizations are required
• Which prescriptions are covered and how much they cost
• The reputation of the plan, including its Medicare star rating 

If changing plans, consider asking your doctors for their offices’ experiences with the new plan to learn whether they’ve had a good experience with it covering treatments, being responsive and providing prompt payment.

Switching to Original Medicare 

You can also switch to Original Medicare during open enrollment. We generally recommend doing so only if you qualify for a Medigap policy to help cover the gaps from Parts A and B. How easy it is to enroll in a Medigap policy will depend on whether you’re within your 12-month trial right period, your state’s rules and/or your health. In addition to a Medigap policy, we generally recommend enrolling in a standalone Part D drug plan.

Medicare Advantage Open Enrollment Period

In addition to the fall Medicare Open Enrollment Period, there’s also a Medicare Advantage Open Enrollment Period that runs Jan. 1 to March 31 each year. This is another opportunity to switch Medicare Advantage plans if you realize yours is no longer meeting your needs, or switch from Medicare Advantage to Original Medicare.

About all those Medicare Advantage commercials

It’s hard to miss all the commercials advertising the benefits of Medicare Advantage plans, but there are a few things to keep in mind.

Benefits to Medicare Advantage

• Often has lower premiums than Medigap/supplement plans
• May include benefits not found in Original Medicare (such as dental and vision)

Drawbacks to Medicare Advantage

• Once you’ve been with an Advantage plan for more than a year, it can be difficult to return to Original Medicare with an affordable Medigap/supplemental plan
• Generally comes with more restrictive coverage networks
• Can require pre-authorizations for certain services
• There’s evidence to suggest that some plans routinely deny care that should be covered¹

Takeaway: Medicare Advantage plans can be a great choice, especially if you’re a savvy insurance shopper. But there’s a lot of variation among plans, so it’s important to fully understand the plan and the reputation of the company providing it before signing up.

Ensure you have the best coverage for your needs

If you’ve done all the work of enrolling in Medicare, which is no small task, you may be tempted to set it and forget it. But it’s important to review at least some of your Medicare decisions annually to make sure you’re getting the coverage you need at the best available price.