Research shows that more than half of people with Medicare plans don’t compare or review their plans on a yearly basis.
While staying with your current plan requires less effort than switching, you could be paying more than you need to or missing out on benefits altogether.
“It’s always a good idea to shop around the health insurance options available in your area to decide on the right plan for your needs,” says Ari Parker, bestselling author and lead Medicare advisor at Chapter.
Evaluating your Medicare plan can help you get the full range of benefits, often at lower costs and with more convenience. Here’s how to decide whether to shop or stay.
Deciding to switch Medicare plans isn’t a choice to make lightly. Changing Medicare plans can improve your healthcare experience or worsen it. Some plans may be pricier or lack important benefits, but switching could potentially improve your coverage and reduce costs.
With so many plan options, making a choice can be overwhelming.
Consider discussing available options with a licensed Medicare advisor or using online tools to compare plans.
Some changes you might want to consider may include:
- changing from a Medicare Original plan to a Medicare Advantage plan
- changing from a Medicare Advantage plan to a Medicare Original plan
- changing from one Medicare Advantage plan to another
- adopting or canceling a supplemental plan
- adopting, canceling, or changing a Medicare Drug plan (Part D)
Here are some factors to consider when deciding whether to stay or switch.
The most important thing to consider is the kind of coverage you need. If your plan covers all your needs, keeping it may be the way to go. But if there are considerable gaps in your current plan, switching may help you get the coverage you need.
You may also consider getting supplemental coverage to meet the needs your current plan doesn’t cover.
Some Medicare plans are more expensive than others. Review your current plan’s monthly premium, deductibles, and copayments and compare it to others to see whether your benefits line up with what you’re paying.
You should also consider Medicare out-of-pocket maximums. While Original Medicare (Part A and Part B) has no out-of-pocket maximum, Medicare Advantage plans have an out-of-pocket limit.
And while some Medicare Advantage plans are free, meaning you don’t need to pay a monthly premium, you’ll still have to pay other premiums, deductibles, and copayments.
Are your preferred health providers covered?
“Before changing your Medicare plan, noting the doctors, pharmacies, and hospitals you plan to access in 2023 is the first step toward finding the most comprehensive coverage,” says Parker.
“People often don’t realize that many Medicare Advantage plans have limited networks that restrict your choice of doctors, pharmacies, and hospitals.”
Healthcare providers are “in-network” when a Medicare plan covers them and “out-of-network” when it doesn’t.
If your current Medicare plan covers your preferred doctor, hospital, and pharmacy, keeping it may be the best option. If not, you may want to change to a plan that covers them.
Health conditions and special needs
If you have a health condition that requires expensive medication and specialized procedures, you should consider this before changing your Medicare plan.
“Your costs and number of doctor’s visits are crucial,” says Gabrielle Juliano-Villani, a licensed clinical social worker, therapist, Medicare consultant, and owner of Medicare Consulting for Therapists.
“Someone with many specialist visits or planned surgeries may do better with traditional Medicare and a supplemental plan. It has a higher cost for the premium, but they’ll have fewer medical bills to pay out of pocket.”
Multiple locations and frequent travel
If you have more than one home or travel often between states, you might consider changing to a Medicare plan with an extensive network. Doing so will help you find health providers that are in-network wherever you are.
Supplemental coverage may be your best bet if you travel outside the United States because Medicare doesn’t cover you abroad.
Changes in current offerings
Providers can sometimes suddenly change their offerings. For example, Medicare providers can reduce the locations, drugs, and procedures they cover, which can affect your quality of and access to care.
If this happens, carefully review the changes to decide whether the plan still works for you or whether it’s time to switch.
Satisfaction with current services
If you’re satisfied with your current plan’s services, you may not feel a need to switch. But if you consistently get unpleasant, mediocre service, it might be time to start shopping for a better plan.
Even if you don’t have complaints about your current plan, you should consider how favorable its ratings are. A plan with low ratings likely delivers poor service to its clients, and it might just be a matter of time before you have a similar experience.
Medicare Advantage plans are rated on a five-star system. One star is the lowest and five stars the highest. You can find star ratings by using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE.
Additional benefits and services
“Medicare Advantage plans often offer extra benefits beyond the basics,” says Amanda Baethke, director of corporate development at Aeroflow Healthcare.
Additional benefits to look out for include:
- routine eye exams
- routine dental exams
- routine hearing tests
- chiropractic services
- bathroom safety devices
- emergency response systems
- over-the-counter (OTC) benefits
- transport to medical appointments
To get a complete list of plan benefits, don’t hesitate to contact a plan representative.
It’s hard to predict the future, but some factors that might change over time and affect your plan choice include:
- where you live
- your overall health
- your financial situation
- current medications and planned surgeries
- expiry of existing coverage
- eye, dental, or hearing needs
Can I change my plan at any time?
You can change your plan during specific periods every year. These periods are:
- Open Enrollment Period, from October 15 through December 7
During this period, you can change your Medicare plan from Original Medicare to Medicare Advantage or from Medicare Advantage to Original Medicare.
- Medicare Advantage Open Enrollment Period, from January 1 through March 31
During this period, you can change your Medicare Advantage plan.
- Special Enrollment Periods
Special Enrollment Periods are granted under exceptional circumstances. For example:
- You moved out of your plan’s coverage area.
- Your plan is canceled.
- You move into or out of a facility.
Deciding to keep or change your Medicare plan should be an informed choice based on your needs and budget. The best plan for you will give you access to services, benefits, and support without straining your wallet.
If you aren’t sure which plan to choose, consider contacting a licensed Medicare advisor. And remember, you can always change a plan that isn’t serving you during the designated enrollment periods.