Checking Your Doctors and Pharmacies During Medicare Annual Enrollment

Medicare's Annual Enrollment Period is open now through December 7. Changes you make generally take effect January 1. Before you keep a plan or switch, one of the most practical steps is checking that the people and places you already use will still work with next year's coverage.

If you live in Mooresville, elsewhere in Iredell County or around Lake Norman, you may see a primary care doctor locally and specialists in Huntersville, Charlotte or another nearby town. Networks and drug lists can change from year to year, so a short provider and pharmacy check now can spare you a January surprise.

This is a closer look at that one piece of the review. For a fuller enrollment checklist, see what to review before Medicare Annual Enrollment.

Start with your Annual Notice of Change

If you're in a Medicare Advantage or Part D plan, your plan sends an Annual Notice of Change each fall. Skim the sections on the provider network and the drug list. Note anything that mentions a doctor leaving, a hospital change or a medicine moving to a different tier.

You don't have to rebuild your whole care picture from scratch. Use the notice as a flag list, then confirm the details for the providers and pharmacies you actually use.

How to check your doctors and specialists

Make a simple list: primary care, each specialist, and any clinic you visit regularly. For each name, ask:

1. Is this provider in the plan's network for next year, not only this year?
2. Are they accepting new patients under this plan, if that applies to you?
3. Do you need a referral to see a specialist under this plan?

The plan's provider directory (online or printed) is a starting point. Directories can lag, so it's wise to call the office and ask them to confirm. Around Lake Norman, people often split care across counties. Check every doctor on your list, not just the one you see most often.

If you're comparing more than one plan, run the same list against each option. A plan that looks similar on premium can differ a lot once you see who is in network.

Don't skip hospitals and facilities

Ask the same questions about the hospitals and outpatient facilities you'd want to use for planned care or in an emergency. Some plans use networks that favor certain hospital systems. Confirm the locations that matter to you in Mooresville, Statesville, Huntersville or Charlotte before you enroll.

How to check your pharmacies and prescriptions

Drug coverage is often where plans differ most. Make a list of every medicine you take, with the dose and how often you take it. Then, for each plan you're considering:

• Is each drug on the plan's formulary (covered drug list) for next year?
• What tier is it on, and what does that typically mean for your cost?
• Does it need prior authorization, step therapy or a quantity limit?
• Is your pharmacy in network, and is it a preferred pharmacy?

Preferred pharmacies can mean lower cost sharing on some plans. If you use a local independent pharmacy, a chain store near Lake Norman or mail order, check how each one is treated. Benefits vary by plan, so read the details rather than assuming last year's setup still applies.

If one of your medicines isn't covered, ask your doctor or pharmacist whether a similar covered option exists, or compare another plan that includes it.

A simple order that keeps you focused

1. Confirm your doctors, specialists and hospitals for next year.
2. Confirm your prescriptions and pharmacy.
3. Then compare premiums, deductibles, copays and the out-of-pocket maximum.
4. Only after that, weigh extras like dental or vision, remembering that benefits vary by plan.

Star ratings and marketing flyers can wait until your care team and drug list are cleared. For more on how ratings fit into the decision, see Medicare star ratings explained. If you're still weighing the two main paths, Original Medicare vs. Medicare Advantage walks through how they differ.

Talk it through with a local broker

I'm Matt MacMillan, a licensed independent broker based in Mooresville. I can check your doctors, hospitals and prescriptions against the Medicare Advantage plans I represent in your area before you decide. There's no fee for my help, and you're never under any obligation. Learn more on my Medicare page, the Iredell County Medicare Advantage guide or Medicare Advantage in Mooresville.

When you're ready, call me at (704) 802-2523 or request a call below, and we'll go through your providers and pharmacies at your pace.

We do not offer every plan available in your area. Currently we represent 8 organizations which offer 1,210 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. The MacMillan Agency is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits and costs vary by county and plan.