What to Review Before Medicare Annual Enrollment (Oct 15 to Dec 7)

Every fall, people with Medicare get a chance to look at their coverage and decide whether it still fits. The Annual Enrollment Period runs from October 15 to December 7, and any changes you make take effect January 1.

If you're happy with your plan, you don't have to do anything. But plans can change from one year to the next, so a short review now can help you avoid surprises in January. Here's what to look at.

Start with your Annual Notice of Change

If you're in a Medicare Advantage or Part D prescription drug plan, your plan sends an Annual Notice of Change each fall. It lists what's different for next year, such as the premium, copays, the drug list or the provider network.

It's easy to set aside with the rest of the mail. Pull it out and read the summary page first. If anything there affects a doctor you see or a medicine you take, mark it down.

Check your doctors and hospitals

Provider networks can change. If you're in a Medicare Advantage plan, confirm that your primary care doctor, your specialists and the hospitals you'd want to use are in the plan's network for next year.

Around Lake Norman, plenty of people see doctors in more than one county, with a primary care office in Mooresville and a specialist in Huntersville or Charlotte, for example. Check each one, not just the doctor you see most often. The plan's provider directory is a start, but it's a good idea to also call the office and ask.

Review your prescriptions

Make a list of every medicine you take, with the dose and how often you take it. Then check:

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

Drug coverage is one of the areas that changes most often, so it's worth a careful look even if nothing else in your plan has changed.

Look at total costs, not just the premium

The monthly premium is only part of what you pay. Also look at the deductible, the copays or coinsurance for the care you actually use, and the plan's maximum out-of-pocket limit. Keep in mind that you generally still pay your Part B premium, even with a Medicare Advantage plan.

A plan with a lower premium may cost more over a year if you see specialists often or take several brand-name drugs. Your own costs depend on how you use care, and they may vary from someone else's on the same plan.

Extra benefits vary by plan

Many Medicare Advantage plans include extra benefits, such as dental, vision, hearing or an allowance for certain over-the-counter items. These benefits vary by plan, and they often come with limits, networks or rules about how to use them. If an extra benefit matters to you, read the details for next year rather than assuming it works the same way it did this year.

Think about how you use care

Ask yourself a few questions about the year ahead:

• Do you travel, or spend part of the year somewhere else?
• Are you planning a surgery, or managing a condition that needs regular visits?
• Do you prefer a plan where you need referrals, or one with more flexibility to see providers out of network?

The answers can point you toward one type of plan over another.

Know the other enrollment windows

The Annual Enrollment Period isn't your only chance to make changes:

• Medicare Advantage Open Enrollment, January 1 to March 31. If you're in a Medicare Advantage plan, you can make one change, such as switching to another Medicare Advantage plan or going back to Original Medicare.
• Initial Enrollment Period. If you're turning 65, your window is generally the seven months around your 65th birthday month.
• Special Enrollment Periods. Certain life events, such as moving or losing other coverage, may let you make changes at other times.

Where to get help

You can compare plans on Medicare.gov or by calling 1-800-MEDICARE. North Carolina's Seniors' Health Insurance Information Program (SHIIP) also offers unbiased counseling.

You can also sit down with a local broker. Matt MacMillan is an independent broker based in Mooresville, and he can compare the Medicare Advantage plans offered in Iredell County and the surrounding area from the carriers he represents. He'll check your doctors and prescriptions against each plan before you decide, and there's never a fee for his help. You can meet in person, by phone or by video. If you live in a nearby town, see Medicare Advantage in Mooresville or our North Carolina Medicare Advantage page.

If we discuss Medicare Advantage plans, we'll first confirm the products you want to talk about (Scope of Appointment). Call the number above, or use the form below to request a call at a time that suits you.

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.