I'm happy with my Medicare Advantage Plan. Why should I review my options during AEP?
Updated: Sep 15
Even if you are happy with your current Medicare health care coverage, it's important to conduct a Medicare Advantage Plan review during AEP. Every year from October 15 to December 7, people who are enrolled in a Medicare Advantage plan have the option to change to a different plan for the coming year. These dates define the Medicare Annual Enrollment Period, or AEP. Many people choose to stick with their current provider instead of making a change during AEP. If you do nothing, your plan will automatically renew.
However, even if you decide not to change plans, the coverage you have today will likely be different starting on January 1. That's because every year, your carrier has the option to change the features of your plan. These changes are not limited to but might include the monthly premium you pay; your cost-sharing on a benefit-by-benefit basis; your dental, vision and hearing coverage; the plan's drug formulary, and/or its provider network. You will learn about the specific changes that affect your coverage when you receive your Annual Notice of Change (or ANOC) from your plan carrier a few weeks prior to the start of AEP.
Even if your current plan coverage looks similar for next year, it's important to remember that the other plans available to you have also changed, sometimes significantly. Therefore, a plan that previously didn't stack up against the coverage you originally chose might now offer you new opportunities to save money, increase benefits, or both. Here in Minnesota in recent years, plan benefits have usually improved while premiums have either stayed steady or gone down. So generally speaking, plan changes have resulted in new and better opportunities available to you.
Additionally, over the past few years there have been significant changes to Medicare Advantage plan provider networks in Minnesota. Several health care groups have dropped or added Medicare Advantage plan carriers. You might find that your doctors are no longer participating with your current plan carrier, or that they are now covered by a plan they previously were not.
Or maybe you have made recent changes to the list of doctors you see. Perhaps you no longer need to see a specialist you required when you enrolled in your current plan, or you now need access to a new clinic, or have changed primary care physicians. The Annual Enrollment Period is a great time to review your list of doctors against your plan's network to be sure you are getting the highest level of coverage when you see a medical professional.
This process applies to your prescriptions as well. If your drug list has changed, you will want to see if the new drugs you are taking are covered by your current plan. But importantly, even if your drug list hasn't changed you might now be able to get the same drugs for less with a different plan. This is due to the changing tier structures within each plan's formulary. For example, a drug may be classified as a more expensive Tier 3 with one plan and a less expensive Tier 2 with another. Or maybe a drug that was previously a Tier 1 drug with a plan is now a Tier 2 drug on that same plan. Plans often change their formularies and their tiers for the coming year. So your best option in 2022 may not be your best option for 2023. It always pays to review your drug coverage during AEP to see if there is a new opportunity for you to save money on your prescriptions. Again, here in Minnesota we have found that changes in plan formularies have offered some beneficiaries significant money-saving opportunities for 2023.
In summary; you will want to review your current coverage during AEP for the following reasons:
Premiums, benefits and cost sharing change; on your current plan but also on the other plans available to you. There may be new opportunities available to you to save money AND increase to benefits.
You may be seeing new doctors. Even if you aren't, it's possible your plan's network has changed. You will want to be sure your current providers are all in-network so that you can take advantage of your plan's highest level of coverage.
Your drugs might now be less expensive on a different plan, even if your drug list hasn't changed. And if you've added drugs, you'll want to see how the co-pays stack up with your current plan versus other plans available to you.
Keep in mind: During AEP, it can be helpful to sit down with a licensed insurance agent who specializes in Medicare. Your agent can audit your current coverage against other plans that are available to you, with specific consideration to your doctors and drugs. Independent agents who specialize in Medicare also have the benefit of understanding annual plan changes across multiple carriers, so they can reduce the time you spend researching your options. Best of all, you can work with an agent at no cost to you.