During the annual Medicare Open Enrollment period, seniors have an opportunity to choose a new Medicare, Medicare Advantage, or prescription drug plan. MedicareFAQ shares five top things to consider before renewing or making changes to their healthcare plans.
The Medicare Annual Enrollment Period (AEP), commonly known as Fall Open Enrollment, runs from October 15 to December 7.
Each fall, new enrollees have an opportunity to join a new Medicare, Medicare Advantage, or prescription drug plan.
If you decide to join a new plan during the Annual Enrollment Period, your benefits take effect on January 1 of the following year.
It’s also a chance for beneficiaries to make changes to their current plan for the next calendar year.
If this is your first time enrolling in a Medicare plan, you may not know where to start.
Here are the five things you should consider before signing up.
Note: If you happen to miss AEP, there are several enrollment windows to choose from.
1. Out-of-pocket costs
Before enrolling in any policy, make sure you understand all the out-of-pocket expenses you’ll be responsible for.
Out-of-pocket costs include premiums, deductibles, copayments, and any other payments not covered by Medicare.
If you’re on a budget, you will benefit from a plan that offers a yearly spending limit, otherwise known as a maximum out-of-pocket amount.
Once you reach a certain amount, you won’t have to pay for any covered services for the remainder of the year.
2. Prescription drug coverage
Whether or not you’re currently on medications, it’s a good idea to have prescription drug coverage with your Medicare.
These plans help lower costs and provide peace of mind in case you need coverage.
Before you join a drug plan, list out your medications, and ask yourself these important questions.
- Do I meet the eligibility requirements for the free Medication Therapy Management (MTM) program?
- Are my prescriptions covered under the plan’s drug formulary?
- How much will I pay for my medications under each plan?
- How much are brand name drugs versus generic drugs on the plan?
- Am I eligible for Medicare’s Extra Help or any other financial assistance programs?
If you have Original Medicare and need drug coverage, you’ll need a Medicare drug plan (Part D).
Or if you’re enrolled in a Medicare Advantage plan that doesn’t have prescription coverage, you can enroll in a separate Part D plan.
3. Travel plans
Traveling with Medicare can be tricky. That’s why it’s important to understand how each plan’s travel coverage works.
You should also ask yourself if you plan on travelling within the next year.
Note that Original Medicare typically doesn’t cover services overseas.
Remember, you may have the option of purchasing a supplemental insurance plan that will cover you in case of an emergency.
Contact an insurance carrier to learn which plans cover travel.
4. Health care needs
Other than finances, your health will be the determining factor in whatever health plan you choose.
Consider any upcoming surgeries or doctor appointments you may have in the coming year.
Make sure any plan you choose covers all your health needs.
5. How to find coverage that’s right for you
If this is your first time enrolling in a Medicare plan, you may feel overwhelmed.
Before you purchase any plan, always compare costs and benefits to make sure the policy meets all your health needs.
Luckily, there are a couple of online tools that can help:
Five-star ratings
Five-star ratings are one way to determine if a Medicare plan is right for you. The Centers for Medicare & Medicaid Services (CMS) assesses Advantage and Part D plans every year.
Ratings are based on several factors like quality, overall performance, customer service, and more.
Each plan is ranked 1 to 5, with 5 being the highest score. Choosing plans with a 5-star rating means you’ll receive the best quality health care coverage possible.
Medicare plan compare tool
The Medicare plan compare tool is another great tool that allows you to browse plans in your area.
It’s easy to use and is available on mobile devices, smartphones, and tablets.
Recommended for you:
- Medicare Open Enrollment 2025: Maximize Coverage, Minimize Costs
- Get Medicare Advice From State Counseling Programs
- 9 Medicare Open Enrollment Scams To Avoid
Guest contributor: Jagger Esch is a Medicare expert and the founder, president, and CEO of MedicareFAQ. He has been working in the Medicare space for over 10 years. Jagger has a passion for sharing his expertise on Medicare to beneficiaries so they can be better prepared for health care costs after retirement.
This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.
