Should I Change My Medicare Coverage During Open Enrollment?
Decision flowchart to evaluate whether switching Medicare plans during open enrollment makes sense.
What Issues Should I Consider During Medicare Open Enrollment?
Medicare Open Enrollment is an annual opportunity for Medicare beneficiaries to review their healthcare coverage and determine whether their current plan continues to meet their needs.
Because plan costs, provider networks, prescription drug coverage, and available benefits can change from year to year, many retirees review their Medicare elections annually rather than automatically renewing their existing coverage.
This resource outlines several common issues individuals review during Medicare Open Enrollment.
Understanding Medicare Open Enrollment
Medicare Open Enrollment generally occurs each year from October 15 through December 7.
During this period, individuals may be able to:
- Switch from Original Medicare to a Medicare Advantage Plan
- Switch from a Medicare Advantage Plan to Original Medicare
- Change Medicare Advantage Plans
- Enroll in, change, or drop a Medicare Part D prescription drug plan
Coverage changes made during Medicare Open Enrollment generally become effective on January 1 of the following year.
Review Prescription Drug Coverage
One of the most common reasons individuals review their Medicare coverage is a change in prescription drug needs.
Drug formularies, which are lists of covered medications, can change from year to year. A medication covered by a plan one year may move to a different tier, require prior authorization, or no longer be covered the following year.
Many retirees review:
- Current medications
- Prescription costs
- Drug coverage tiers
- Preferred pharmacy networks
- Annual out-of-pocket prescription expenses
Review Healthcare Providers and Network Changes
Provider networks can also change over time.
Individuals enrolled in Medicare Advantage plans often review whether their preferred physicians, specialists, hospitals, and healthcare facilities remain in-network for the upcoming year.
Changes to provider networks may affect access to care as well as out-of-pocket costs.
Many retirees compare provider networks annually before making enrollment decisions.
Review Plan Costs and Out-of-Pocket Expenses
Premiums are only one component of Medicare costs.
During Medicare Open Enrollment, individuals often review:
- Monthly premiums
- Annual deductibles
- Copayments
- Coinsurance amounts
- Maximum out-of-pocket limits
A plan with a lower monthly premium may have higher out-of-pocket expenses, while a plan with higher premiums may provide broader coverage or lower cost-sharing.
Comparing total projected healthcare costs can provide a more complete picture than reviewing premiums alone.
Review Medicare Advantage and Original Medicare Options
Some individuals use Medicare Open Enrollment to reevaluate whether Medicare Advantage or Original Medicare better aligns with their healthcare needs.
Factors commonly reviewed include:
- Provider flexibility
- Referral requirements
- Travel considerations
- Prescription drug coverage
- Supplemental benefits
- Expected healthcare utilization
Because healthcare needs can change over time, the coverage option selected at age 65 may not necessarily remain the best fit later in retirement.
Review Income-Related Medicare Premiums
Higher-income retirees may also review how income affects Medicare premiums.
Certain individuals may be subject to Income-Related Monthly Adjustment Amounts (IRMAA), which can increase Medicare Part B and Part D premiums.
Because IRMAA is generally based on income reported on prior-year tax returns, retirees often review how retirement account withdrawals, Roth conversions, capital gains, and other sources of income may affect future Medicare costs.
Additional information is available in our resources covering:
Review Coverage Annually
Healthcare needs, prescription drug costs, provider networks, and plan benefits can change each year.
For that reason, many retirees review their Medicare coverage annually during Medicare Open Enrollment to better understand whether their current elections continue to align with their healthcare and financial situation.
About This Resource
This resource provides general educational information regarding Medicare Open Enrollment and Medicare coverage options. It is not intended as investment, tax, legal, healthcare, or financial advice. Medicare rules, plan availability, and costs may change over time.
If you would like to discuss how healthcare costs fit within your broader retirement plan, we invite you to schedule an introductory conversation.