According to one, nearly two-thirds of Americans (64%) believe that Medicare benefits will be reduced under the current administration. A recent NerdWallet survey. For some, benefits may drop as soon as next year — with a big cost.
Medicare Part B premiums are projected to increase by $21.50 to $206.50 next year, according to the Medicare trustees. Medicare Part D prescription drug plans could increase premiums by as much as $50, up from the government’s $35 cap last year. And many of the largest private insurers are scaling back their Medicare offerings or exiting the market altogether due to lack of profitability.
Consumers have a major defense against rising costs, shrinking provider networks and disappearing benefits. Medicare Fall Open Enrollment. From October 15 to December 7 of each year, you can add, drop, or switch Medicare plans.
“This is the most important open enrollment period in Medicare’s 60-year history,” offers the Medicare guidance. “Everyone should review their plan.”
Here’s a Medicare Open Enrollment checklist to help you review your plan and compare your options this fall.
1. Read your Annual Notice of Change carefully
Medicare enrollees should have received an Annual Notice of Change (ANOC) in the mail in September detailing changes to the upcoming year’s plan. Note any changes to your plan:
Maximum pocket limit.
Provider network and service area.
Prescription drug coverage and pharmacy networks.
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2. Confirm that your prescription drugs are still covered and affordable
Carolyn McClanahan, a physician and certified financial planner (CFP), says the biggest mistake seniors can make is not reviewing their prescription drug coverage. “A lot of people let it coast, and their medications may not be on formulary or the cost has gone up too much,” McClanahan says.
Don’t rely on your molecule alone. Kaggle urges consumers to visit their insurance company’s website and look for their drugs on the plan’s new formulary, or list of covered drugs. Although Medicare prescription drug plans come with a $2,100 cap on out-of-pocket costs in 2026, the cap only applies to covered drugs. If you need a drug that isn’t on your plan’s formulary, it can easily wipe out your savings.
Even if your drugs are covered, they may have different cost-sharing tiers. For example, a drug that came with a $10 copay this year might change to a 25% coinsurance next year. If the drug has a retail price of $1,000, your cost will increase by $10 to $250. “Plans that work this year may not work for you at all next year, so you want to compare your coverage with others,” says Cagle. Medicare prescription drug plans.
3. If you are on Medicare benefits, verify your doctors and hospitals are still in network.
“The wild card in Medicare Advantage is plan networks, because they can change at any time. If your medical provider is suddenly dropped from your plan’s network, you’ll either have to find a new one or face higher out-of-network costs. And as insurance companies pull back their offerings, the region (where) your plan operates can shrink,” says Cagle.
On top of that, Preferred Provider Organization (PPO) plans, which give enrollees more freedom to see out-of-network providers, are being discontinued by some insurance companies. Call your primary care doctor and any specialists or hospitals you plan to visit and confirm they will be in your plan’s network next year.
4. Look past compensation and prioritize long-term financial security
Rising costs may entice seniors to enroll Medicare Advantage Plans These lower premiums and additional amenities such as dental allowance and gym membership. But McClanahan cautions against trying to save money this way.
Premiums are often lower because the plan limits who you can see and where you can go for care. Your doctor can leave your plan at any time, and some services may not be covered if you don’t get pre-approval. “You can shoot yourself in the foot down the road when you get sick and need better care,” she says.
When it comes to extras offered by Medicare Advantage plans, Kaggle doesn’t recommend them to be the deciding factor. “They’re like sprinkles,” she says. “None of us have cancer, strokes, heart attacks, chronic conditions, car accidents because of health insurance.” Make sure you have adequate coverage for these things before you “splash up,” and prioritize keeping your deductibles and out-of-pocket expenses as low as possible.
5. When major changes occur, consider returning to Original Medicare
If you are on Medicare benefits and your plan is discontinued or your area leaves, you may want to think about switching. Original Medicare And getting a Medicare Supplement insurance, or Medigap, plan.
Medigap The plans help cover out-of-pocket costs, which are unlimited on original Medicare. “You should never be on traditional Medicare without a Medigap plan, because it puts you at higher financial risk,” McClanahan says.
If you miss out on signing up for Medigap when you join Medicare, you’re often subject to medical underwriting, which can make it difficult to get an affordable policy. But some important changes, such as if your Medicare Advantage plan closes or no longer works in your area, temporarily give you “guaranteed issue rights.” This means Medigap insurers cannot deny you or charge you more because of your health.
Once you’ve reviewed your plan changes, you can search for Medicare on the Medicare Plan Finder tool. gov to compare options and decide if it makes financial sense. Change Medicare plans. If you decide to switch, enroll in your new plan by the December 7 deadline.
