It’s Fall Medicare Open Enrollment Time: Is Your Medicare Plan Still a Good Fit?

Older woman on her balcony looks over paperwork.

Every year between mid-October and early December, people with Medicare can switch their plan coverage. With so many plan options, this time period — known as fall open enrollment — can be stressful and confusing.

If you haven’t run into any major health issues in the past year, or if you were satisfied with the health coverage you did get, you may be tempted to keep your Medicare plan the same. But health insurance laws and coverage options are constantly changing, says Michelle Katz, L.P.N., a health care advocate and public speaker in Washington, D.C. Your current health plan may even look different moving forward. The only way you’ll know is if you check your coverage before you renew.

“Beyond changes to your current plan, your health changes over time,” says Katz. “It’s important to reevaluate your plan every year to make sure it still meets your needs.”

Use these steps to help figure out which Medicare plan options are best for you and discover how to score more perks from your plan.

Step 1: Know your options

It’s always good to begin with a quick refresher course on Medicare. Hospital stays, preventive screenings, and trips to the doctor fall under Original Medicare, Parts A and B. If you want prescription drug coverage, you can enroll in Medicare Part D.

Medicare Advantage plans — aka Part C — bundle Parts A, B, and often D into one plan managed by private insurers. Advantage plans generally include extra benefits that Original Medicare doesn’t cover, things like vision, hearing, and dental coverage. There are also supplemental Medicare plans known as Medigap plans.

Many Medicare Advantage plans (plus a few Medigap plans) also include the popular SilverSneakers fitness program for older adults—at no additional cost. A SilverSneakers membership includes access to thousands of fitness locations, senior communities, and other neighborhood health facilities, plus live online classes.

Step 2: Make a list

Before you shop around for a plan, Katz suggests making a complete list of your health needs.

Be sure to list:

  • Prescriptions you take regularly
  • Existing health conditions
  • Recent past health issues or events, such as a fall or hospitalization
  • Family health history
  • Health tools, equipment, and accessories that you use regularly 
  • Doctors you routinely visit (don’t forget your eye doctor or hearing specialist)
  • Any surgeries or procedures you may need in the next year
  • Any long-term travel plans or homes out of state

As you make your list, highlight any must-haves: What do you need your insurance plan to cover, and what items or services are you okay covering on your own?

You may change your mind about some things once you research plans, but this will give you a starting point, says Katz.

Step 3: Review your current plan

Look closely at the coverage you would have if you keep your plan the same for the next year. Compare it to the list you put together. Check for things like:

Are your prescriptions covered? Every insurance plan has a list of prescription drugs it will cover (in full or in part). The medication list may change from year to year, so be sure to check your current plan’s list to see if it includes your prescriptions.

Are your health tools and accessories covered? If you wear glasses, use a hearing aid or walker, or need to monitor your blood glucose, check to see if your plan will cover the cost if you need to replace or upgrade these items.

Are your doctors in network? Every insurance plan has a network of doctors and hospitals it will cover if you need health services. Even if your plan doesn’t cover the full cost of a visit, it may pay for a portion. However, in-network providers can change from one year to the next. Call your current health care provider(s) to confirm that they accept your insurance plan.

Do you have coverage for hearing, vision, and dental? Many older adults are shocked to learn that their insurance plan doesn’t cover dental, hearing or vision, Katz says. To get these benefits, you’ll have to look to Medicare Advantage Plans and private supplemental insurance plans.

What’s the coverage for hospital stays, surgeries, and procedures? If you’re planning to get a joint replaced or another elective procedure or surgery done in the next year, check your current plan for coverage.

If your current plan falls short on anything you put on your list, consider how important that coverage is to you or whether you can make up the cost elsewhere. If you need coverage on something you’re not currently getting, it’s time to look for a different plan.

If your current plan falls short on anything you put on your list, consider how important that coverage is to you or whether you can make up the cost elsewhere. If you need coverage on something you’re not currently getting, it’s time to look for a different plan.

Step 4: Look for a plan with perks

Once you have a handle on the absolute musts that you’ll need, it’s time to explore the lesser-known benefits that come with many Medicare Advantage plans, says Katz. With more and more providers prescribing exercise for all their patients — just as they would write out a prescription for blood pressure medication — finding a plan that makes getting fit easier is a definite plus.

A plan that includes SilverSneakers, for example, can help you stay active. Members can take advantage of both in-person and live online classes. There’s even an on-demand library of workouts, wellness videos, and exercise programs created by SilverSneakers’ top instructors. Learn more about SilverSneakers here

Other perks to be on the lookout for include home meal delivery after surgery, mail-order prescription services, and free transportation to and from the doctor’s office. If you don’t see these extras highlighted in the plans you’re considering, be sure to ask your licensed eHealth insurance advocate to help you narrow your search to ones that do.

Step 5: Consider your travel plans

Insurance plans can vary from one state to another. So if you own a home in another state or plan on traveling often or for a portion of the year, check for coverage in that state. Be sure you can get your prescription drugs and any health care services you may need while you’re away from home.