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3 Signs You May Need to Switch Your Medicare Plan During Open Enrollment

By Christy Bieber – Oct 12, 2020 at 8:04AM

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Do any of them apply to you?

Medicare Open Enrollment starts Oct. 15 and will run through Dec. 7. This period of time is usually the one chance seniors have to change their health insurance coverage options, including their prescription drug coverage.

You can't afford to miss out on the chance to make a change if your current coverage isn't the right fit. Here are three signs that may be the case and that you should explore your options. 

Doctor talking with patient.

Image source: Getty Images.

1. You're spending too much out-of-pocket on care

Coverage can vary substantially from one plan to another, with traditional Medicare coming with 20% coinsurance costs on most outpatient services, while some Medicare Advantage plans require less out-of-pocket spending. If you're currently spending a lot of your money on medical services, it may be worth paying higher premiums for a more comprehensive plan.

For many seniors, buying more coverage is the smarter move not just because a plan that provides broader coverage reduces out-of-pocket expenses, but also because it makes your expenditures more predictable. You can easily plan for higher premiums in your monthly budget, but it may be more difficult to cover unexpected and substantial medical bills on a fixed income. 

2. Your health situation has changed since last year

A lot can change when it comes to your health in your later years. If you've developed new chronic conditions or an acute health issue, it may be worth shopping for an insurance plan that's better suited to your current health status. A different prescription drug plan, for example, may make it cheaper to purchase supplies if you've been diagnosed with diabetes during the course of the year. 

You'll want to carefully review your current coverage of any new health issues and compare that with what other plans are offering to make sure your coverage is best suited to your current medical needs. 

3. Your preferred doctors or pharmacies don't accept your plan

Not all doctors accept Medicare or the various Medicare Advantage plans on offer. If you don't have a convenient pharmacy close by that takes your prescription drug plan, or if your preferred medical provider is no longer willing to accept your current coverage, a switch to a different policy could be your best bet. 

Medicare.gov makes it easy to find providers near you, including doctors and clinicians as well as hospitals and pharmacies. But if it is especially important that you receive your care from a certain specialist or if you want to make absolutely sure a particular doctor is going to accept your insurance, it doesn't hurt to call them and ask. 

You can't always assume your current plan will remain the same from one year to the next, either, as it's possible networks or coverage options could change. Your insurer should send you an Evidence of Coverage (EOC) document as well as an Annual Notice of Change alerting you to anything that may be different about your plan going forward so you can make a fully informed choice. 

With healthcare counting as a major expense for most seniors,  you can't afford to waste the opportunity to make sure your coverage is aligned with your needs. So, if any of these three situations sounds like yours, start researching coverage options today so you'll be ready to act when open enrollment comes. 

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