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Should I Change My Medicare Coverage During Open Enrollment?

Updated: Nov 2, 2022

Many of our clients currently rely on Medicare plans for their healthcare coverage. They may have enrolled in Original Medicare or Medicare Advantage, and they likely have prescription drug coverage as well. For current beneficiaries of all of these plans (Medicare A, B, C, and D), October 15 marks the beginning of the Open Enrollment Period, during which changes in coverage may be made.

This flowchart helps you guide your clients through a series of considerations when evaluating and comparing their Medicare options. It covers:

  • Changes in healthcare needs

  • Costs of premiums, deductibles, etc.

  • Access to specific providers, services, and prescription drugs

  • Out-of-state concerns

  • Effective dates of any changes


Hi, Todd Pouliot, Gateway Financial visit us at I really appreciate you coming back again for another checklist and flow chart series. I think we’re at over 60 videos now, which is fantastic. And I appreciate you all with some great ideas. So, one of the ideas we were given was about healthcare. And we have open enrollment coming up. So open enrollment for Medicare normally starts around October 15th every year and this is a very short window for one of their work done, so we decided that today might be a good thing to look at Medicare options in this flowchart. So many of our clients rely on Medicare for Health Care coverage. They were enrolled in original Medicare or Medicare Advantage and they're likely to have prescription drug coverage as well. For current beneficiaries, there’s Medicare A, B, C, and D. And again, October 15th marks the open enrollment period during which changes for those coverage has made be made. Now I want to advise you that we do not sell these types of products, but we’d like to help our clients make sure they're doing the proper things through financial planning and it's always good to have people that you can trust nearby and good people to refer out to to get more information on these Medicare plans, whether or not it's the original Medicare or Medicare Advantage. So we’re going to cover a couple of needs here. We’re going to look at the changes in healthcare needs, cost premiums, and deductibles, access to specific providers, services, and prescription drugs, any out-of-state concerns, and any effective date changes. So, before I switch over, I do want to caution you that there have been some recent changes in some of the healthcare plans, and we are still trying to work through those. But we try to update our flow charts for you. So here we are in 2022, we have this flow chart for you and obviously, we will update it as we get more information about the current changes on that plan. Specifically, those changes were about that some diabetic drugs and some prescription drugs you want to make sure we add to this. So, here is our flow chart for 2022. Have your Medicare Plan costs and her health care costs recently increased or are you paying for the coverage that you don't use? And then let's go here to yes right away to kind of get into the meat of things. Consider seeking a more affordable plan that meets your needs, compare premiums, co-pays, and out-of-pocket maximums. Make sure you're going to somebody who has access to several different plans and understands your state-specific issues where you live in. So we want to make sure we're in here. And again, all of these flow charts, if you follow all of the areas, all of the yes-no logic statements. We want to get to, “Are you currently enrolled in original Medicare parts A and B?” So I’m going to pause there and I’m going to go through some of the other areas and then come back since they all lead into here. So if we answered no, has your plan's coverage of service, or has your need for service recently changed? Have you become more ill? Or whatever the situation is do you need to change the plan? And has the services or needs for services changed? Consider seeking a new plan obviously. If you expect dental, hearing, or vision expenses, consider a Medicare Advantage plan because remember those things. I remember when I was younger and a friend of mine who was a doctor in audiology told me that hearing aids weren’t covered I was absolutely shocked by that. And those are some of the experiences through life that wisdom will bring you that, “Hey I will need some dental care, I will need some hearing care or vision.” As we age we all know that our vision, obviously with my glasses or hearing. I'm sure my wife says my hearing is probably not as good as it used to be and also dental expenses. So again, do you require access to certain hospitals, physicians, and or prescription drugs that are not covered under your current plan? Again if the answer is yes, consider seeking a new plan. Including out-of-state specialists if any. I know for my personal situation, my father's had a lot of health care issues over the last, I would say 3 years, he lives in a different state and comes up here to see us at our local hospital and these are considerations for him that we need to talk about because of certain specialist that he needs to see. So essential for prescription drug specialists and compare networking drug formularies and tiers. Again, that's why having somebody who is efficient and really understands this is really important to have on your side. And again, could there be other compelling reasons to update your coverage? It can be convenience, it can be quality, it could be travel plans. You know we have those, as we talked to people who move into retirement or financial freedom, the ‘Go Go’ years when they are still a senior citizen but relatively young and they want to go see family, vacation, do all those things. The ‘Slow Go’ years are when they're not able to move around as much or don't want to have to fly as much. And then the ‘No Go’ years as you age and get critical illness and those things change, so be careful of those compelling reasons. Even if your cost, coverage, and service needs haven’t changed, consider giving your plan an alternative annual review. Always review your health insurance. My wife is very fortunate and more versed in health care that I am, so I have her review our family plan and that's important for us and our family. And, if the answers are no, consider maintaining your existing coverage another year if you have none of these things to consider. But back to where I paused earlier about being enrolled in the original Medicare. If the answer is yes, you can change change from original Medicare to a Medicare Advantage plan but only between the dates October 15th to December 7th. Now mind you, I will tell you if you are considering these things be ahead, plan ahead, and try to get these decisions figured out before, because when you wait and wait and wait, a lot of these Healthcare Providers, this is their busiest time of the year is probably worse than being a tax preparer. That last week in November, obviously we have Thanksgiving here in the United States and then that first week in December it's almost impossible to get a hold of them. They're just usually physically and emotionally drained at that point. So, be ahead of that planning. Do you have a Medicare prescription drug plan? Again that's part D. You can drop your Medicare drug plan or change to another drug plan, again between the dates of October 15th and December 7th. So I'm just going to back up a little bit to that original Medicare, we do not have it. Are you currently enrolled in Medicare Advantage plan part C? If the answer is no, you must first enroll during your initial enrollment period. It's a seven-month window that includes the month you turn 65 and the 3 months before and after. So the very limited window there. So the general enrollment periods are usually January 1st through March 31st or a special enrollment period if you're eligible. So be careful of those windows. Again that's why you work with a financial planner that does holistic or comprehensive planning and we kind of talked about these things prior to you turning age 65. When you get to age 65 you have a lot of decisions to make in a very short time. So if we answered yes, you can change to a new Medicare Advantage plan, adding or removing drug coverage, or return to original Medicare enrollment during two open enrollment periods between October 15th and December 7th with we said quite a bit already, and January 1st and March 31st. So be aware that you can do that and make sure you look at joining that Medicare drug plan again any late enrollment penalties may be there from coverage gaps and you may be subject to penalties. Again we want to make sure we make the correct decision up front. We have a little bit of flexibility, but however, we want to make these decisions early and often you want to also be very – communicating very well with your physician. Whether you have a general practitioner or specialist and just talk about whatever situation you may have personally. Talk about what the long-term prognosis is for those things. And what your life expectancy may be. They're never going to tell you what day or year, but you need to have those conversations. So if you require access to certain providers, services, and/or prescriptions, ensure that those changes will meet your specific needs. Now again I brought up a personal situation with my father. I really need to make sure he has access to that certain provider that he needs to see at a certain hospital. So if we made any changes, we really need to make sure that he's got a specific provider that he can still stay and work with. And any changes you make during open enrollment will not go into effect immediately. Remember, those changes are made and the effect will be on January 1st of the following year. And if you enrolled in the Medicare supplement, which is called Medigap, you may make changes at any time, but you might be subject to underwriting and/or denied coverage. Be cognizant that Medigap is aware the reason why you're making a change is that you might need underwriting and you might be denied coverage because your personal needs have changed. I mean this is a great topic of conversation and I love that people have these conversations with us. We do not sell health insurance and that's one of the things that I think people forget. Being fee-only, we’re only held accountable to our clients and having discussions about healthcare are very important when you talk about financial planning. People always have this goal of retirement. Well, we don't really talk about longevity on the end side. And that longevity can be 90 years or a hundred years. I've got a client that wants me to plan to age 120. Why? Because it's her money and it's her plan and that's what we're going to do. She's a very healthy person who wants to have that plan in place for her if that life expectancy is reached and she has longevity in her family. So we want to make sure that we come here with an open mind and we talk about these things. And health insurance is one of the topics that was never discussed in financial planning 20 years ago. We found that that is a topic that needs to be discussed and how that interlays with all the web of financial planning for social security and then withdrawing from certain assets to live on. So I appreciate you coming back. We love those subscribers. You guys really make us happy. It helps us with the algorithm when you click that thumbs-up. Don't forget to ring that bell and we’ll provide you with more education hopefully we’re making these simplified enough you understand what we're talking about. Thanks and have a great day. Be well.

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