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Should I Change My Medicare Coverage During Open Enrollment?

Updated: Jun 5, 2023

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

Welcome back to another installment of Todd Pouliot's Checklist and Flow Chart series! We're thrilled to have you here at MyGatewayMoney.com. With over 60 videos already, we appreciate your continued support and the great ideas you share with us. Today, we'll be focusing on healthcare options and the upcoming open enrollment period for Medicare, which typically starts on October 15th each year. We understand that this can be a short window to make important decisions, so we thought it would be valuable to explore Medicare options through a flowchart. Many of our clients rely on Medicare for their healthcare coverage, whether they are enrolled in original Medicare or Medicare Advantage, including prescription drug coverage. Please note that while we don't sell these products, we aim to provide helpful financial planning advice and can refer you to trusted sources for more information on Medicare plans. In this blog post, we'll cover key considerations such as changes in healthcare needs, cost premiums and deductibles, access to specific providers, services, and prescription drugs, out-of-state concerns, and effective date changes.


Changes in Healthcare Needs and Affordability:

If your Medicare plan costs or healthcare needs have recently increased, or if you find yourself paying for coverage you don't use, it might be worth considering a more affordable plan that still meets your needs. Take the time to compare premiums, co-pays, and out-of-pocket maximums. Consulting with someone who has access to multiple plans and understands state-specific issues can be invaluable.


Coverage and Service Changes:

If your plan's coverage of certain services has changed, or if your healthcare needs have shifted due to illness or other factors, it may be necessary to seek a new plan. Consider Medicare Advantage plans if you expect dental, hearing, or vision expenses, as these are often not covered under original Medicare. Ensure that any new plan provides access to hospitals, physicians, and prescription drugs that meet your specific requirements. If you need access to out-of-state specialists, be sure to factor that into your decision-making process. It's crucial to review and compare networking drug formularies and tiers, especially if prescription drugs are a significant part of your healthcare needs.


Other Compelling Reasons:

In addition to cost and coverage changes, there may be other compelling reasons to update your Medicare coverage. Consider factors such as convenience, quality of care, and travel plans. If you anticipate a period of active travel or have specific lifestyle needs, it's important to choose a plan that accommodates those requirements. Reviewing your health insurance annually, even if your circumstances haven't changed, is a wise practice. It's always a good idea to communicate effectively with your physician, discussing your personal situation, long-term prognosis, and life expectancy.


Enrollment Periods and Options:

If you are currently enrolled in original Medicare (Parts A and B), you have the option to switch to a Medicare Advantage plan (Part C) during the open enrollment period, which typically runs from October 15th to December 7th. However, it's advisable to make these decisions ahead of time to avoid the rush and ensure that healthcare providers have ample time to assist you. If you have a Medicare prescription drug plan (Part D), you can drop or change your plan during the same open enrollment period. It's important to be aware of the limited window for enrolling in Medicare Advantage plans, as it typically coincides with your initial enrollment period (a seven-month window that includes the month you turn 65, plus three months before and after). If you miss this window, the general enrollment periods are usually from January 1st to March 31st, with potential eligibility for special enrollment periods.


Considerations for Medicare Supplement (Medigap) Plans:

If you have a Medicare Supplement (Medigap) plan, which provides additional coverage for expenses not covered by original Medicare, you have more flexibility to make changes at any time. However, it's crucial to note that you might be subject to underwriting and potential denial of coverage based on changes in your health needs. Therefore, it's essential to carefully evaluate your options and make informed decisions to avoid any coverage gaps or penalties.


Healthcare is an integral part of financial planning, particularly as we approach retirement and consider our longevity. With advancements in medical care, it's crucial to navigate Medicare options wisely and ensure that our coverage aligns with our evolving healthcare needs. Open enrollment periods provide an opportunity to review and make changes to your Medicare plans, but it's advisable to plan ahead and make decisions in a timely manner. Remember, the changes made during open enrollment will go into effect on January 1st of the following year. Work with a trusted financial planner and engage in open communication with healthcare providers to make informed decisions that will safeguard your health and financial well-being in the years to come.


Thank you for your continued support, and don't forget to like, subscribe, and ring the bell for more educational content. We're here to simplify complex topics and empower you to make informed financial decisions. Have a great day and be well!

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