5 questions to ask before you let your Medicare benefits auto-renew

1. Have your total costs changed?

It’s important to start with how your medical needs have changes year over year. It’s entirely possible that you could’ve had a new health issue pop up. You’ll want to do the math on all of your potential out-of-pocket costs. Those could include:

• Your copayments or coinsurance (a fixed price you’ll pay for covered health services)

• Your deductibles (what you have to pay out of your own pocket before your plan pays the rest)

• Your prescription drug costs (in other words, what you pay for the medication or medications you’re currently taking)

• Your premium (that’s your monthly insurance bill)

These are all costs you’ll have to pay out of pocket on a regular (or monthly) basis. You’ll want to be fair with yourself: Do you have enough saved up to cover it? You’ll also want to be aware of what your plan’s annual out-of-pocket limit is so you can see if it lines up with your estimate. If your out-of-pocket costs are more than you can afford, it might be a good idea to shop around for a plan with a lower out-of-pocket limit during Medicare’s AEP.

One other cost-related thing to keep in mind: Your plan’s benefits and costs may change from year to year. Maybe the monthly premium you’re paying for your Medicare plan may be going up. Or, one or more of your medications will no longer be covered by your Medicare Part D (prescription drug) plan.

That’s why it’s a good idea to check your Annual Notice of Changes. That’s a letter from your private Medicare insurance company that explains the changes that will be made to your Medicare Advantage plan or Part D plan in the following year. You’ll get that in the fall, and it’ll include any changes that may have been made to costs and coverage.

2. Has your provider network changed?

Let’s say you’re on Medicare Advantage (MA). That’s a type of Medicare health plan offered by a private company that contracts with Medicare. (You might also see it called Medicare Part C.)

When it comes to MA plans, in many cases, you may only use the doctors who are in your MA plan’s network and service area. That would be for non-emergency care. That means if you use your plan’s in-network doctors, you will likely only have to pay a copay or coinsurance when seeing your doctor or a specialist. (Speaking of specialists, you may also need to get a referral to see them if you have an MA plan.)

It’s important to check that your doctors are still in your plan’s network and that the providers in the plan are in locations that are convenient for you, says Katz. “It’s very common for doctors to drop a plan, and you can’t always trust that they’ll remember to tell you,” she explains.

With that in mind, if you have to use a provider outside of your MA plan’s network, it may cost you a lot more. While some MA plans offer non-emergency coverage out of network, typically it’s offered at a higher cost. So, if you think you’ll need to use any out-of-network providers, you’ll want to add that to your estimate.

You’ll also want your pharmacy to be in your plan’s network. Make sure that all your drugs are covered under the plan’s drug list (formulary) and that you’re familiar with the coverage rules that apply to your prescriptions.

3. Has your plan’s star rating changed?

Each Medicare Advantage and Part D plan has a star rating, which measures the plan’s overall quality and performance. A plan can get a rating between 1 and 5 stars, with a 5-star rating considered high performing. It’s a good idea to check whether your plan’s star rating has gone up or down, as well as whether there are any other 5-star plans you can switch to.

4. Have your health needs changed?

If your health needs have changed, you may need a different plan. For example, you may need:

• Better access to health care services

• Better-quality health care, based on your changing needs

• To make more doctor visits

• To take different or more prescription drugs

In all cases, you may want to shop around for a new plan. You can do this by calling a licensed insurance agent at (863) 746-7873 or (863)-7-INSURE.

5. Do you want additional benefits that are not covered by your plan?

Medicare Part A and Part B (often referred to as “Original Medicare”) doesn’t cover benefits such as dental, vision or hearing,  but — say, your audiologist suggests that you get a hearing aid in one or both ears — you may want to consider another plan. You have options:

1. If you’re on Original Medicare, you can add a Medicare Supplement (Medigap) plan, which can help pay for additional health care costs, such as copayments, coinsurance and deductibles.

2. If you wait until AEP, which kicks off on October 15 and runs through December 7, you can switch to an MA plan. Most MA plans cover benefits that Original Medicare doesn’t.

Even if you’re happy with your current health coverage, it’s important to know your coverage options and to compare other health and drug plans during AEP season, says Katz. You may find Medicare coverage that better meets your needs for the upcoming year. A good way to start that process is by calling a licensed insurance agent at (863) 746-7873 or (863)-7-INSURE.