Medicare’s open enrollment period is – for millions of beneficiaries – a welcome opportunity to make changes to Medicare health plans – changes that could result in lower costs and better coverage. But there are some enrollment mistakes you’ll want to avoid when you’re selecting your plan for the coming year. Here are three to keep in mind.
1. Choosing an Advantage plan where your providers aren’t in-network
Medicare Advantage offers several benefits you won’t find in Original Medicare, including expanded coverage for dental, vision, and hearing services (on the majority of plans), and compared with adding a stand-alone Part D plan and Medigap to Original Medicare, Medicare Advantage generally also offers lower premium costs. But with an Advantage plan, you’re limited to a specific network of providers (unlike Original Medicare + Medigap, which will cover you at any provider who accepts Medicare, nationwide). Go out of network, and you risk having to pay for your care out of pocket.
The problem? Networks within Advantage plans can change from year to year. If you have a specific provider you’ve come to trust, or whose office is convenient for you to access, then the last thing you want is to stick with your existing Advantage plan only to find that it’s no longer in-network.
Therefore, look out for such changes before renewing your Medicare Advantage plan for the coming year. And if you do find that your preferred providers are no longer in-network, explore your options for switching to a different plan.
For 2025, some Medicare Advantage insurers are scaling back their plan offerings and coverage areas, meaning that some plans are not available for renewal., If your Medicare Advantage plan is not available for the coming year, you can pick a new Medicare Advantage plan (as long as one is available in your area) by December 31, 2024 and it will take effect January 1.
Alternatively, you can choose to switch to Original Medicare and pick a stand-alone Part D plan and a Medigap plan. You would have guaranteed-issue access to most Medigap plans available in your area due to the non-renewal of your Medicare Advantage plan.
Want to make changes to your coverage? Talk with a licensed advisor at 1-844-309-3504.
2. Sticking with the same Part D plan without exploring others
Part D premiums can increase from year to year, making your existing drug plan more expensive. Plan formularies – which determine what medications are covered by the plan and how much you’ll pay to fill a prescription – can also change from year to year, potentially resulting in coverage changes for the drugs you take (keep in mind that most Medicare Advantage plans have integrated Part D drug coverage; the formularies on those plans can change just as they can for stand-alone Part D plans).
Holding on to your Part D plan — either a stand-alone plan (PDP) or a Medicare Advantage plan that includes Part D coverage — without looking into alternatives is a big mistake that could cost you a fair amount of money. So before you decide to stick with your current plan, see what choices are available.
But also, reassess your needs. If you’re no longer taking the same prescriptions, you might find a cheaper Part D plan that gives you the coverage you need.
If the idea of combing through different Part D plans seems too overwhelming, try using Medicare’s Plan Finder. It lets you input your location – as well as prescription and pharmacy information – to help you better evaluate your options.
For 2025, the government has said that average PDP premiums will decrease to about $40/month, down from an average of $41.63/month in 2024. But there will continue to be significant variation in premiums from one plan to another. And there will also be fewer PDPs available: A total of 524 nationwide (across the 34 PDP regions), down from 709 in 2024.
So some PDP enrollees may find that their 2024 coverage is no longer available for 2025. In that case, they will need to pick a new plan; as long as they do so by December 31, 2024, their new coverage will take effect January 1, 2025.
3. Assuming you and your spouse need to be on the same Part D or Medicare Advantage plan
There are certain things it’s nice to do as a couple – but choosing a Part D or Medicare Advantage plan isn’t necessarily one of them.
If you and your spouse take different medications, see different doctors, or have different medical needs, the plan that’s right for you isn’t necessarily the best choice for him or her. A better bet? Approach the selection process individually, both initially and each year during open enrollment.
Medigap plans are also purchased on an individual basis, just like Original Medicare, Part D, and Medicare Advantage. You and your spouse might choose the same Medigap plan, but you’ll each have your own policy regardless of whether you each pick the same one. Unlike Medicare Advantage and Medicare Part D, there’s no federally-provided annual enrollment window for Medigap, so your Medigap choice isn’t a decision you have to revisit annually (enrollees in some states have access to an annual plan change window for Medigap; as noted above, there is also guaranteed-issue access to Medigap if your Medicare Advantage plan isn’t available for renewal).
Don’t rush through the process
Open enrollment for Medicare Advantage and Medicare Part D is nearly two months long, which means you have plenty of time to review your choices and secure the right health coverage for the coming year. Take your time when weighing your plan options; doing so could save you a world of money and stress.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
Footnotes
