Do I Change My Insurance? A Guide for Surviving This Year's Enrollment Period

By Elie Harriett

September 23, 2016

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Every year, Medicare gives you the opportunity to change certain insurance plans.  October 15 through December 7 is the change period.   Every company ratchets their advertising of these plans up to such a high level that it is virtually impossible not to be aware of them.  But do you need to act?  Here’s a handy guide to help you out this enrollment period.

First off, do I need to change?

Some people MUST change their plan this year.  If you received a special notice from your insurance company saying your plan is not renewing, you MUST find a new plan.  No choice.  Contact us immediately and we will be glad to help find you a new option that meets your needs.  If you received a note stating that any of your medications will not be covered next year, or one or more of your doctors or hospitals are not going to be in the plan’s network next year, you may want to consider changing.  In general, our advice to clients is to change their insurance before considering changing medications or doctors.  There’s usually an alternative insurance plan which will continue to cover medications and doctors for the upcoming year.  It is always more advisable to consider changing insurance before changing the medications or medical professionals which are keeping you healthy.  If you fall into this group you most likely will change insurance during this year’s election period.

 If I do not NEED to change my insurance, then SHOULD I?

This is where we come in.  It is always advisable to at least look at your options.  Many plans will make a change on January 1.  Sometimes they add covered drugs, sometimes they drop them.  Sometimes they raise drug cost-sharing prices, and sometimes premiums go up.  Sometimes doctors leave networks.  These are all factors you are powerless to avoid EXCEPT during this time of the year.  We look at all our client’s insurance every year.  Even if it is the best insurance you can possibly have this year, next year it will be different.  So exploring options is always a good idea.

 I hit the Coverage Gap (donut hole) this year with my prescriptions.  Can you stop it from happening again?

3 out of 4 times, no.  The coverage gap is treated very much the same on most Part D plans, and it is based on the retail cost of your drugs, not which plan you are in.  But that isn’t to say you are out of luck.  Everyone that enters the coverage gap gets into it for different reasons.  Sometimes there is a reason you are in it that can be dealt with.  Some plans will give limited coverage in the coverage gap.  It is always a good idea to explore those reasons with someone familiar with the plan you are in to find out what options might be available to you next year.

 I’m in a Medicare Supplement.  Do I need to do anything during this annual change period?

Well, there’s good news for you on that front: Medicare Supplements have benefits which are guaranteed renewable for life.  That means that you will not be seeing any kind of change on the benefits that your Medicare Supplement covers.  Premiums, of course, will change at some point.  But a plan covering 100% of Medicare Part B’s remaining 20% will continue to do that for as long as you have the policy.  However, that does not mean you do not need to take action.  People in supplements still need to look into their Prescription Drug Plans.  Prescription Drug Plans will change every year just as Medicare Advantage plans do.  Just make sure that if you are satisfied with your Medicare Supplement, you ask to take a look at options for standalone Part D Prescription Drug Plans only.

 My coverage is provided to me by a former employer or union.  What about me?

Rules are slightly different for you.  The best thing you can do to give yourself piece of mind during this enrollment period is contact your group’s benefits administrators and ask them what actions you can or should take.  They will be able to inform you best about your personal situation.

 Virtually everyone on Medicare is affected by this annual period of change in some aspect.  The biggest criticism we hear from people when they become our clients is their plan worked great the first couple of years and then gradually became more expensive and worked less.  This is due to the fact that your plan needs to be reviewed annually to make sure that it keeps up with your needs.

 So this year, we encourage you to be proactive.  Between October 1^st and December 7^th, we encourage you to contact us to review your medical and prescription plans and make sure you are in the best coverage available to you for 2017.

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