Key Takeaways
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Medicare plans change every year, so reviewing your coverage annually ensures you don’t get caught off guard by cost increases, benefit reductions, or provider network changes.
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Checking your prescription drug coverage, out-of-pocket costs, and enrollment deadlines can help you avoid unexpected expenses and disruptions in your healthcare.
Why Reviewing Your Medicare Coverage Annually Matters
Medicare isn’t a “set it and forget it” type of plan. Every year, there are adjustments to premiums, deductibles, copayments, and coverage options. If you don’t review your plan, you could end up paying more or losing access to services you rely on. Taking the time to check your coverage ensures that you are getting the best possible care at the most reasonable cost.
1. Verify Your Plan’s Costs and Benefits
Medicare costs and benefits change each year, so you should always review:
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Premiums and Deductibles: The amount you pay for your coverage may have increased for 2025. Knowing these costs ahead of time can help you budget accordingly.
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Copayments and Coinsurance: If your plan has raised copays for doctor visits, hospital stays, or prescriptions, you may need to adjust your healthcare spending.
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Out-of-Pocket Maximums: Some Medicare plans cap your annual expenses. If your plan has changed these limits, it could affect how much you pay for medical care throughout the year.
2. Check Your Prescription Drug Coverage
Medicare Part D and Medicare Advantage plans with drug coverage can change their:
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Formularies: Your medications may no longer be covered or may be moved to a higher cost tier.
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Preferred Pharmacies: Your regular pharmacy might no longer be in your plan’s network, which could lead to higher costs.
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Annual Deductibles and Copays: Prescription drug costs can vary, so reviewing changes will help you prepare for any increased expenses.
Since the Medicare Part D coverage gap has been eliminated in 2025, once your out-of-pocket costs reach $2,000, your drug expenses are fully covered for the rest of the year. This is a significant change that could impact how you budget for prescriptions.
3. Confirm Your Doctors and Hospitals Are Still Covered
Even if you love your current doctor, you need to confirm they still accept your Medicare plan:
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Provider Networks: Medicare Advantage plans, in particular, change their provider networks every year. If your doctor is no longer in-network, you may face higher costs or need to find a new provider.
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Hospital and Specialist Coverage: Some plans limit access to certain hospitals and specialists. If you require ongoing treatment, make sure your providers remain covered.
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Out-of-Network Costs: If you travel frequently or live in multiple states throughout the year, check if your plan provides coverage outside your local area.
4. Review Changes to Supplemental Benefits
Medicare Advantage plans often provide additional benefits beyond Original Medicare. However, these benefits can change yearly. If you rely on any of the following, review your plan details:
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Dental, Vision, and Hearing Coverage: Some plans reduce or eliminate coverage for these essential services.
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Over-the-Counter (OTC) Benefits: Fewer plans are offering OTC allowances in 2025, so check if yours has changed.
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Transportation Services: If you depend on rides to medical appointments, confirm whether your plan still provides this benefit.
Additionally, new mid-year notifications will remind enrollees about unused supplemental benefits. If you’re enrolled in a Medicare Advantage plan, expect to receive this notification between June and July 2025.
5. Be Aware of Enrollment Periods and Special Enrollment Opportunities
Missing a Medicare enrollment deadline can leave you without coverage or lead to penalties. Here are the key periods to keep in mind:
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Medicare Open Enrollment (October to December): This is your chance to switch Medicare Advantage or Part D plans for the upcoming year.
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General Enrollment Period (January to March): If you missed your initial enrollment, you can sign up for Medicare during this time, but coverage won’t start until July.
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Special Enrollment Periods: If you experience a qualifying life event—such as moving, losing employer coverage, or qualifying for Medicaid—you may have additional opportunities to change your plan outside the standard enrollment periods.
Don’t Let Your Medicare Plan Surprise You
Waiting until you need care to check your Medicare plan details can be costly. Instead, take the time now to review your coverage, confirm your providers, and ensure your medications are still covered. This proactive approach will help you avoid unexpected expenses and gaps in care.
If you have any concerns about your Medicare options, speak with a licensed agent listed on this website for personalized guidance and professional advice.
