Even if you feel confident in your Medicare coverage, it’s smart to review your plan at least once a year. Costs change. Networks change. Prescription formularies change. And sometimes your own health needs change — which can make a plan that worked last year less effective this year.
Here’s a simple checklist Medicare beneficiaries can use each year to make sure their coverage still fits.
1) Confirm your doctors are still in-network
If you’re enrolled in a Medicare Advantage plan, provider networks can change. Before you schedule new appointments, check whether your primary doctor, specialists, and preferred hospitals are still in-network. Out-of-network care can lead to higher costs — or not be covered at all depending on the plan.
2) Review your prescription drug coverage
Prescription coverage is one of the most common reasons people overpay. Each year, Part D plans can update:
-
Which drugs they cover (formulary)
-
What tier a medication is on
-
Prior authorization requirements
-
Preferred pharmacies
If you take regular medications, it’s worth checking that your plan still covers them at a reasonable cost.
3) Re-check your total “real” costs — not just the premium
A $0 premium sounds great, but it doesn’t tell the full story. When reviewing your plan, consider:
-
Copays for primary care and specialists
-
Hospital and outpatient costs
-
Maximum out-of-pocket limit (MOOP)
-
Costs for labs, imaging, and procedures
The best plan is usually the one that fits your expected healthcare usage — not the one with the lowest premium.
4) Look at extra benefits (and whether you’ll actually use them)
Many Medicare Advantage plans include extras like dental, vision, hearing, OTC cards, transportation, fitness benefits, and more. The key question is: Will you truly use them?
If a plan’s extras look impressive but the network is limited or costs are higher where it matters most, the “extras” may not be worth it.
5) Check your travel and out-of-area coverage needs
If you travel often, split time between states, or visit family out of the area, your plan choice matters. Some plans are more restrictive outside your local service area, while others provide more flexibility. A quick review can prevent surprises.
6) Verify your eligibility for assistance programs
Many people qualify for help and don’t realize it. Depending on income and resources, you may be eligible for programs that can reduce premiums, prescriptions, or other costs. Even if you didn’t qualify last year, it can change.
7) Make sure your coverage matches your stage of life
Health needs evolve. If you’ve been diagnosed with a condition, added medications, or anticipate procedures, your plan should match your current reality. The goal isn’t to switch plans constantly — it’s to avoid being stuck with coverage that no longer fits.
Want a second set of eyes on your Medicare coverage?
A quick review can help you confirm you’re on track — or identify savings and better coverage options based on your needs.
If you’d like, we can walk through your doctors, prescriptions, and budget and make sure your plan still fits.
(“No obligation. We do not offer every plan available in your area. Any information provided is for educational purposes and not a complete description of benefits. Plan availability varies by location.”)