Should You Review Your Medicare Plan Mid-Year?
You likely felt a lot better when you signed up for your Medicare plan. That is because it can be hard to choose a health plan! Did you know that it’s still a good idea to look over your Medicare plan in the middle of the year, even after you’ve picked a plan?
Checking your plan in the middle of the year may help you remain on target, save money, and make sure your needs are still being addressed. Let us discuss it in detail.
Why Would You Review Your Medicare Plan Mid-Year?
Your health and life can change. It is possible that your medicines have changed, or you may need to see a new doctor. The plans for Medicare can also swap out. Some plans change their networks, drop some drugs, or change the prices of drugs they cover.
By checking in mid-year, you can:
- Make sure your doctors are still in-network
- Confirm that your prescriptions are still covered
- Avoid unexpected costs
- Catch any plan changes you did not notice before
Your Medicare Advantage or Part D prescription medication plan may have made changes since you signed up, even if nothing important has changed for you.
What Kinds of Changes Should You Look For?
When you review your Medicare plan mid-year, you want to look at the things that matter most:
Doctors and Providers
Are your doctors still in-network? If they are not, you could be paying much more out of pocket than expected.
Medications
Has your medication list changed? Some plans update their drug list (called a formulary). That means a medicine that was covered in January might not be covered now, or may cost more.
Costs
Have your premiums, copays, or deductibles gone up? Plans might change, so you need to be ready.
New Health Needs
Did you receive a new diagnosis? Your existing plan may not be the best fit anymore if you require additional experts or new therapies.
When Can You Make Changes?
You may be wondering, If I find a problem with my plan, can I switch right away? The answer is: sometimes.
You may alter your Medicare plan at certain times, even after the primary enrollment periods are over. People call them Special Enrollment Periods (SEPs). You may be able to get one if:
- You move to a new area
- You lose other health coverage
- You get Extra Help or Medicaid
If you qualify for a Special Enrollment Period, you can drop your current plan and switch to a better one that meets your needs.
2025 Updates: Medicare Advantage Plans May See Payment Increases
There is major news for 2025 if you are in a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) has said that payments from the government to Medicare Advantage (MA) plans are likely to rise by 3.7%. That is more than $16 billion more than what similar initiatives got in 2024.
What does this mean to you? additive? Plans with more money could provide better services, greater benefits, or rates that stay the same for the next year. But not all plans are the same. That is why you should go at your Medicare plan halfway through the year. You need to know what changes are coming and whether your plan is still suitable for you.
The government is giving the plans extra money, but not every Medicare Advantage plan will be the same. Some may make benefits better, while others may make adjustments that influence your prices or coverage. A check-in in the middle of the year lets you remain on top of these changes and figure out whether you need to make one during the following enrollment period.
2025 Part D Changes: Lower Drug Costs and Simpler Coverage
People with Medicare Part D prescription coverage will be happy to hear that substantial changes are coming in 2025. The Inflation Reduction Act is helping to revamp Medicare Part D programs so that people may afford their prescription drugs.
One of the greatest changes is that there is now a $2,000 limit on how much you may pay out of pocket for medicines each year. That implies that in 2025, once you spend $2,000 of your own money, you would not have to pay anything more for the rest of the year. This might be a big help for folks who have to pay a lot for their medicine.
Also, the confusing coverage gap (also called the donut hole) is being removed. Starting in 2025, your prescription coverage will be easy to comprehend since it will just have three parts: deductible, normal coverage, and catastrophic coverage. Also, you will still get:
- $35 monthly insulin caps
- $0 cost for adult vaccines recommended by health experts
Because of these big updates, it is a smart idea to review your Medicare plan mid-year, especially if you rely on regular prescriptions. Checking now helps you plan and make sure youâre getting the best deal when these changes roll out.
Benefits of Mid-Year Reviews
Hereâs why taking time to review your Medicare plan mid-year is so smart:
- You avoid surprises at the pharmacy or doctorâs office
- You stay ahead of plan changes
- You can catch mistakes or errors in your coverage
- You keep your health care on track, even as your needs change
A quick review can give you peace of mind and help you feel more confident about your coverage.
Final Thoughts
You do not have to do it by yourself! Every day, we serve seniors with Medicare at LMS Insurance Group. We’ll sit down with you, examine your existing coverage, and help you figure out whether you need to make any changes. There is no pressure, just straightforward, useful advice.
It is still a good idea to go over your Medicare plan in the middle of the year, even if you’re satisfied with it. Your coverage should evolve as your life does.
Do you need help? Get in touch with LMS Insurance Group immediately. We’re here to make Medicare easy and stress-free.
