Assess Your Medicare Coverage During Fall Open Enrollment

Each year, during Fall Open Enrollment (October 15 through December 7), people with Medicare have the opportunity to make certain changes to their coverage, including switching prescription drug plans or between Original Medicare and Medicare Advantage (MA). It is important for beneficiaries who are enrolled in these plans to compare their current coverage with other options in order to find the best coverage for their individual circumstances and maximize savings. 

In part, this is because from year to year, MA and stand-alone Part D prescription drug plans (PDPs) can change their costs, benefits, and rules in ways that might make them less attractive or less affordable for their enrollees. For example, a plan may stop including an expensive drug on its formulary, which would mean that beneficiaries who need that drug would have to switch to another comparable drug (if one is available), try to get an exception from the plan, or pay for the drug out of pocket. All of these options may be burdensome or expensive for the beneficiary, and another plan may be a better fit. This makes it vital for people with Medicare to review all of their coverage options each year and switch to another plan if their current plan no longer meets their needs, to ensure they will not be hurt by these annual changes. 

However, it’s not clear that efforts to conduct or act upon these annual coverage reviews are widespread. Last year, a data note from the non-profit Kaiser Family Foundation (KFF) revealed that very few people with Medicare end up switching plans during the fall. Among MA and PDP plan enrollees who did not receive low-income subsidies, around 8% chose to switch from one plan to another in 2016. This could mean that beneficiaries have reviewed and are happy with their coverage. But it might also highlight a more troubling reality—people may not know they can switch plans or may find the process of doing so overly burdensome.

KFF’s findings indicate that awareness of and complexity within the plan comparison process may be factors. More than one in three Medicare beneficiaries said it was difficult to evaluate their options, and these numbers go up when the person has poor health or five or more chronic conditions. At the same time, others may not even know that comparing plan options is a good idea. According to KFF, in 2017, 45% of beneficiaries rarely or never reviewed their options. That number climbed to 57% for people 85 and older. 

This year, coverage evaluations may be even more challenging—and less prevalent. Because of the COVID-19 pandemic, some in-person assistance will be limited or unavailable. Plus, recent changes to Medicare rules mean there is a lot to wade through. Companies can now offer more plans, even if they are similar to each other. And more insurers are offering, and marketing, supplemental benefits. Even more concerning, as the pandemic stretches into the new year, is that people who fail to evaluate their options and ensure that their plan will serve them well in 2021 may face barriers to care when they need it most. More options, more variables, and less help, combined with potentially greater consequences, is worrisome.  

Looking ahead, policymakers must do more to give people with Medicare the tools they need to compare their coverage options—including further improvements to the Medicare Plan Finder—and also to limit some of the unnecessary clutter in the market that can derail those who want to choose the best plan for their circumstances.  

The Medicare Rights Center has several resources to help people with Medicare navigate Fall Open Enrollment, including a free guide for consumers as well as questions to ask before joining an MA plan and when comparing Part D plans. These and other resources are available on Medicare Interactive. 

Read the KFF data note. 

Read more about Fall Open Enrollment.