Is Your Medicare Plan Doing It’s Job?

I am always struck by the number of people I run into who are in a Medicare plan that has not been reviewed in several years. In most cases, these plans are falling far short of being their best option. Medicare Advantage is a very popular program for people on Medicare, but it changes often and needs to be reviewed annually to make sure it is still the best plan for you. Changes that affect the plan include:

Prescription drug formularies: This is the biggest factor. While you may not know how many times you will visit the doctor or whether or not you will need to be hospitalized or have surgery this year, you can be quite sure of what medicines you will be taking. If you are paying a lot for your medicines and they seem to be creeping up more and more each year, chances are good that your drug formulary has changed. I see people often who are unnecessarily paying thousands of dollars more than they should just because they are on a plan with a formulary that no longer fits their needs. It is often an easy fix.

Doctor networks: Doctors are continually adjusting their “accepted carrier” lists. One year they may take a certain plan only to drop it the next year. Just like ice cream, favorite flavors come and go. A carrier that is wildly popular this year may not be as popular next year. This can be caused by customer dissatisfaction with the plan structure or service or it could be because a plan with better benefits hits the market in your area. If you have had doctor issues with you plan, get it reviewed. Plans are usually available that will accommodate most people’s “doctor lists”.

Plan benefits: Each year, Medicare Advantage plans review their benefit structure and financial viability and will often make changes. These changes can be good or bad depending on the year. For example, a plan may decide to begin charging a premium (or increase and existing premium) on a plan that was $0 premium in prior years. They might increase or decrease doctor co-pays or co-insurance amounts. They could decide to discontinue a popular “extra” program. In more extreme cases, a plan can actually pull out of an area entirely leaving current members searching for a new alternative for the next plan year. Thankfully, these changes are usually announced at the end of a plan year and go into effect for the next one so members can decide on what they want to do, but many people don’t react and they stay in a plan that may not serve their needs as well as another on the market in their area.

Changing health needs: Nobody has a crystal ball to tell our health future. Sometimes a diagnosis will come along that really knocks us for a loop. A plan that is working well today may not function as well when a new diagnosis comes into the picture. Did you know that there are Special Needs plans available for those with certain chronic conditions?

Changing financial status: I sat with a lady yesterday that was in a plan that did not fit her needs as well as it could have. The co-pays and co-insurances were just too much for her budget. In her case, after a few questions, I realized she likely qualifies for Medicaid. Once she applies, if accepted, she will potentially get copious amounts of help on everything from co-pays, co-insurances, extras like dental, vision and hearing and, perhaps most importantly, prescription drugs. Has your financial status changed recently? Are you have problems paying for meds, food, or other necessities?

The above are just a few of the many potential changes that can occur that can affect a Medicare plan. The biggest danger is just sitting tight and doing nothing. If you are having issues affording medicines or co-pays, or your doctors no longer take you plan, speak up! Call Houston Life and Annuity and get a thorough review (It’s free!). It might just make your day!

Justin K. White CLU®


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