Fall in Michigan isn’t just about crisp air and vibrant foliage; it’s also the time older adults should review their Medicare coverage. The Medicare Annual Enrollment Period, which runs from Oct. 15 through Dec. 7, gives beneficiaries the opportunity to make changes to their health and prescription drug plans for the coming year.
Health care insurance experts say reviewing your plan during this window can help avoid unexpected costs and coverage gaps.
“A lot can change from year to year, and missing a review can mean higher out-of-pocket costs or discovering too late that a key benefit has changed,” said Kyle Ingraham, director of sales for government programs at HAP.
Even if a plan seems to be working well, it’s worth revisiting the details.
“Networks change, prescription drug costs shift, and sometimes new benefits get added,” Ingraham said. “Spending just an hour reviewing plan materials this fall can prevent surprises later.”
Experts recommend looking beyond just the monthly premium. Key factors include:
- Copayments and deductibles
- Annual out-of-pocket maximums
- Provider networks
- Prescription drug formularies
Sometimes, a plan with a higher premium may offer lower total costs by reducing expenses at the pharmacy or doctor’s office.
Prescription coverage and provider networks
Prescription drug coverage and provider networks can change from year to year. Formularies, which are lists of covered medications and their associated costs, should be reviewed closely to ensure medications are still covered. It’s also important to confirm that preferred doctors, specialists and hospitals are still in-network.
Extra benefits worth noting
Many Medicare Advantage plans include additional services such as dental, vision, hearing and wellness programs. Some plans may also offer transportation support, fitness memberships or allowances for over-the-counter items.
“These extras really matter,” Ingraham said. “Dental coverage can help prevent more serious health problems. And wellness benefits support overall health and help people stay active.”
Evaluating quality through star ratings
The Centers for Medicare & Medicaid Services rates Medicare plans on a five-star scale based on preventive care, chronic condition management, customer service and other factors. A higher rating may reflect better performance and higher satisfaction among members.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
Special considerations for chronic conditions
For individuals living with chronic conditions such as diabetes or kidney disease, some plans offer condition-specific management programs or extra support resources. Choosing a plan that aligns with those needs can improve daily care and health outcomes.
The takeaway
The Annual Enrollment Period is the best time each year for Medicare beneficiaries to assess their current coverage and make informed choices for the year ahead.
“This is the chance to make sure coverage is working for the individual,” Ingraham said. “If options are reviewed carefully, the new year can start with confidence.”
For additional resources and to learn more about Medicare, visit the HAP website here.
Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. Enrollment depends on contract renewal.
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