Do You Need a Medicare Plan Review Every Year?

Does Medicare Require You to Change Plans Every Year?

No. Medicare does not require you to switch Medicare Advantage or Part D prescription drug plans every year.

When your current plan continues to be available and you remain eligible for it, you may be able to keep that coverage for the next year.

But continuing in the same plan does not necessarily mean every cost, rule, provider arrangement, drug benefit, or supplemental benefit will remain the same.

Why a Yearly Medicare Plan Review Still Matters

A useful Medicare plan review looks at both your coverage and your current healthcare needs.

A plan that worked well last year may still be an appropriate choice. But it deserves to be checked against the healthcare needs you have now—not the needs you had when you first enrolled.

What Can Change in a Medicare Advantage or Part D Plan?

Medicare health and drug plan details can vary from one plan year to the next.

Depending on the type of plan, areas worth reviewing may include:

• Monthly plan premiums
• Annual deductibles
• Copayments and coinsurance
• The plan’s maximum out-of-pocket limit for covered medical services
• The list of covered prescription drugs
• Prescription drug tiers
• Drug coverage requirements, such as prior authorization or step therapy
• Preferred and standard network pharmacies
• Mail-order pharmacy options
• Participating doctors, specialists, hospitals, and facilities
• Referral or prior-authorization requirements
• Dental, vision, hearing, fitness, transportation, or other supplemental benefits
• The counties or service area in which the plan is offered

Your plan sends materials explaining its coverage for the coming year. Read those materials before deciding whether to stay or compare other options.

What May Have Changed in Your Own Life?

Sometimes the plan is not the biggest change—you are.

Consider whether anything has changed since your last Medicare plan review:

• You started or stopped taking a prescription.
• Your medication dosage or refill frequency changed.
• You began seeing a new doctor or specialist.
• You received a new diagnosis or began a new treatment.
• You changed pharmacies or want to consider mail order.
• You moved or expect to move.
• Your budget or healthcare spending changed.
• You travel more often or spend part of the year in another state.
• You now care more about certain dental, vision, hearing, transportation, or fitness benefits.
• You want more flexibility in where you receive care.

Medicare coverage is personal. The plan that works well for your spouse, neighbor, sister, or best friend may not fit your medications, providers, budget, or healthcare priorities.

The Five Items to Review Every Year

You do not need to begin by comparing every benefit in every available plan. Start with the five areas most likely to affect your care and out-of-pocket costs.

When Should You Complete Your Medicare Plan Review?

Begin gathering your information before Medicare Open Enrollment gets busy.

Medicare Open Enrollment runs from October 15 through December 7 each year.

During this period, people with Medicare can make certain changes involving Medicare Advantage and Medicare drug coverage. Changes made during Open Enrollment take effect January 1 of the following year, as long as the plan receives the enrollment request by December 7.

Certain events—such as moving or losing other coverage—may provide a Special Enrollment Period. The changes available and the timing depend on the specific event.

Read more about Medicare Open Enrollment dates and rules .

When Keeping Your Current Medicare Plan May Make Sense

Keeping your current plan may make sense when:

• Your prescriptions remain covered at an acceptable cost.
• Your doctors, specialists, hospitals, and other providers continue to work with the plan.
• Your preferred pharmacy continues to work well with your coverage.
• The plan’s premiums and other out-of-pocket costs remain manageable.
• The plan’s rules and network fit your healthcare needs.
• The benefits you regularly use remain available.
• You do not find another option that better fits your situation.

When Your Medicare Plan Deserves a Closer Look

Take a closer look when:

• A prescription is no longer covered or is placed on a different tier.
• Your medication cost is changing significantly.
• Your preferred pharmacy is no longer in the plan’s network or is no longer preferred.
• A doctor, hospital, specialist, or facility you use is not listed with the plan.
• Premiums, deductibles, copayments, or coinsurance are increasing.
• The maximum out-of-pocket limit is changing.
• A service has a new referral or prior-authorization requirement.
• A supplemental benefit you use is changing or ending.
• Your health, prescriptions, budget, residence, or travel needs have changed.
• Your plan tells you that it will not be available for the next year.

One change does not automatically mean you should leave your plan. It means you should understand how the change may affect you before deciding.

Should You Compare Medicare Advantage and Original Medicare?

Some people use an annual review to compare more than individual Medicare Advantage or Part D plans. They may also want to reconsider how they receive Medicare coverage.

Original Medicare and Medicare Advantage work differently when it comes to provider access, networks, prescription coverage, costs, and supplemental benefits.

Review the differences in Medicare Advantage vs. Original Medicare before making a change.

Frequently Asked Questions About Medicare Plan Reviews