5 Questions to Ask Before Changing Your Medicare Plan

Every fall, people with Medicare are flooded with advertisements telling them about new plans, new benefits, lower premiums, and other reasons to consider changing coverage.

Sometimes changing plans makes sense. Sometimes the best decision is to stay exactly where you are.

Before making a change, ask these five questions.

1. What is actually changing in my current plan?

Start with the plan you already have.

If you have a Medicare Advantage or Medicare prescription drug plan, you should receive an Annual Notice of Change (ANOC) each fall. It explains changes that will take effect January 1, including changes to premiums, deductibles, copays, benefits, drug coverage, and other plan rules.

Don't assume you need a new plan just because another plan looks attractive.

Instead, ask:

• Is my premium changing?

• Are my medical copays or coinsurance changing?

• Is my prescription drug coverage changing?

• Are benefits I regularly use changing?

• Has anything changed that actually affects me?

If your current coverage still meets your needs at a reasonable cost, changing simply for the sake of changing may accomplish nothing.

2. Will I still be able to use my doctors, hospitals, and pharmacies?

A low premium does not help much if your doctor is not in the network.

If you are considering a Medicare Advantage plan, check the providers that matter to you, including:

• Primary care physician

• Specialists

• Preferred hospital or health system

• Clinics

• Therapy providers

• Durable medical equipment suppliers

• Pharmacies

Do not check only your primary doctor.

Medicare Advantage plans can have provider networks, and out-of-network care may cost more or may not be covered except in specific circumstances.

If you spend part of the year outside Minnesota or travel frequently, also ask how the plan works when you are away from home.

3. How will the plan cover the prescriptions I actually take?

Prescription coverage should be reviewed using your medications, not someone else's.

For each prescription, check:

• Is the medication on the plan's formulary?

• What tier is it on?

• Is there a deductible?

• What is the copay or coinsurance?

• Does it require prior authorization?

• Is step therapy required?

• Are there quantity limits?

• Is your pharmacy preferred, standard, or out of network?

• Would a different pharmacy significantly reduce your cost?

A prescription drug plan with a lower premium can easily cost more overall if one important medication is placed on a higher tier or your pharmacy is no longer preferred.

This is one reason I recommend reviewing Part D coverage every year, even when you are happy with your current plan.

4. What will the plan really cost me for the year?

The monthly premium is only one part of Medicare costs.

When comparing plans, consider the entire picture:

For Medicare Advantage:

• Monthly premium

• Medical deductible, if any

• Primary care and specialist copays

• Hospital costs

• Outpatient surgery costs

• Diagnostic testing and imaging

• Prescription drug costs

• Maximum annual out-of-pocket limit

For Original Medicare with a Medicare Supplement:

• Medicare Supplement premium

• Part D premium

• Medicare deductibles not covered by the supplement

• Copays or other cost sharing under the specific supplement

• Prescription drug expenses

Then consider how you actually use healthcare.

Someone who rarely sees a doctor may reasonably make a different choice than someone who sees several specialists every month.

The lowest premium plan is not automatically the lowest-cost plan.

5. What am I giving up if I make this change?

This may be the most overlooked question.

It is easy to focus on what a new plan provides. You also need to understand what you are leaving behind.

For example:

• Will you lose access to a particular provider network?

• Are you giving up lower copays for services you use frequently?

• Are you losing travel flexibility?

• Are dental, vision, hearing, fitness, or other supplemental benefits different?

• Will the new plan have different prior authorization requirements?

• Are you giving up employer or retiree coverage that may be difficult or impossible to restore?

Pay particular attention when moving between Medicare Advantage and Original Medicare with a Medicare Supplement (Medigap).

Medicare Advantage, Part D, and Medicare Supplement enrollment rules are not the same. Medicare Supplement rules also vary by state. Minnesota's Medicare Supplement rules changed in 2026, so do not assume that something you read about Medigap in another state applies here.

Before canceling a Medicare Supplement policy, make sure you know exactly what coverage you will have next and whether you could return to a supplement later if you change your mind.

Don't Start With "Which Plan Is Best?"

There isn't one Medicare plan that is best for everyone.

A better question is:

Which coverage fits my doctors, prescriptions, healthcare needs, budget, and preferences?

That's why a good Medicare review starts with you, not with a list of plans.

What to do now

September is a good time to prepare.

Gather:

• Your Annual Notice of Change

• Your current Medicare plan information

• A current medication list, including dosage and frequency

• Your doctors and preferred hospitals

• Your preferred pharmacies

• Any changes you expect in your healthcare needs next year

Beginning October 1, 2026, Medicare beneficiaries can start comparing Medicare Advantage and prescription drug plan options for 2027. Medicare Open Enrollment runs October 15 through December 7, with changes generally taking effect January 1, 2027.

There is no advantage to making a rushed decision.

The goal is not to change Medicare plans every year. The goal is to make sure the coverage you have continues to make sense for you.

Need help preparing for your Medicare review?

Lakes Health Insurance can help you understand your current coverage, identify what you should review, and prepare for the upcoming Medicare enrollment season. Specific 2027 Medicare Advantage and prescription drug plan comparisons can begin October 1.