Healthcare Educators


How to Assess Your Medicare Plan’s Fit

by | Apr 30, 2024

Several months have passed since your Medicare coverage went into effect for 2024. This is a good time to assess your plan choice. Is everything working like you thought it would? Or have there been unexpected surprises?

Here are a few things to consider when taking stock of your Medicare plan:


Your Doctors

Are all of your doctors, specialists and hospitals covered in network? Have you encountered any situations where they are not?


Your Prescriptions

Are all of your prescriptions covered and are you paying what you expected? Have any of your medications changed tiers? Have you experienced any issues with prior authorizations, mail order, or the pharmacy network?


Your Out of Pocket Costs

Are your deductibles, copays, and coinsurances what you anticipated? Are there unexpected costs you weren’t planning for?


Your Ancillary Benefits

Are you using all of your benefits? Most Medicare Advantage plans include extra benefits such as dental, vision, and hearing. Some plans include gym memberships, massage, chiropractic, over the counter rewards and more. It’s easy to forget or overlook many of the ancillary benefits included on your plan. Are there benefits you don’t have that you wish you did?


Your Circumstances Have Changed

Do you have a new medical diagnosis and treatment of your condition means you are seeing new doctors or taking new medications that weren’t considered when you chose your current plan? Or perhaps your change in circumstances means you are paying for benefits you no longer need. Are you traveling out of the area more than you had planned?


Your Financial Situation Has Changed

Have your finances changed making your Medicare coverage difficult to afford? If so, you may qualify for additional assistance offered through state and federal programs.

Special Enrollment Periods

In most cases you cannot switch plans mid-year, but in some circumstances you might qualify for a  Special Enrollment Period.  If you live an area where a 5-star Medicare plan is available, you can use the 5-star Special Enrollment Period to switch plans. You can only use this enrollment period once between December 8 and November 30 the following year, so you want to be sure the plan covers all your needs before you switch.

Your Medicare Agent Can Help

If you find your plan is no longer the best fit, you are dissatisfied with your plan choice, or you have questions about your benefits, your Medicare agent is your best resource. Your Medicare agent will:

  • Discuss any changes to your lifestyle, budget, or health.
  • Offer a full review your benefits to answer any questions you have and ensure you are using all the benefits available to you.
  • Determine if you qualify for a special enrollment period that would allow you to switch plans.
  • Help you determine if you qualify for financial assistance through federal programs such as Medicare Savings Programs  and Extra Help , or state programs such as Medicaid  and Texas Rx Assistance Programs.

Even if you are unable to change plans in 2024, your Medicare agent will better understand your circumstances and can start looking for a plan that will more effectively meet your needs next year.

The experienced and knowledgeable team at Healthcare Educators is here to help. Contact us today.