It’s not unusual for Medicare plans to change from one year to the next, changing the benefits you receive.
It’s also completely normal for your own medical needs to change, meaning you may now qualify for benefits you weren’t eligible for before.
Whether you’re enrolled in Original Medicare or a Medicare Advantage plan, reviewing your health benefits annually is a smart idea, because who doesn’t want more helpful things in their life?
A Medicare Benefits Review can help you save money, get more coverage, access more benefits and resources, and avoid surprise medical bills.
Must read: Important info about Medicare Advantage enrollment
What is a Benefits Review?
A Benefits Review is a review of your current Medicare coverage, what it includes, what it doesn’t include, and whether it still meets your health and financial needs.
Medicare is complicated, that’s why a Benefits Review should be done through a trusted, licensed Medicare broker who understands how health insurance benefits work.
9 reasons why a Benefits Review matters
If you haven’t already given some thought to reviewing your own benefits, here are reasons why you should.
- Medicare plans change every year
Each year private Medicare insurers can change their benefits and coverage. This means:
- New benefits may be added.
- Old benefits might be removed.
- Premiums, copays, and coinsurance can go up or down.
- Prescriptions covered and their costs may change.
- Coverage areas and provider networks may change.
A plan that worked well for you this year might not offer the same value next year.
Every year Medicare Advantage and Part D plan must send enrollees an Annual Notice of Change (ANOC) in the fall, usually around September. But many people don’t read it, or don’t fully understand what’s changed. A Benefits Review helps you make sense of it all.
- You could be missing out on important benefits
Did you know that most Medicare Advantage plans offer extra services at no additional cost, like:
- Dental, vision, and hearing care
- Hearing aids and exams
- Transportation to medical appointments
- Gym memberships or wellness programs
- Over-the-counter medication allowances
If you haven’t reviewed your options recently, you might be missing out on benefits that can help keep you healthy and help you keep your costs down.
- Your health needs change over time
Before reviewing your benefits, let’s review your health.
- Have you started a new medication recently?
- Been diagnosed with a chronic condition that needs regular follow-ups?
- Maybe you’ve quit driving, and need other kinds of mobility assistance.
If your health has changed, then so should your healthcare benefits. The benefits have to meet your current needs, not the ones you had last year.
A Benefits Review can help you:
- Find a plan with prescription drug coverage that might work better for you
- Choose a provider with more availability to see you and spend more time with you
- Get access to specialists for a new diagnosis
- Lower and limit your out-of-pocket costs
- You might be paying too much
Many people aged 65 years and up stick with the same Medicare plan for years without comparing costs. But premiums, deductibles, and copays can increase each year, and your plan may no longer be the most affordable choice.
A review of your summary of benefits and coverage could reveal:
- A lower-cost plan with similar or better coverage
- Savings on prescriptions
- Additional benefits such as dental, vision, hearing aids and more without an extra cost
According to Medicare.gov, the average person could save hundreds to thousands of dollars each year just by reviewing their options and selecting a plan that more closely fits their needs.
- You may qualify for new benefits you didn’t before
Life evolves, and so should your benefits. You may now qualify for:
- A Special Needs Plan (SNP) for chronic conditions like diabetes or heart disease
- Dual eligibility if you qualify for both Medicare and Medicaid
- Extra assistance programs based on income and assets
A knowledgeable, trusted, licensed Medicare broker can check for eligibility changes during a Benefits Review and help you apply for programs that save money or expand coverage.
- Plan networks can change. Your doctor might no longer be covered
Even if your plan hasn’t changed much, the network of doctors and specialists you can see in-network might have. If your current provider is no longer in-network, you could be stuck with higher costs, or need to find a new doctor.
During your Benefits Review, you can:
- Confirm your current providers are still covered
- Switch to a plan that includes your preferred doctors and hospitals
- Get access to specialized doctors who focus on individuals 65+ to help keep them healthy and feeling their best as they age
- Avoid out-of-network fees
- Prescription coverage can shift
Prescription costs are a big concern for people on Medicare. But Part D plans (and Medicare Advantage plans with drug coverage incorporated) change their drug formularies every year.
This means:
- A medication you take may no longer be covered
- There may be new medications added to the formulary
- The tier of the drug may have changed, affecting your cost
- There may be better pricing available in a different plan
During your Benefits Review, you can check how each of your prescriptions is covered and avoid costly surprises at the pharmacy.
How to read the label of your prescription drug
- You’ll be ready for Medicare Annual Enrollment Period or Special Enrollment Periods
The Medicare Annual Enrollment Period (AEP) runs from October 15 to December 7 every year. This is the time to switch plans or make changes.
But some people may qualify for a Special Enrollment Period (SEP) because they have:
- Moved to a new area
- Lost other coverage
- Become eligible for Medicaid
- Or, other reasons
If you’ve had any recent changes in your life, a Benefits Review ensures you don’t miss important deadlines and helps you take action in time.
- Peace of mind: Know exactly what your plan covers
A common question many people ask is, “How do I know what my insurance covers?”
A Benefits Review answers that question in plain terms. You’ll get a clear picture of:
- What services are covered
- What costs to expect
- What providers you can see
- What benefits you might be missing
- How much your prescriptions will cost and whether or not they’re covered
It’s not just about finding a cheaper plan. It’s about making sure you’re protected and prepared for whatever life throws your way.
What is reviewed in a Benefits Review or Benefits Check?
A complete Benefits Review usually includes:
- A thorough look at the benefits and coverage you’re currently getting
- A check of your prescriptions and how they’re covered
- A review of doctor and hospital networks
- A breakdown of out-of-pocket costs
- Comparison of other available plans
- Eligibility for Extra Help, Medicaid, or other programs
Who should do a Benefits Review?
Everyone on Medicare should do a Benefits Review at least once a year, but it’s especially helpful if:
- You take multiple medications
- You’ve had recent health changes
- You’ve moved to a new ZIP code
- Your doctor or pharmacy changed
- Your income or financial situation changed
- If you’re struggling to afford your care and prescriptions
- You’re thinking about switching to or from a Medicare Advantage plan
Frequently Asked Questions about Benefits Reviews
- Why should I do a Benefits Review every year?
Plans and benefits change annually. A review helps you avoid higher costs, discover new benefits, and get the care you need. - How do I know what my insurance covers?
A Benefits Review includes your summary of benefits and coverage, helping you clearly understand what’s included and what isn’t. - When is the best time to do a Benefits Review?
The best time is if your coverage isn’t working for you or something has changed with your situation. You may qualify for a special plan or program and be able to enroll outside of the Medicare Annual Enrollment Period, from October 15 to December 7 each year. - Can I do a Benefits Review on my own?
Yes, but it is not recommended to ensure you’re fully understanding all of the options and implications. We can connect you with a licensed Medicare broker who we trust with our patients with no-cost or no obligation to enroll. - Will I lose my current doctor if I switch plans?
You could lose access to your current provider that’s one reason why we recommend that you work with a licensed Medicare broker who we trust with our patients so you will be able to continue seeing your IntraCare provider.
How IntraCare can help
At IntraCare Health Centers, we care about more than just your next appointment. We want to help you get the quality care that you need at an affordable cost, which can vary depending upon what Medicare plan you’re on.
We can connect you with a trusted, licensed Medicare broker who will perform a no-cost, no-obligation Benefits Review. You’ll understand your current coverage, explore options, and get help choosing the right plan for you.
To schedule a Benefits Review with a trusted, licensed Medicare adviser, call our Patient Relations Team helpline 800-941-1106, Monday-Friday 8 a.m. – 5 p.m. CST or click here to request a member of our team to reach out to you.
Or click here to schedule a visit at your nearest IntraCare Health Center. Our staff will connect you with an IntraCare-recommended Medicare agent, and take the sure step towards better health.