Choosing a Medicare plan is an important, but difficult decision. This choice could determine your health for years to come and save (or cost) you hundreds of dollars in out-of-pocket costs. However, during the Medicare Open Enrollment Period (OEP)/Annual Election Period (AEP) October 15 through December 7, you can re-evaluate your Medicare Advantage (MA/Part C) and/or Part D coverage to make sure you’re enrolled in the plan that fits your needs best.

But with so many options it’s hard to figure out:

1. If your current plan is best for you, and
2. How to choose a better plan to fit your needs

Using the 4Cs of Medicare – Coverage, Cost, Convenience, and Customer Service you can assess the quality of your current plan and if needed, find a new one that better fits your needs. Here’s what you should consider when switching plans during the OEP/AEP.

Coverage

Before you begin comparing Medicare plans, you should start by assessing your health needs. Make a list of how many doctors you have, how often you have appointments, and your prescription drug needs. Then, you can begin assessing your coverage options. If you decide to add or switch Medicare Advantage and/or Part D plans there are few things you should consider about coverage:

• Has your health status changed within the last year?
• Are the services you need covered under your current plan (treatments, prescriptions, vision coverage, etc.)? Are there other health-related services that you would like covered? Examples might include alternative treatments, personal health devices, transportation or meal assistance. Be sure to check when, and how frequently, these other services are offered.
• Does your current plan or the plans you’re considering cover all the drugs you think you will need in the coming year?
• How do the plans rank under the star quality rating system? Are there any 5-star plans?

Cost

When you first enrolled in Medicare, you may have picked a plan based on the recommendation of a friend or just chose a fairly inexpensive plan since the coverage difference between each option seemed nominal. Now as a seasoned Medicare beneficiary there are a few cost considerations you should re-evaluate.

• Are your financial circumstances the same?
• What is the total projected annual and monthly cost with the plan you have vs the plan you’re considering? Have these costs gone up?
• Was your out-of-pocket cost more expensive than you had planned? Are you visiting the doctor as much as you had anticipated? Or perhaps more frequently than expected, causing more copays and deductibles than you had anticipated? You may want to switch to a more affordable option.
• Did you enter the Part D Coverage Gap (“donut hole”) this year? While the donut hole officially "closed" in 2020, that doesn't mean you won't have costs after hitting your initial coverage period threshold.

Convenience

When deciding on the type of coverage you need you should also think about how accessible your physicians need to be. With Original Medicare, you can choose to see any physician who accepts Medicare. This means that you can access major medical centers nationwide. On the other hand, MA plans are more restricted in terms of the provider networks (doctors, hospitals, or pharmacies) they work with, which means you need to see doctors or visit hospitals that are “in-network” with your MA plan to avoid paying higher medical fees.

Before enrolling in a Medicare Part D plan confirm if your local pharmacy is included in their network. Typically these pharmacies will reduce your out-of-pocket cost for prescription drugs. Here are a few things you should consider before choosing a plan:

• Do you plan on going a few long trips this year? All plans cover emergency hospital coverage, but if you need routine access to a physician while on vacation you may want to consider a plan that has a flexible network. Will you be able to get your prescriptions easily while away from home?
• Do you have a preferred pharmacy and is it included in the plans you’re considering? Do the costs of your medications change under the different plans based on that pharmacy?
• If you prefer to get your prescription in the mail, do the plans offer mail order delivery? Is the price higher or lower than picking it up at a “brick & mortar” pharmacy?

Customer Service

Last, but certainly not least, you should consider the quality of customer service you received with your current plan when thinking about switching.

• Were you satisfied with the quality of care you desired with your current plan?
• How responsive was your plan with questions or problems you may have had?
• How did your plan help you manage your health care needs (access to primary care, specialist, and prescriptions)?

There are a lot of consideration when choosing a Medicare plan, but using the 4Cs helps you focus on the aspects that are most important. The good news is that you don’t have to search for Medicare plans on your own. A national network of State Health Insurance Assistance Programs (SHIPs) is federally funded to provide free, unbiased assistance wtih Medicare selection. In addition, our Medicare questionnaire was created to help you figure out your options. You’ll be able to talk to a free licensed benefits advisor to discuss changing Medicare plans and discuss any other questions you may have about Medicare.

Remember that the Medicare Open Enrollment Period (OEP)/Annual Election Period (AEP) is October 15 – December 7 every year, so research your options and get expert advice before you make a final decision.