The fall review can feel like it requires comparing dozens of options. Usually it doesn't. Most decisions come down to five questions about your own situation, and you can answer them from your own papers.
Have these in front of you: your plan's Annual Notice of Change, your membership card, a list of the medications you take regularly, and the names of your doctors.
1. Are my doctors in the network next year?
Check every doctor you see regularly, every specialist, and the hospital you'd want to use. Networks change, and a doctor being in network this year doesn't guarantee next year. If you have Original Medicare, the question is simply whether they accept Medicare.
2. Are my drugs still covered — and at the same tier?
For each drug you take, check three things: that it's still on the drug list, which tier it's on, and whether it now requires a step such as prior authorization or trying another drug first. A drug moving up a tier can change what you pay more than any other single line in the notice.
3. Is my pharmacy still in network?
Many plans have "preferred" pharmacies where costs are lower. Confirm that the pharmacy you actually use is in network next year, and whether its status changed. If you use mail order, check that too.
4. What's the most I could pay in a year?
Monthly premiums are easy to compare and easy to over-weight. The bigger number in a bad year is what you pay when you actually use care. Medicare Advantage plans have a yearly out-of-pocket limit; look at what it is for next year and whether it changed.
A plan with a low premium and a high out-of-pocket limit can cost more in a year with a hospital stay than a plan with a higher premium. Think about the year you might have, not only the year you expect.
5. Do I travel, or live in two places?
If you spend part of the year in another state, or travel often, check how your plan handles care outside its service area. Plans with local networks may only cover emergencies and urgent care away from home.
Reading your answers
If all five answers come back "no change that matters to me," staying in your plan is a reasonable decision. If one or more comes back with a problem, that's the specific thing to look into before December 7 — and it gives you a short, concrete list of what any other option has to get right.
Free, unbiased help
Every state has a State Health Insurance Assistance Program (SHIP) offering free, one-on-one counseling from trained volunteers who don't sell anything. You can also use the plan tools on Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048).
Free printable
The annual review checklist
Seven things to check before December 7, in the order they appear in your plan's letter. The email version is coming soon.